Feng Chi Shian, Jin Ki Won, Yi Kayoung, Choi Dong Gyu
Department of Ophthalmology, Hallym University College of Medicine, Seoul, South Korea; Somang Ophthalmic Clinic, Incheon, South Korea.
Department of Ophthalmology, Hallym University College of Medicine, Seoul, South Korea.
Am J Ophthalmol. 2015 Nov;160(5):937-943.e1. doi: 10.1016/j.ajo.2015.07.029. Epub 2015 Jul 23.
To compare intraocular pressure (IOP) among rebound, noncontact, and Goldmann applanation tonometry (GAT) and their relationships to central corneal thickness in children.
Diagnostic protocol comparison and evaluation.
In right eyes of 419 children, mean IOP, rates of successful measurement with 3 tonometries, and intermethod agreement by Bland-Altman plot were assessed. The influences of central corneal thickness, and of average IOP of 3 tonometries on IOP differences between tonometries, were evaluated.
The mean age was 8.89 ± 3.41 years (3-15 years). There was significant difference in mean IOP of each tonometry; GAT showed the lowest values (P < .05). The IOP was successfully measured by noncontact tonometry in 89%, by rebound tonometry in 75%, and by GAT in 64% of children less than 10 years old, and in 100%, 98%, and 94% of children older than 10 years, respectively. The IOP of each tonometer positively correlated with central corneal thickness (P < .05). The mean differences and limits of agreement were 0.81 ± 6.19 mm Hg (noncontact minus rebound), 2.56 ± 4.62 mm Hg (rebound minus GAT), and 1.81 ± 4.76 mm Hg (noncontact minus GAT). Rebound and noncontact tonometry overestimated IOP relative to GAT for thicker central corneal thicknesses. Rebound tonometry overestimated IOP relative to GAT and noncontact tonometry at higher average IOP of 3 tonometries.
Rebound, noncontact, and Goldmann applanation tonometries can be considered appropriate methods for children, though noncontact tonometry is the most accessible. Given the risk of false-positive diagnosis of pediatric glaucoma, attention should be devoted to children with IOP within a suspicious range or thicker cornea.
比较回弹式眼压计、非接触眼压计和戈德曼压平眼压计（GAT）测量儿童眼压（IOP）的结果，以及它们与中央角膜厚度的关系。
诊断方案比较与评估。
评估419名儿童右眼的平均眼压、三种眼压计的成功测量率以及通过Bland-Altman图评估的方法间一致性。评估中央角膜厚度以及三种眼压计的平均眼压对眼压计之间眼压差异的影响。
平均年龄为8.89±3.41岁（3至15岁）。每种眼压计的平均眼压存在显著差异；GAT显示的值最低（P<0.05）。10岁以下儿童中，非接触眼压计成功测量眼压的比例为89%，回弹式眼压计为75%，GAT为64%；10岁以上儿童中，相应比例分别为100%、98%和94%。每种眼压计测量的眼压与中央角膜厚度呈正相关（P<0.05）。平均差异和一致性界限分别为0.81±6.19mmHg（非接触眼压计减去回弹式眼压计）、2.56±4.62mmHg（回弹式眼压计减去GAT）和1.81±4.76mmHg（非接触眼压计减去GAT）。对于较厚的中央角膜厚度，回弹式眼压计和非接触眼压计相对于GAT高估了眼压。在三种眼压计平均眼压较高时，回弹式眼压计相对于GAT和非接触眼压计高估了眼压。
回弹式眼压计、非接触眼压计和戈德曼压平眼压计均可视为适用于儿童的方法，不过非接触眼压计是最容易操作的。鉴于小儿青光眼存在假阳性诊断的风险，对于眼压处于可疑范围或角膜较厚的儿童应予以关注。
