Davis Ryan, Jiramongkolchai Kim, Silverstein Evan, Freedman Sharon F
Duke Eye Center, Durham, North Carolina.
Duke Eye Center, Durham, North Carolina.
J AAPOS. 2016 Apr;20(2):159-64. doi: 10.1016/j.jaapos.2016.01.003.
Intracameral air is a critical component of multiple ophthalmic surgical procedures and is frequently used in pediatric intraocular surgery. Among other benefits, it helps to facilitate postoperative examination in uncooperative children by allowing quick confirmation of a formed anterior chamber. The purpose of this study was to evaluate the usefulness and accuracy of a position-independent rebound tonometer (Icare PRO) in measuring intraocular pressure (IOP) intraoperatively in pediatric eyes with intracameral air compared to a commonly used handheld applanation tonometer (Tono-Pen XL).
In this prospective study of sequential children undergoing intraocular surgery, IOP was measured immediately following general anesthesia induction using both Icare PRO rebound tonometry and Tono-Pen XL tonometry, with instrument order randomized, in the supine child's eye(s). At completion of surgery after standard placement of intracameral air IOP was again measured using both instruments.
A total of 42 eyes of 30 children were included. Surgeries included glaucoma (25), cataract-related (16), and both (1). Mean preoperative IOP by Tono-Pen XL was 23.52 ± 9.76 mm Hg; by Icare PRO, 20.94 ± 10.01 mm Hg (P = 0.0012). Mean IOP over intracameral air at surgery conclusion by Tono-Pen XL (n = 41) was 12.66 ± 4.90; by Icare PRO (n = 42), 12.96 ± 5.10 mm Hg (P = 0.46). One eye had postoperative IOP unrecordable by Tono-Pen XL but 7.9 mm Hg by Icare PRO. Bland-Altman analysis, which included only paired measurements, showed a preoperative mean difference in IOP (ΔIOPT-I) of 2.58 mm Hg (95% CI, -6.86 to 12.02); postoperative mean ΔIOPT-I of -0.42 mm Hg [95% CI, -7.57 to 6.73].
Position-independent rebound tonometry (Icare PRO) accurately measured IOP in supine children's eyes postoperatively in the presence of intracameral air.
前房内注入空气是多种眼科手术的关键组成部分，常用于小儿眼内手术。除其他益处外，它有助于在不配合的儿童中促进术后检查，通过快速确认前房形成情况。本研究的目的是评估与常用的手持压平眼压计（Tono-Pen XL）相比，位置独立的回弹眼压计（Icare PRO）在小儿眼内注入空气的术中测量眼压（IOP）的有用性和准确性。
在这项对连续接受眼内手术的儿童进行的前瞻性研究中，在全身麻醉诱导后立即使用Icare PRO回弹眼压测量法和Tono-Pen XL眼压测量法测量仰卧位儿童眼睛的眼压，仪器顺序随机。在标准注入前房内空气的手术完成后，再次使用两种仪器测量眼压。
共纳入30名儿童的42只眼睛。手术包括青光眼（25例）、白内障相关手术（16例）以及两者皆有的手术（1例）。Tono-Pen XL测量的术前平均眼压为23.52±9.76 mmHg；Icare PRO测量的为20.94±10.01 mmHg（P = 0.0012）。手术结束时Tono-Pen XL测量的前房内空气存在时的平均眼压（n = 41）为12.66±4.90；Icare PRO测量的为12.96±5.10 mmHg（P = 0.46）。一只眼睛术后眼压Tono-Pen XL无法记录，但Icare PRO测量为7.9 mmHg。Bland-Altman分析（仅包括配对测量）显示术前眼压平均差异（ΔIOPT-I）为2.58 mmHg（95% CI，-6.86至12.02）；术后平均ΔIOPT-I为-0.42 mmHg [95% CI，-7.57至6.73]。
位置独立的回弹眼压测量法（Icare PRO）在小儿眼内注入空气的术后仰卧位眼睛中准确测量了眼压。
