中央角膜偏厚的高眼压症患者临床观察

目的预测中央角膜厚度在高眼压症转归中的作用。方法将门诊用非接触眼压计检测的高眼压症患者做超声角膜厚度测量,中央角膜厚度大于及等于575μm的患者60例(120只眼)纳入本研究,不予降眼压治疗,追踪观察眼压、视乳头、视野变化。结果随访36～76个月,平均48个月。其中1例1只眼出现视野改变,发生率为0.83%(1/120)。结论角膜厚度是判断高眼压症是否发展为青光眼的最有力的预测因素.常规中央角膜厚度测量对高眼压症患者的合理处理是非常重要的。中央角膜偏厚且眼压低于28mmHg的高眼压症患者不需要抗青光眼治疗,仅需定期观察。     

高眼压症的角膜厚度分析与临床处理

目的评价高眼压症中角膜厚度的作用及其临床处理。方法对39例(75眼)高眼压症者进行回顾性研究,包括CCT及IOP测量,视野、房角镜、裂隙灯及眼底检查。根据CCT值对眼压进行校正,并对校正眼压>21mmHg者行药物干预,眼压降低25%～30%为靶眼压。结果CCT最厚为684.6μm,最薄为532.5μm,均值为588μm。眼压值最高为27.4mmHg,最低为22.3mmHg,均值为23.5mmHg。校正后眼压最大值为24.3mmHg,最小为17.6mmHg,均值为20.1mmHg。校正后眼压均低于校正前。校正前后眼压变化值≥3mmHg。对校正后眼压>21mmHg的31眼行药物干预后眼压下降达到靶眼压,其眼压值为14.21～17.96mmHg。随访时间1～4年。失去随访7例(12眼),2年后有2例(4眼)出现视野鼻侧阶梯状缺损。结论对高眼压症者应测量其CCT并校正眼压,对校正眼压大于21mmHg者须行药物干预,使其控制在靶眼压水平并密切随访。     

近视眼角膜厚度与眼压相关因素分析

目的 探讨近视眼角膜中央厚度(CCT)、屈光度、角膜曲率、年龄、性别与眼压(IOP)测量值之间的关系.方法 对219例431只眼用超声角膜测厚仪、Goldmann眼压计、检影镜及电脑验光仪和ObscanⅡ角膜地形图分别测量其数据.结果 近视眼患者CCT与IOP之间具有直线正相关性,CCT每增加10μm,眼压值约增加0.5 mmHg(1 mmHg=0.133 kPa).近视患者CCT与屈光度数具有负相关性.近视患者CCT与角膜曲率、年龄及性别不相关.结论 CCT为影响IOP测量的一个重要因素,检查CCT有助于更好的了解真实IOP值;CCT随近视眼患者屈光度数的增加有变薄的趋势.     

中央角膜厚度对压平眼压计测量值的影响

目的采用非接触式角膜内皮镜测量高眼压症与临床常见类型青光眼患者的中央角膜厚度central corneal thickness(CCT),并与正常人CCT平均值比较,探讨CCT对青光眼诊断、分类与治疗的指导意义.方法采用KONAN非接触式角膜内皮镜测量中央角膜厚度,Goldmann压平眼压计测量眼内压(IOP).将39例52眼原发性开角型青光眼(POAG),32例45眼慢性闭角型青光眼(CACG),18例29眼高眼压症眼(OHT),15例24眼正常眼压性青光眼(NTG),34例66眼可疑开角型青光眼(GS)的CCT和IOP值与173例322眼正常眼进行比较研究.所有资料输入计算机后在Windows操作环境下使用SPSS10.0统计软件进行统计分析.结果平均CCT值比较高眼压症(OHT)眼(600.21±24.20μm)＞POAG眼(574.37±31.92μm)＞正常对照眼(554.78±32.61μm)＞NTG眼(528.43±36.40μm).OHT、NTG、POAG眼与正常眼的CCT值有差异(F=9.629,P=0.000),CACG眼与POAG及正常眼CCT值均无差异(P=0.119).GS眼CCT值(564.72±31.96μm)较正常眼厚.CCT与IOP成直线正相关,眼压测量值的校正公式为眼压校正值(mmHg)=-(测得的角膜厚度μm-555μm)×(1/24).IOP经CCT校正后,OHT眼平均高估1.89mHg,NTG眼平均低估1.1mmHg,POAG眼平均高估0.80mmHg.根据经CCT校正后的IOP值,13.5%POAG眼重新诊断为NTG眼,34.5%OHT眼重新诊断为正常眼,16.7%NTG眼重新诊断为POAG眼.结论非接触式角膜内皮镜能准确地测量中央角膜厚度.OHT眼CCT较厚,而NTG眼CCT较薄.CCT测量对青光眼的分类与治疗有重要的指导意义,应作为OHT、NTG及GS的常规检查项目.     

