Intraocular Pressure in Children: The Effect of Body Position as Assessed by Icare and Tono-Pen Tonometers

Dosunmu, Eniolami O.; Marcus, Inna; Tung, Irene T.; Thiamthat, Warakorn; Freedman, Sharon F.

doi:10.1016/j.ajo.2014.09.009

Cited by 13 publications

(9 citation statements)

References 15 publications

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“…Our finding of lower IOP readings with the Icare PRO contrasts with results from some previous studies in children, 6 7 8 which have reported a tendency for similar or higher measurements with the Icare PRO. Higher IOP measurements with the Icare PRO compared to applanation tonometry have also been reported for supine adults.…”

Section: Discussioncontrasting

confidence: 99%

“…However, a recent study of cooperative supine children, most of whom had glaucoma, Dosunmu et al . 8 found no significant difference between the Icare PRO measurement and the Tono-Pen. Both devices showed a slightly higher IOP measurement when the child was supine versus sitting.…”

Section: Discussionmentioning

confidence: 60%

“…Some studies that compare the Icare PRO to other tonometers in supine children suggest Icare measurements tend to be slightly higher or the same as other tonometers. 6 7 8 However, these studies are rare and have typically evaluated data from a Western population. 6 7 8 The purpose of this study is to compare IOP measurements with Icare PRO to measurements by two applanation devices (the Tono-Pen XL and Pneumotonometer Model 30 classic; both by Reichert, Buffalo, NY, USA) in supine children with glaucoma.…”

Section: Introductionmentioning

confidence: 99%

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A comparison of rebound to indentation tonometry in supine sedated children with glaucoma

AlHarkan

Shamlan

Edward

et al. 2016

Middle East Afr J Ophthalmol

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Purpose:To compare intraocular pressure (IOP) measurements by rebound tonometry (Icare PRO; Icare Finland Oy, Helsinki, Finland) to measurements by indentation tonometry (Pneumotonometer Model 30 classic and Tono-Pen XL; Reichert, Buffalo, NY, USA) in supine sedated children with glaucoma.Methods:Prospective comparative observational study of Saudi Arabian children with glaucoma undergoing chloral hydrate sedation for ophthalmic examination (February 2012 - February 2013). Nonglaucomatous eyes were included as controls. Eyes with corneal scars or prior corneal transplant or lamellar surgery were excluded.Results:Fifty-two eyes (26 OD, 26 OS) of 28 children were included. Thirty-six eyes had glaucoma (32 primary congenital glaucoma, two Sturge-Weber related, and two aphakia related). Sixteen eyes did not have glaucoma (six with pediatric cataract, five normal eyes, two strabismic eyes, two eyes with simple megalocornea, and one eye had peripheral corneal laceration repair. In the glaucoma group, the mean IOP was 17.55 ± 5.97 mmHg (range, 8-31.5 mmHg) with the Icare PRO and 20 ± 6.4 mmHg (range, 8-35.5 mmHg) with the Pneumotonometer from 20.47 ± 6.81 mmHg (range, 10-43 mmHg) with the Tono-Pen XL. The Icare PRO readings were significantly lower than each of the indentation tonometers. For the control group, there was no statistically significant difference in IOP measured by the Icare PRO and the indentation tonometers.Conclusions:In this population of supine sedated children with glaucoma, IOP measurements with the Icare PRO tend to be lower than readings from the Pneumotonometer and Tono-Pen XL.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

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A comparison of rebound to indentation tonometry in supine sedated children with glaucoma

AlHarkan

Shamlan

Edward

et al. 2016

Middle East Afr J Ophthalmol

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“…Significant reductions in IOP were measured by both tonometers at all time points after anesthesia; however, the IOP measurements obtained via the ICare PRO tonometer were higher than those obtained via the Perkins tonometer by an average of 1.4 mm Hg for all time points (these differences were statistically significant for time points T1 and T3); this result validates the results of several other studies. [ 22 35 36 ]…”

Section: Discussionmentioning

confidence: 99%

Changes in intraocular pressures associated with inhalational and mixed anesthetic agents currently used in ophthalmic surgery

