유리체절제술 이후 치료용 콘택트렌즈를 착용한 환자에서 안압 측정의 정확성

Accuracy of Intraocular Pressure Measurements of Eyes with Therapeutic Contact Lenses after Vitrectomy

목적: 유리체절제술을 시행받고 콘택트렌즈를 착용한 환자에서 리바운드안압계와 비접촉 공기안압계를 이용한 안압 측정의 정확성을평가하고자 하였다. 대상과 방법: 유리체절제술을 시행받은 정상 각막 60안을 대상으로 골드만압평안압계로 측정한 안압(IOPGAT)과 치료용 콘택트렌즈착용 전후 리바운드안압계, 비접촉 공기안압계로 측정한 안압(IOPRT, IOPNCT)을 비교하였다. 결과: IOPRT는 콘택트렌즈 착용 전후 각각 12.55 ± 5.43, 13.12 ± 5.13 mmHg로 통계적으로 유의한 차이를 보였으나(p=0.02), 두측정값 사이의 높은 양의 상관관계를 보였다(r=0.90, p＜0.001). IOPNCT는 콘택트렌즈 유무와 상관없이 비슷한 값을 보였다(12.18 ± 3.24, 12.17 ± 3.14 mmHg, p=0.17). IOPRT와 IOPNCT 모두 IOPGAT (12.57 ± 5.22 mmHg)와 유의한 차이는 없었다. IOPGAT와의 일치도는IOPRT (ICC=0.955), 콘택트렌즈 착용 후 측정한 IOPRT (ICC=0.945), IOPNCT (ICC=0.856), 콘택트렌즈 착용 후 측정한 IOPNCT (ICC=0.850) 순으로 높게 나타났다. 리바운드안압계는 모든 경우 안압 측정에 성공하였으나 비접촉 공기안압계는 콘택트렌즈 착용전 7안, 착용 후 9안에서 측정에 실패하였다. 안내 충전재의 종류에 따른 안압 측정법의 정확성 차이는 관찰되지 않았다. 결론: 유리체절제술 후 치료용 콘택트렌즈를 착용하여 골드만압평안압계를 사용하기 어려운 경우 리바운드안압계를 대체 검사법으로사용할 수 있다.

Purpose: To evaluate the accuracy of intraocular pressure (IOP) measurements obtained by a rebound and non-contact tonometer in eyes with a therapeutic contact lens (CL) after vitrectomy. Methods: In 60 eyes of 60 patients who underwent vitrectomy for vitreoretinal disease, IOP was measured using a rebound tonometer (iCare ic200？？; IOPRT) and non-contact computerized air puff tonometer (CT-80, IOPNCT), before and after wearing a CL (Purevision2？？, +0.0 diopter). The mean IOP of three consecutive measurements were analyzed, and a comparative analysis with IOP measured by a Goldman applanation tonometer (IOPGAT) was performed. Results: The mean IOPRT without and with the CL was 12.55 ± 5.43 and 13.12 ± 5.13 mmHg, respectively, showing a statistically significant difference (p = 0.02) and strong positive correlation (r = 0.90, p < 0.001). The mean IOPNCT with and without the CL was 12.18 ± 3.24 and 12.17 ± 3.14 mmHg, showing no statistically significant difference (p = 0.17). The consistency with IOPGAT (12.57 ± 5.22 mmHg) was highest in IOPRT without the CL, followed by IOPRT with the CL, IOPNCT without the CL, and IOPNCT with the CL (intraclass correlation coefficients = 0.955, 0.945, 0.856, and 0.850, respectively). In addition, the rebound tonometer successfully measured IOP, regardless of whether the CL was worn; however, the non-contact tonometer failed to measure IOP in seven eyes without the CL and nine with the CL. No difference was observed according to intraocular tamponade type. Conclusions: A rebound tonometer can be used as an alternative IOL measuring method in eyes for which it is difficult to use a Goldman applanation tonometer due to the postoperative presence of a therapeutic CL.