角膜厚度与高眼压症及青光眼的眼压

目的 探讨高眼压症、正常眼压性青光眼、原发性开角型青光眼患者及正常人的角膜厚度差异,分析角膜厚度与眼压间的关系,以及角膜厚度的测定对各型青光眼的诊断意见。方法 用超声波角膜测厚仪检测７３例（７３只眼）高眼压症、７９例（７９只眼）正常人的中央角膜厚度,并将其测定结果进行比较。回顾性分析每只青光眼治疗前的最高眼压（Ｇｏｌｄｍａｎｎ）,包括２４ｈ眼压曲线,用Ｅｈｌｅｒ法通过中央角膜厚度对眼压进行校正。结     

角膜中央厚度对高眼压症和开角型青光眼眼内压测量值的影响

目的研究角膜中央厚度对高眼压症和原发性开角型青光眼病人的眼内压测量值的影响.方法对44例(88眼)临床诊断为高眼压症的患者,31例(61眼)原发性开角型青光眼患者及52例(104眼)与高眼压症患者屈光状态相近的正常人的角膜中央厚度及眼内压进行检测,用统计学方法比较3组的角膜中央厚度的差异及高眼压症患者的眼内压值与角膜中央厚度的相关关系.结果①高眼压症组的角膜中央厚度的平均值585.6±35.7μm明显高于原发性开角型青光眼(54.1±38.7μm)(P＜0.01)及正常对照组(535.5±29.4μm)(P＜0.01),而原发性开角型青光眼的角膜中央厚度与正常对照组相比无显著性差异(P＜0.05).②将高眼压症患者的角膜中央厚度与眼内压测量值进行简单线性相关分析,可见角膜中央厚度与眼内压测量值呈明显正相关,相关系数为0.636(P＜0.01).角膜中央厚度每增加50μm可使眼内压测量值升高约2mmHg.结论①高眼压症患者的角膜中央厚度明显大于原发性开角型青光眼和正常眼,高眼压症患者的角膜中央厚度与眼内压呈明显的正相关,提示高眼压症患者是由于角膜中央厚度高于正常范围而造成眼内压测量值的升高.②角膜中央厚度值可作为高眼压症及原发性开角型青光眼的诊断与鉴别诊断的重要依据.提示临床工作中,可将角膜中央厚度检测作为排除青光眼的常规检查手段.③当角膜中央厚度在520±50μm的范围内,眼压读数相对准确,如果角膜中央厚度超过570μm,眼压读数相应增高,这可能是高眼压症患者眼压测量值高于正常范围的重要原因之一.     

正常人中央角膜厚度与Goldmann压平眼压的关系

目的:了解正常人中央角膜厚度(central corneal thickness,CCT)的分布特点并探讨其与压平眼压测量值的关系。方法:采用光学角膜测厚仪及Goldmann压平眼压计检测169名正常人CCT和压平眼压。结果:169名受检者右眼平均CCT为0.547mm(95%可信区间0.443~0.651mm),左眼0.551mm(95%可信区间0.453~0·649)。压平眼压右眼平均15.8mmHg,左眼15.5mmHg。CCT与年龄无相关关系,但与压平眼压测量值显著相关。线性回归分析表明,CCT每增加0.018mm,压平眼压增加1mmHg。结论:CCT变异是眼压测量误差的主要来源。CCT较厚的正常个体可表现"眼压增高"被误诊为高眼压症,而CCT偏薄的原发性开角型青光眼患者则可能因眼压测量"正常"被误诊为正常眼压性青光眼。在诊断青光眼或高眼压症时,特别是在眼压值与其他临床表现不符时,应考虑CCT有无变异。     