Senthil

Nakka²,

Rout³

et al. 2021

Indian Journal of Ophthalmology

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Purpose: The aim of this study was to measure changes in intraocular pressures (IOPs) associated with inhalational and mixed anesthetic agents currently used for general anesthesia (GA) in ophthalmic surgery. Methods: In a cross-sectional study, 48 eyes from 48 consecutive subjects that underwent ophthalmic surgery under GA were included. Mixed anesthetics were used in 26 eyes and sevoflurane in 22 eyes. IOPs of the nonsurgery eyes were recorded at T1 (5 min before induction of anesthesia), T2 (5 min after intubation), and T3 (at the conclusion of surgery before extudation) using ICare PRO and Perkins tonometers. Linear mixed-effects models were used to compare differences in IOPs at various time points. Outcome measures were changes in IOP after induction of GA, intubation, and just before extubation and comparisons of decreases in IOPs induced by sevoflurane and mixed anesthetics. Results: Mean preanesthesia IOP for patients in this study (mean age ± standard deviation = 26.9 ± 18.3 years; range: 5–70 years) was 17.9 ± 4.9 (range: 10–30) mm Hg. There was a significant decrease in the mean IOP (standard error (SE) (in mm Hg) at T2 (Perkins: –4.65 (0.57); ICare PRO: –5.16 (0.56) and T3 (Perkins: –5.63; ICare PRO: –5.36) as compared to the IOP at T1 ( P < 0.001 ). The decreases in IOPs at T2 and T3 were similar in both anesthetic groups (T2: P = 0.60 ; T3: P = 0.33 ). Conclusion: Significant decreases in IOPs after GA were observed and the differences were not significantly different between sevoflurane and mixed anesthetic agents. For management decisions in pediatric glaucoma, the IOP measurements under GA are crucial, the underestimation of IOP as noted with currently used anesthetic agents has to be accounted for and decisions are taken appropriately.

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“…Prior studies have shown that IOP is higher in the supine position, 22 but it is only an increase in 1mmHg, which is unlikely to be clinically significant. 23 It is also unclear whether measurements would correlate as well, in the setting of a severely swollen eyelid. Further studies would need to be performed to evaluate this.…”

Section: Limitationsmentioning

confidence: 99%

Change in Intraocular Pressure During Point-of-Care Ultrasound

Berg¹,

Doniger²,

Zaia³

et al. 2015

WestJEM

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IntroductionPoint-of-care ocular ultrasound (US) is a valuable tool for the evaluation of traumatic ocular injuries. Conventionally, any maneuver that may increase intraocular pressure (IOP) is relatively contraindicated in the setting of globe rupture. Some authors have cautioned against the use of US in these scenarios because of a theoretical concern that an US examination may cause or exacerbate the extrusion of intraocular contents. This study set out to investigate whether ocular US affects IOP. The secondary objective was to validate the intraocular pressure measurements obtained with the Diaton® as compared with standard applanation techniques (the Tono-Pen®).MethodsWe enrolled a convenience sample of healthy adult volunteers. We obtained the baseline IOP for each patient by using a transpalpebral tonometer. Ocular US was then performed on each subject using a high-frequency linear array transducer, and a second IOP was obtained during the US examination. A third IOP measurement was obtained following the completion of the US examination. To validate transpalpebral measurement, a subset of subjects also underwent traditional transcorneal applanation tonometry prior to the US examination as a baseline measurement. In a subset of 10 patients, we obtained baseline pre-ultrasound IOP measurements with the Diaton® and Tono-Pen®, and then compared them.ResultsThe study included 40 subjects. IOP values during ocular US examination were slightly greater than baseline (average +1.8mmHg, p=0.01). Post-US examination IOP values were not significantly different than baseline (average −0.15mmHg, p=0.42). In a subset of 10 subjects, IOP values were not significantly different between transpalpebral and transcorneal tonometry (average +0.03mmHg, p=0.07).ConclusionIn healthy volunteer subjects, point-of-care ocular US causes a small and transient increase in IOP. We also showed no difference between the Diaton® and Tono-Pen® methods of IOP measurement. Overall, the resulting change in IOP with US transducer placement is considerably less than the mean diurnal variation in healthy subjects, or pressure generated by physical examination, and is therefore unlikely to be clinically significant. However, it is important to take caution when performing ocular ultrasound, since it is unclear what the change in IOP would be in patients with ocular trauma.

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Intraocular Pressure in Children: The Effect of Body Position as Assessed by Icare and Tono-Pen Tonometers

Cited by 13 publications

References 15 publications

A comparison of rebound to indentation tonometry in supine sedated children with glaucoma

A comparison of rebound to indentation tonometry in supine sedated children with glaucoma

Changes in intraocular pressures associated with inhalational and mixed anesthetic agents currently used in ophthalmic surgery

Change in Intraocular Pressure During Point-of-Care Ultrasound

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