Changes in corneal properties and its effect on intraocular pressure measurement following phacoemulsification with intraocular lens implantation with or without trabeculectomy
Purpose: To evaluate the changes incorneal biomechanical properties and their effect on pre and postoperative differences in IOP measurement by each tonometer
Design: Observational study.
Methods: The study was done in subjects who underwent phacoemulsification with intraocular lens (IOL) implantation (phaco-IOL) and combined phacoemulsification with IOL implantation and trabeculectomy (phaco-trab). IOP was measured by a single trained examiner using rebound tonometer (RBT), Ocular Response Analyzer (ORA), Goldmann applanation tonometer (GAT), dynamic contour tonometer (DCT), and Tono-Pen. Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured using ORA, central corneal thickness (CCT) using ultrasonic pachymeter, and corneal curvature (CR) with manual keratometry. All measurements were done one week prior to surgery and after four weeks and six weeks of the two surgeries, respectively. Only the operated eye was included for analysis.
Results: Twenty-nine eyes of 29 normal subjects who underwent phaco-IOL and 23 eyes of 23 glaucoma subjects who underwent phaco-trab were studied. Increase in CCT [10.2 ± 14.86 microns, p = 0.001], decrease in CH [0.82 ± 1.38 mmHg, p = 0.003] and CRF [0.97 ± 1.0 mmHg, p < 0.001] were found post-phaco-IOL, whereas post-phaco-trab decrease in CCT [16.61 ± 15.22 microns, p < 0.001], CRF [2.28 ± 1.93 mmHg, p < 0.001] with increase in CH [0.95 ± 1.89 mmHg, p = 0.03] were noted. Multiple linear regression analysis showed significant associations for change in CH and CRF with change in IOP and not with CCT and CR postoperatively.
Conclusion: Alterations in CH and CRF were associated with changes in IOP measured postoperatively by different tonometers. CH and CRF changes contribute to postoperative changes in measured IOP.
2. Newton RH, Meek KM. Circumcorneal annulus of collagen fibrils in the human limbus. Invest Ophthalmol Vis Sci 1998;39(7):1125-1134.
3. Hjortdal JØ. Regional elastic performance of the human cornea. J Biomechanics 1996;29(7):931-942.
4. Woo SY, Kobayashi AS, Schlegel WA, et al. Nonlinear material properties of intact cornea and sclera. Exp Eye Res 1972;14(1):29-39.
5. Luce DA. Determining in vivo biomechanical properties of the cornea with an ocular response analyzer. J Cataract Refract Surg 2005;31(1):156-162.
6. Kotecha A. What biomechanical properties of the cornea are relevant for the clinician? Surv Ophthalmol 2007;52(6):109-114.
7. Mansouri K, Leite MT, Weinreb RN, et al. Association between corneal biomechanical properties and glaucoma severity. Am J Ophthalmol 2012;153(3):419-427.
8. Wells AP, Garway-Heath DF, Poostchi A, et al. Corneal hysteresis but not corneal thickness correlates with optic nerve surface compliance in glaucoma patients. Invest Ophthalmol Vis Sci 2008;49(8):3262-3268.
9. Congdon NG, Broman AT, Bandeen-Roche K, et al. Central corneal thickness and corneal hysteresis associated with glaucoma damage. Am J Ophthalmol 2006;141(5):868-875.
10. Kaushik S, Pandav SS, Banger A, et al. Relationship between corneal biomechanical properties, central corneal thickness and intraocular pressure across the spectrum of glaucoma. Am J Ophthalmol 2012;153(5):840-849.
11. Johnson CS, Mian SI, Moroi S, et al. Role of corneal elasticity in damping of intraocular pressure. Invest Ophthalmol Vis Sci 2007;48(6):2540-2544.
12. Whitacre MM, Stein R. Sources of error with use of Goldmann-type tonometers. Surv Ophthalmol 1993;38(1):1-30.
13. Park, SJ, Ang GS, Nicholas S. The effect of thin, thick, and normal corneas on Goldmann intraocular pressure measurements and correction formulae in individual eyes. Ophthalmology 2012;119(3):443-449.
14. Bhan A, Browning AC, Shah S, et al. Effect of corneal thickness on intraocular pressure measurements with the pneumotonometer, Goldmann applanation tonometer, and Tono-Pen. Invest Ophthalmol Vis Sci 2002;43(5):1389-1392.