原发性青光眼及高眼压症患者中央角膜厚度的比较研究

目的 探讨用超声角膜测厚仪测量的急性原发性闭角型青光眼、慢性原发性闭角型青光眼、原发性开角型青光眼、高眼压症及正常人中央角膜厚度(central corneal thickness,CCT)的差异.方法 临床病例对照研究.对2010年2月至2011年11月在承德医学院附属医院眼科应用超声角膜测厚仪测量62例(107只眼)的CCT值.急性原发性闭角型青光眼16例(18只眼)、慢性原发性闭角型青光眼14例(26只眼)、原发性开角型青光眼10例(19只眼)、高眼压症6例(12只眼)及正常人16例(32只眼).采用单因素方差分析及SNK-q检验行统计分析.结果 各组CCT值:急性原发性闭角型青光眼(548.44±30.46)μm、慢性原发性闭角型青光眼(522.70±50.39)μm、原发性开角型青光眼(546.32±22.85) μm、高眼压症(585.67±21.22) μm、正常人(536.38±26.53)μm.组间比较差异有统计学意义(F=7.661,P＜0.01).两两比较显示:高眼压症与原发性青光眼组及正常人比较,差异有统计学意义;原发性青光眼各组及正常人两两比较,差异无统计学意义.结论 与正常人及原发性青光眼相比,高眼压症CCT较厚;原发性青光眼CCT与正常人相比差异无统计学意义;CCT与原发性青光眼类型无相关性.     

角膜补偿眼压与前房穿刺测量眼内压的比较

目的 比较角膜补偿眼压(IOPcc)与前房穿刺测量眼压(direct intracameral IOP,IOPintra),探讨角膜生物特性对眼压测量的影响.方法 双肓前瞻性研究.拟行超声乳化手术患者73例(73只眼),随机选择1只眼.超声测厚仪测量中央角膜厚度(CCT),ORA测量IOPcc和角膜生物属性:角膜滞后性(cornealhysteresis,CH).角膜阻力因子(corneal resistance factor,CRF).应用IOD眼压测量装置行前房穿刺测量IOPintra.结果 IOPintra为(15.48±4.64)mmHg,IOPcc为(16.63±3.68)mmHg;IOPcc高出IOPintra(1.15±4.12)mmHg(P=0.019);IOPcc和IOPintra与CH、CRF相关,IOPcc,IOPintra及两者的差异与CCT不相关;IOPcc与IOPintra的差异与cH相关(r=-0.283 P=0.015).结论 IOPcc读数比IOPintra高1.15mmHg,其差异受CH影响.角膜生物属性对眼压测量的影响需慎重考虑.     

角膜厚度对眼压测定的影响

目的：探讨角膜厚度（CCT）对眼压（IOP）测量的影响及其临床意义。方法：用超声角膜测厚仪吸非接触式眼压计检测288例眼科患者500眼之CCT及IOP进行统计学分析。结果：IOP随CCT增加而增高并成正相关（CCT每增加27μm,IOP将随之增加1mmHg）而与屈光度无关,CCT与患者年龄成负相关。结论：CCT为影响IOP检测的一个重要因素,检查CCT有助于更正确的估计IOP,可以作为鉴别某些临床疾病的重要指标。     

The role of central corneal thickness in the diagnosis of glaucoma

PURPOSE: To determine the effect of central corneal thickness (CCT) on applanation tonometry and any resultant misclassification of normals as ocular hypertension. METHOD: The central corneal thickness was measured using the ultrasound pachometer in 50 normals, 25 glaucoma and 23 ocular hypertensive patients. The student's "t" test was used to determine any significant difference in CCT between the three groups. RESULTS: There was a statistically significant difference in the mean CCT of the ocular hypertensives (0.574 +/- 0.033 mm) as compared to the glaucomas (0.534 +/- 0.030 mm) and normals (0.537 +/- 0.034 mm). Applying the described correction factor for corneal thickness, 39% of eyes with ocular hypertension were found to have a corrected IOP of 21 mmHg or less. CONCLUSIONS: Increased corneal thickness in ocular hypertension may lead to an overestimation of IOP in 39% of cases. Measurement of central corneal thickness is advisable when the clinical findings do not correlate with the applanation IOP.     

