Clinical Evaluation of a Rebound Tonometer in Patients Who Underwent Penetrating Keratoplasty

Jong Woo Kim; Ji Won Jung

doi:10.3341/jkos.2018.59.12.1122

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Kim and Jung: Clinical Evaluation of a Rebound Tonometer in Patients Who Underwent Penetrating Keratoplasty

Original Article

J Korean Ophthalmol Soc 2018;59(12):1122-1128.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.12.1122

Clinical Evaluation of a Rebound Tonometer in Patients Who Underwent Penetrating Keratoplasty

Jong Woo Kim, MD, Ji Won Jung, MD

Department of Ophthalmology, Inha University School of Medicine, Incheon, Korea

Address reprint requests to Ji Won Jung, MD Department of Ophthalmology, Inha University Hospital, #27 Inhang-ro, Jung-gu, Incheon 22332, Korea Tel: 82-32-890-2400, Fax: 82-32-890-2417 E-mail: panch325@hanmail.net

Received 3 May 2018 Revised 29 July 2018 Accepted 27 November 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the measurements of the rebound tonometer (RT), Goldmann applanation tonometer (GAT) and non-contact tonometer (NCT) in patients who underwent penetrating keratoplasty (PKP), and to evaluate the reproducibility of the RT measurements.

Methods

This study included 19 PKP eyes and 28 normal eyes. We compared the intraocular pressure (IOP) measurements of the GAT and NCT with the RT in both groups using Spearman's correlation analysis and the Wilcoxon signed-rank test. The IOP, as measured with an RT in each group, was assessed with respect to reproducibility using the intraclass correlation coefficient (ICC).

Results

In normal eyes, there was no significant difference in the measurements obtained with the RT, GAT, and NCT (p > 0.050). In the patient group, the RT measurements were not significantly different from those of the GAT (p = 0.872), but they were significantly lower than those obtained with the NCT (p = 0.011). However, the RT measurements showed a relatively high correlation with those of the GAT and NCT (r = 0.770 and 0.879, respectively). The ICC of the RT was 0.986 for the PKP eye group and 0.961 for the normal eye group, both of which were highly reproducible.

Conclusions

In PKP eyes, the measurements obtained with the RT showed a relatively high correlation with those of the GAT and NCT, and the repeatability of the RT measurements was high and similar to those for normal eyes. The RT can therefore be considered a useful method for measuring the IOP in PKP eyes.

Keywords: Goldmann applanation tonometer, Noncontact tonometer, Penetrating keratoplasty, Rebound tonometer

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Figure 1.

Correlation of IOP obtained by RT, GAT and NCT for PKP eyes and normal eyes. (A) RT and GAT for PKP eyes (r = 0.77, p < 0.001). (B) RT and NCT for PKP eyes (r = 0.88, p < 0.001). (C) RT and GAT for normal eyes (r = 0.84, p < 0.001). (D) RT and NCT for normal eyes (r = 0.90, p < 0.001). The dashed line represents y = xand the solid line represents the linear regression. IOP = intraocular pressure; PKP = penetrating keratoplasty; RT = rebound tonometer; GAT = Goldmann applanation tonometer; NCT = noncontact tonometer.

Figure 2.

Bland-Altman plot of agreement between RT, GAT and NCT. The differences in IOP of two measurements are plotted against the mean of the two measurements. (A) RT and GAT for PKP eyes. (B) RT and NCT for PKP eyes. (C) RT and GAT for normal eyes. (D) RT and NCT for normal eyes. IOP = intraocular pressure; PKP = penetrating keratoplasty; RT = rebound tonometer; GAT = Goldmann applanation tonometer; NCT = noncontact tonometer; SD = standard deviation.

Table 1.

Results of IOP measurement obtained by Rebound tonometer with GAT and NCT in PKP eyes and normal eyes

Subjects	RT (mmHg)	GAT (mmHg)	NCT (mmHg)	RT vs. GAt		RT vs. NCt
Subjects	RT (mmHg)	GAT (mmHg)	NCT (mmHg)	Difference mean	p-value^*	Difference mean	p-value^*
Normal eye (n = 28)	15.18 ± 1.62	15.11 ± 1.57	15.14 ± 1.58	+0.07 ± 0.78	0.724	+0.03 ± 0.66	0.909
Post PKP eye (n = 19)	13.82 ± 3.61	14.26 ± 3.80	15.26 ± 4.23	−0.44 ± 2.34	0.872	−1.44 ± 2.18	0.011

Values are presented as mean ± standard deviation unless otherwise indicated. IOP = intraocular pressure; GAT = Goldmann applanation tonometer; NCT = noncontact tonometer; PKP = penetrating keratoplasty; RT = rebound tonometer.

^* Using a Wilcoxon signed rank test.

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