Goldmann压平式眼压计和经眼睑眼压计(TGDc-01“PRA”)在青光眼患者所测眼压的比较

Purpose: The object of this study was to compare intraocular pressure measurem ents obtained with the TGDc-01 “PRA”, a new, transpalpebral indentation tonom eter, with those from Goldmann applanation tonometry in normal and glaucomatous eyes. Methods and Patients: Forty healthy eyes and 185 eyes suffering from glauc oma were included in the study. For Goldmann tonometry three measurements and fo r the TGDc01 ten measurements were performed in a random order. All participants were placed in an upright position for all measurements. Results: In both group s a systematic increase of intraocular pressure was found within the TGDc-01-m easurements. Therefore, the first 3 measurements of each device were used for fu rther statistical analysis. No learning curve could be demonstrated for the TGDc -01-measurement with normal eyes. Within the group of normal eyes the mean 1OD obtained with the TGDc-01 was 1.84 mmHg lower than the mean 1OD obtained with Goldmann tonometry (two-sided Student’s t-test; P=0.003). In the group of gla ucomatous eyes, the mean intraocular pressure obtained with the Goldmann tonomet ry was 19.7 ±10.1 mmHg, with the TGDC-01 18.1 ±7.1 mmHg (coefficient of correlation r=0.64, P< 0.001). The mean standard deviatio n of intraocular pressure measurements with Goldmann tonometry was 1.2 ±.0.9 mm Hg, with the TGDc01 3.1 ±2.1 mmHg. TGDc-01-measurements over-estimated intra ocular pressure compared to Goldmann tonometry up to values of 16 mmHg and under estimated intraocular pressure at values over 16 mmHg. The difference increased by 5.5 mmHg per 10 mmHg Goldmann tonometry. The probability of success, defined as TGDc-01-recordings within ±3 mmHg of the Goldmann tonometry recordings, wa s less than 53 %between 5 and 20 mmHg and less than 30 %between 20 and 30 mmHg . Intraocular pressure (Goldmann tonometry) over 30 mmHg was always accompanied by TGDc-01-measurements lower than 3 mmHg. Conclusion: In eyes with elevated i ntraocular pressure, the TGDc-01 “PRA”significantly underestimated the intrao cular pressure measurement when compared to the gold standard, Goldmann tonometr y. At present, measurement of the intraocular pressure with the TGDc-01 should not be used for clinical management of patients with glaucoma.

平坦部改良Ahmed青光眼阀治疗顽固性青光眼的初步研究

Purpose:This study was conducted to report the safety and efficacy of pars plana-modified Ahmed Glaucoma Valve PS2 in advanced secondary glaucoma.Methods:We performed a prospective,interventional case series that included patients with advanced secondary glaucoma and uncontrolled intraocular pressure(IOP).Eleven eyes of nine patients with aphakic,neovascular,traumatic,inflammatory and pseudoexfoliation glaucoma were included.All patients had pars plana vitrectomy before tube insertion.Results:One year after surgery,IOP was controlled(21 mmHg or less)in ten of 11 eyes(91%),seven(64%)did not need medical antiglaucoma therapy.Average IOP decreased from 32.2± 8.3 mmHg before surgery to 15.7± 7.7 mmHg postoperatively(P < 0.0001).The average number of topically used medications used decreased from 2.9± 1.2 to 0.545± 0.78(P < 0.0001).Complications included transient hypotony(three eyes-two of them without tube ligature),transient choroidal effusion(three eyes)and an intermediate increase in IOP(seven eyes).Tube exchange was performed in one eye and needling/bleb excision in two patients.Conclusions:Pars plana-modified Ahmed Valve implantation is effective and safe in advanced glaucoma.Partial ligature of the tube is necessary to prevent early hypotony.Close followup of patients is needed to monitor variations of IOP within the first year.