中央角膜厚度与视网膜神经纤维层厚度关系在正常眼和高眼压患者之间的比较研究

目的通过角膜中央厚度分组,观察正常眼和高眼压患者的角膜厚度和视网膜神经纤维层（RNFL）厚度之间的关系,并通过相干光断层扫描成像（OCT）和偏振激光扫描仪联合个体化角膜补偿技术（GDx-VCC）检查高眼压患者是否存在RNFL的异常,并分析OCT和GDx-VCC测得的RNFL厚度之间的相关性。方法对眼压高于21 mm Hg（1 mm Hg=0.133 kPa）的患者测量其中央角膜厚度（CCT）,根据CCT值对眼压进行校正。OCTOPUS-101自动视野仪检查及视盘观察入选高眼压组患者180只眼,均予OCT、GDx-VCC测量视盘一周视网膜神经纤维层厚度,另设正常人180只眼作为对照,获得数据进行统计学分析。结果高眼压患者的平均CCT为（536.14±35.99）（433～609）μm,正常组患者的平均CCT为（516.68±38.27）（368～598）μm。根据平均中央角膜厚度555μm分组,组间平均视网膜神经纤维层厚度（Average RNFL）、上方（S）、下方（I）的RNFL厚度以及其它参数有显著性差异,高眼压组CCT≤555μm的患者平均视网膜神经纤维层厚度要低于CCT〉555μm的患者。结论高眼压患者RNFL厚度GDx-VCC与OCT的检测值低于正常人。高眼压组CCT与平均视网膜神经纤维层厚度正相关。GDx-VCC与OCT有着较好的一致性。     

Comparison of dynamic contour tonometry with Goldmann applanation tonometry in glaucoma practice

Purpose: To compare intraocular pressure (IOP) readings taken using dynamic contour tonometry (DCT) with IOP readings taken with Goldmann applanation tonometry (GAT) in eyes with glaucoma or ocular hypertension. Methods: The present study included 100 eyes in 100 patients with glaucoma or ocular hypertension. After pachymetry DCT and GAT were performed. Intraocular pressures as measured with DCT and GAT were compared with one another and with central corneal thickness (CCT). Results: Mean DCT IOP measurements (20.1 ± 4.3 mmHg) were significantly (p < 0.001) higher than GAT IOP values (17.9 ± 4.7 mmHg). The mean difference between DCT and GAT measurements was 2.1 mmHg (range ? 3.4 to 9.7 mmHg). The difference followed a normal distribution. Measurements made with DCT and GAT correlated significantly with one another (Spearman’s rho = 0.761, p < 0.001). Neither GAT nor DCT measurements showed a significant correlation with CCT (537 ± 39 μm, range 458–656 μm). Multivariate regression analysis has shown that the difference between DCT and GAT is influenced significantly by ocular pulse amplitude (r = ? 0.334, p = 0.001) and it is not influenced by CCT (r = ? 0.106, p = 0.292). Conclusions: In eyes with glaucoma or ocular hypertension, DCT facilitates suitable and reliable IOP measurements which are in good concordance with GAT readings. Variation in CCT cannot by itself explain the differences in measurements taken with DCT and GAT in a number of eyes.     

Clinical comparison of the Oculab Tono-Pen to the Goldmann applanation tonometer

The Oculab Tono-Pen tonometer was compared with the Goldmann applanation tonometer through studies on 197 eyes of 103 patients with glaucoma or ocular hypertension to evaluate the reliability of the Tono-Pen in determining intraocular pressure (IOP). Patients were randomized into four groups and all applanations were done by the same investigator. The Tono-Pen initially used (Tono-Pen #1) failed to calibrate after being used on 77 eyes. Tono-Pen #2 was then obtained and tested. Each Tono-Pen showed high correlation with the Goldmann readings (r greater than or equal to 0.86 in both eyes). The overall sensitivity of the Tono-Pen in detecting IOPs of 21 mmHg or higher (as measured by the Goldmann instrument) was 62.1% in right eyes, 72.4% in left eyes, with corresponding specificities of 92.6% in the right and 97.1% in the left. Given the substantial increase in sensitivity noted with Tono-Pen #2, the Tono-Pen appears adequate for screening programs where an IOP of 21 mmHg or above is considered abnormal; however, at higher IOPs (greater than or equal to 30 mmHg) the Tono-Pens tended to underestimate Goldmann IOPs. At low IOPs (less than or equal to 9 mmHg) the Tono-Pens tended to overestimate the IOPs. Perhaps with further modifications of the instrument, it could be used for clinical diagnosis and management of glaucoma patients.     

