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The effect of corneal thickness on intraocular pressure measurement in patients with corneal pathology

¹ Division of Ophthalmology and Visual Sciences, University Hospital, Queen’s Medical Centre, Nottingham NG7 2UH, UK
² Birmingham and Midlands Eye Centre, City Hospital, Birmingham, UK

Correspondence to:
Correspondence to:
Professor Harminder S Dua
Division of Ophthalmology and Visual Sciences, University Hospital, Queen’s Medical Centre, Nottingham NG7 2UH, UK; harminder.dua{at}nottingham.ac.uk

ABSTRACT
Background/aim: To compare intraocular pressure (IOP) measurements taken by the Goldmann applanation tonometer, the Tono-Pen and the ocular blood flow pneumotonometer in eyes with varying central corneal thickness (CCT) due to penetrating keratoplasty (PK), keratoconus (KC), and Fuchs’ endothelial dystrophy (FED).

Methods: IOP was measured with the Goldmann applanation tonometer, Tono-Pen XL, and OBF pneumotonometer in 127 eyes with the following corneal abnormalities. There were 56 eyes that had undergone PK, 37 eyes with KC, and 34 eyes with FED. CCT was measured using an ultrasound pachymeter after IOP determinations had been made.

Results: Mean IOP measurements in all three patient groups were significantly higher when measured by OBF pneumotonometer. Linear regression analysis showed that patients with FED had a significant increase in IOP with increasing CCT of 0.18 mm Hg/10 µm using the Goldmann tonometer, 0.15 mm Hg/10 µm with the Tono-Pen, and 0.26 mm Hg/10 µm with the OBF pneumotonometer. In patients with KC and after PK, linear regression analysis did not show a significant effect of CCT on IOP. A multivariate linear regression model controlling for age, sex, graft size, and patient group, showed that the effect of CCT on IOP for Tono-Pen (0.13 mm Hg/10 µm CCT) and Goldmann (0.14 mm Hg/10 µm CCT) were significantly lower than for the OBF pneumotonometer (0.26 mm Hg/10 µm CCT).

Conclusions: This study found that mean IOP measurements using the OBF pneumotonometer were significantly higher than those made using the Goldmann applanation tonometer or Tono-Pen in eyes with a variety of cornel pathologies. The OBF pneumotonometer was found to be most affected by variation in CCT. For all three instruments, the relation between IOP and CCT depended on the corneal pathology and was greatest for FED.

Abbreviations: CCT, central corneal thickness; FED, Fuchs’ endothelial dystrophy; IOP, intraocular pressure; KC, keratoconus; PK, penetrating keratoplasty

Keywords: intraocular pressure; corneal thickness; tonometry; pneumotonometry

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