Department of Ophthalmology, Duke University Medical Center, Durham, NC.
Department of Ophthalmology, Medical University of South Carolina, Charleston, SC.
J Glaucoma. 2019 Sep;28(9):818-822. doi: 10.1097/IJG.0000000000001322.
PRéCIS:: Home tonometry is useful in detecting tube-opening and alarming intraocular pressures (IOPs) after Baerveldt glaucoma drainage device (GDD) implantation in childhood glaucoma, allowing for timely physician response and individualized patient care.
The postoperative management of the nonvalved Baerveldt GDD presents challenges in pediatric patients due to widely variable IOP often occurring perioperatively. We evaluated the use of home tonometry in the management of Baerveldt implants for refractory childhood glaucoma.
As part of an ongoing prospective study involving home rebound tonometry, the families of patients receiving Baerveldt implants were trained to use the Icare TA01i rebound tonometer and asked to document IOP, relevant symptoms, and ocular medication changes outside of the clinic setting. Data were analyzed for time to tube-opening, multiple-day fluctuations, and various IOP trends. Clinician response to IOP fluctuations detected by home tonometry was also evaluated.
Included were 19 patients (mean age: 16.1±9.6 y) having Baerveldt implantation from 2015 to 2018 by 1 attending physician. Home tonometry detected 92.3% (12/13) of spontaneous tube-openings, which occurred at a mean of 6.0±0.5 weeks. By home tonometry, mean IOP decreased 32.7% (24 vs. 15 mm Hg, P<0.01); 5-day IOP fluctuation decreased from 15 mm Hg preoperatively to 8 mm Hg after tube-opening (P<0.05). Preoperative, postimplantation, and post-tube-opening IOP ranged from 10 to 59, 3 to 61, and 1 to 51 mm Hg, respectively. Home tonometry prompted 94 documented medication changes and validated 1 surgical decision among 14 patients.
Home rebound tonometry accurately detected tube-opening and alarming IOP fluctuations, allowing clinicians to promptly and appropriately respond to these events. Home tonometry-augmented GDD management in childhood glaucoma may improve the care of these challenging patients.
由于儿童青光眼患者术后眼压（IOP）通常在手术期间波动较大，因此非瓣膜贝伐单抗引流装置（GDD）植入术后的管理具有挑战性。我们评估了家庭眼压计在难治性儿童青光眼贝伐单抗植入物管理中的应用。
作为涉及家庭回弹眼压计的正在进行的前瞻性研究的一部分，接受贝伐单抗植入物的患者的家属接受了培训，以使用 Icare TA01i 回弹眼压计，并要求在诊所环境之外记录眼压、相关症状和眼部药物变化。分析了从置管到管开放的时间、多日波动和各种眼压趋势。还评估了临床医生对家庭眼压计检测到的眼压波动的反应。
共纳入 19 名患者（平均年龄：16.1±9.6 岁），均由 1 位主治医生于 2015 年至 2018 年接受贝伐单抗植入术。家庭眼压计检测到 92.3%（12/13）的自发性管开放，发生在平均 6.0±0.5 周。通过家庭眼压计，平均 IOP 降低 32.7%（24 与 15mmHg，P<0.01）；5 天 IOP 波动从术前的 15mmHg 降至管开放后的 8mmHg（P<0.05）。术前、术后和置管后眼压分别为 10 至 59、3 至 61 和 1 至 51mmHg。家庭眼压计记录了 94 次药物变化，并验证了 14 名患者中的 1 次手术决策。
家庭回弹眼压计准确检测到管开放和警报眼压波动，使临床医生能够及时、适当地对这些事件做出反应。家庭眼压计增强的 GDD 管理在儿童青光眼患者中可能会改善这些具有挑战性患者的护理。