Ocular response analyser to assess hysteresis and corneal resistance factor in low tension, open angle glaucoma and ocular hypertension

Purpose: The aim of this study is to compare the hysteresis and corneal resistance factor (CRF) in normal tension glaucoma (NTG), primary open angle glaucoma (POAG) and ocular hypertension (OHT) eyes measured by the ocular response analyser (ORA). Methods: This is a prospective, cross‐sectional and comparative clinical trial. The setting was a teaching hospital in Birmingham, England. Patients: 216 eyes with POAG, 68 eyes with NTG and 199 eyes with OHT. Observational procedures: Goldmann applanation tonometry and intraocular pressure (IOP), hysteresis and CRF measured by ORA and central corneal thickness (CCT) by ultrasonic pachymetery. The main outcome measures were IOP, CCT, hysteresis and CRF. Results: The hysteresis in NTG, POAG and OHT eyes was 9.0 ± 1.9, 9.9 ± 2.1 and 10.2 ± 2.0 mmHg; CRF was 9.1 ± 2.2, 10.6 ± 2.0 and 12.0 ± 2.0 mmHg; IOP by Goldmann applanation tonometry and ORA was 14.7 ± 2.8 and 15.3 ± 4.2 mmHg, 16.7 ± 4.0 and 16.9 ± 4.6 mmHg and 20.5 ± 4.1 and 20.0 ± 4.5 mmHg; CCT was 526.5 ± 42.2, 537.0 ± 36.0 and 563.4 ± 35.9 µm, respectively. The difference for CRF, IOP and CCT for NTG, POAG and OHT eyes was statistically significant. Conclusion: Hysteresis and CRF were highest in OHT eyes. These factors may prove to be useful measurements of ocular rigidity and may help to understand role of the corneal rigidity in monitoring the progress of conditions such as NTG, POAG and OHT.     

Clinical evaluation of the intraocular pressure in patients with glaucoma or ocular hypertension by a self-assessable tonometer.

PURPOSE: To investigate the clinical efficacy of a new patient-operated intraocular pressure tool, the Proview eye pressure monitor (PEPM; Bausch & Lomb, Inc., Rochester, NY), for monitoring intraocular pressure (IOP) in patients with glaucoma or ocular hypertension. PATIENTS AND METHODS: One hundred and forty eyes of 70 Taiwanese patients from the Tri-Service General Hospital (Taiwan, Republic of China) who had been diagnosed with ocular hypertension or glaucoma were studied. After being fully trained during an initial clinic visit, patients measured their own IOP with the PEPM at home. The IOPs were measured again using a Haag-StreitBern Goldmann tonometer (GT; Haag-Streit, K?niz, Switzerland) during subsequent outpatient visits. The training time, assessment of the patients' ease of PEPM use, and accuracy of measured PEPM IOPs in relation to GT IOPs were recorded and analyzed. RESULTS: Relative to GT readings, PEPM readings tended to be overestimated at lower pressure (<10 mmHg) and underestimated at higher pressure (>20 mmHg). Between 10 to 20 mmHg, PEPM measurements did not significantly differ from GT measurements. Up to 80% of the PEPM measurements fell within +/- 3 mmHg of the corresponding GT readings. When consideration was limited to GT readings of > or =21 mmHg, PEPM measured IOPs of > or =21 mmHg with a sensitivity of 80% and a specificity of 90%. The mean satisfaction rating of PEPM use was 88.3 +/- 2.0 (maximum, 100). The mean training time for appropriate use of PEPM was 17.9 +/- 4.0 minutes. The older the patients, the longer the training time that was required. CONCLUSION: Our data suggest that after appropriate training: (1) PEPM and GT measurements correspond well between 10 mmHg and 20 mmHg and (2) PEPM could offer patients with glaucoma or ocular hypertension an easy-to-use, substantially reliable means of selfmonitoring IOP.     

角膜生物参数对青光眼患者眼压测量影响的研究

目的:探讨角膜生物参数对青光眼患者眼压测量的影响。方法:对80例121眼青光眼患者进行眼反应分析仪(ocular response analyzer,ORA)与Goldmann压平眼压计(Goldmann applanation tonometer,GAT)测量,并用先进的OrbscanⅡ眼前节分析系统测量中央角膜厚度(central corneal thickness,CCT)。结果:平均矫正眼压(IOPcc)值17.41±5.62mmHg;平均GAT值15.76±6.06mmHg;IOPcc与角膜滞后性(cornealhysteresis,CH)有相关性(P=0.000;r=-0.236);IOPcc与GAT显著相关(P=0.000;r=0.857);IOPcc与CCT无相关性。结论:对已经诊断的青光眼患者,平均IOPcc值高于平均GAT值;随着CH的降低,IOPcc值有升高的趋势;且IOPcc值不受CCT值的影响。     

Association between corneal hysteresis and central corneal thickness in glaucomatous and non‐glaucomatous eyes

Purpose: We aimed to determine corneal hysteresis values (CH) using the ocular response analyser (ORA) in non‐glaucomatous and glaucomatous eyes and their relationship with central corneal thickness (CCT). Methods: Corneal hysteresis, intraocular pressure (IOP) as measured by Goldmann applanation tonometry (GAT) and CCT were prospectively evaluated in 74 non‐glaucoma subjects with IOP < 21 mmHg and in 108 patients with treated primary open‐angle glaucoma (POAG). One eye in each subject was randomly selected for inclusion in the analysis. Results: Mean (± standard deviation [SD]) age was 59.2 ± 14.2 years in the non‐glaucoma group and 62.4 ± 9.8 years in the glaucoma group. Mean (± SD) GAT IOP was 15.7 ± 2.65 mmHg and 16.38 ± 2.73 mmHg in the non‐glaucoma and glaucoma groups, respectively. There was no statistically significant difference between the two groups in mean age (p = 0.396) or mean GAT IOP (p = 0.098). Mean (± SD) CH was 10.97 ± 1.59 mmHg in the non‐glaucoma and 8.95 ± 1.27 mmHg in the glaucoma groups, respectively. The difference in mean CH between the two groups was statistically significant (p < 0.0001). There was a strong positive correlation between CH and CCT in the non‐glaucoma group (r = 0.743) and a significantly (p = 0.001) weaker correlation (r = 0.426) in the glaucoma group. Conclusions: Corneal hysteresis was significantly lower in eyes with treated POAG than in non‐glaucomatous eyes. The corneal biomechanical response was strongly associated with CCT in non‐glaucoma subjects, but only moderately so in glaucoma patients. It can be assumed that diverse structural factors, in addition to thickness, determine the differences in the corneal biomechanical profile between non‐glaucomatous and glaucomatous eyes. Corneal hysteresis could be a useful tool in the diagnosis of glaucoma.     

Central corneal thickness in congenital glaucoma

PURPOSE: The aim of this study was to compare central corneal thickness between eyes with congenital glaucoma and normal fellow eyes in unilateral glaucoma or less affected fellow eyes in bilateral glaucoma. METHODS: Eyes of consecutive phakic children with congenital glaucoma and previous glaucoma surgery were examined under chloral hydrate. Complete ophthalmologic examination, central corneal thickness (CCT), axial length, and corneal diameter measurements were performed. Patients were included in the study if presented with intraocular pressure (IOP) less than 21 mm Hg and no biomicroscopic signs of corneal edema. RESULTS: Nine patients were included in the study. The mean CCT in the more affected eye/glaucomatous eye was 522.3 +/- 65.2 microm and in the less affected eye/healthy eye was 579.7 +/- 44.5 microm. This difference was statistically significant (P = 0.0013). CONCLUSION: CCT was significantly thinner in glaucomatous eyes than in normal fellow eyes in phakic children with congenital glaucoma. This finding may be another confounding factor when measuring IOP in these patients.