15. Gunvant P, Baskaran M, Vijaya L et al. Effect of corneal parameters on measurements using the pulsatile ocular blood flow tonograph and Goldmann applanation tonometer. Br J Ophthalmol 2004;88(4):518-522.
16. Kotecha A, White E, Schlottmann PG, et al. Intraocular pressure measurement precision with the Goldmann applanation, dynamic contour, and ocular response analyzer tonometers. Ophthalmology 2010;117(4):730-737.
17. Wang J, Cayer MM, Descovich D, et al. Assessment of factors affecting the difference in intraocular pressure measurements between dynamic contour tonometry and Goldmann applanation tonometry. J Glaucoma 2011;20(8):482-487.
18. Ouyang PB, Li CY, Zhu XH, et al. Assessment of intraocular pressure measured by Reichert ocular response analyzer, Goldmann applanation tonometry, and dynamic contour tonometry in healthy individuals. Int J Ophthalmol 2012;5(1):102-107.
19. Pepose JS, Feigenbaum SK, Qazi MA, et al. Changes in corneal biomechanics and intraocular pressure following LASIK using static, dynamic and noncontact tonometry. Am J Ophthalmol 2007;143(1):39-47.
20. Shemesh G, Soiberman U, Kurtz S. Intraocular pressure measurements with Goldmann applanation tonometry and dynamic contour tonometry in eyes after Intra LASIK or LASEK. Clin Ophthalmol 2011;6:1967-1970.
21. Kucumen RB, Yenerel NM, Gorgun E, et al. Corneal biomechanical properties and intraocular pressure changes after phacoemulsification and intraocular lens implantation. J Cataract Refract Surg 2008;34(12):2096-2098.
22. de Freitas VB, Ventura MP, da Silva RS, et al. Central corneal thickness and biomechanical changes after clear corneal phacoemulsification. J Refract Surg 2012;28(3):215-219.
23. Alió JL, Agdeppa MCC, Rodríguez-Prats JL, et al. Factors influencing corneal biomechanical changes after micro-incision cataract surgery and standard coaxial phacoemulsification. J Cataract Refract Surg 2010;36(6):890-897.
24. Kamiya K, Shimizu K, Ohmoto F, et al. Time course of corneal biomechanical parameters after phacoemulsification with intraocular lens implantation. Cornea 2010;29(11):1256-1260.
25. Hager A, Loge K, Füllhas MO, et al. Changes in corneal hysteresis after clear corneal cataract surgery. Am J Ophthalmol 2007;144(3):341-346.
26. Foster PJ, Buhrmann R, Quigley HA, et al. The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol 2002;86(2):238-242.
27. Kontiola AI. A new induction based impact method for measuring intraocular pressure. Acta Ophthalmol. Scand 2000;78(2):142-145.
28. Hessemer V, Rössler R, Jacobi, KW. Tono-Pen, a new position-independent tonometer Comparison with the Goldmann tonometer by applanation measurement. Klin Monatsbl Augenheilkd 1988;193(4):420-426.
29. Kanngiesser HE, Kniestedt C, Robert YC. Dynamic contour tonometry: presentation of a new tonometer. J Glaucoma 2005;14(5):344-350
30. Lu F, Xu S, Qu J, et al. Central corneal thickness and corneal hysteresis during corneal swelling induced by contact lens wear with eye closure. Am J Ophthalmol 2007;143(4):616-622.
31. Sun L, Shen M, Wang J, et al. Recovery of corneal hysteresis after reduction of intraocular pressure in chronic primary angle-closure glaucoma. Am J Ophthalmol 2009;147(6):1061-1066.
32. Neuburger M, Böhringer D, Reinhard T, et al. Recovery of corneal hysteresis after reduction of intraocular pressure in chronic primary angle-closure glaucoma. Am J Ophthalmol 2010;149(4):687-688.
33. Francis BA, Hsieh A, Lai MY, et al. Effects of corneal thickness, corneal curvature, and intraocular pressure level on Goldmann applanation tonometry and dynamic contour tonometry. Ophthalmology 2007;114(1):20-26.
34.Tonnu PA, Ho T, Sharma K, et al. A comparison of four methods of tonometry: method agreement and interobserver variability. Br J Ophthalmol 2005;89(7):847-850.
35. Hamilton KE, Pye DC, Kao L, et al. The effect of corneal edema on dynamic contour and Goldmann tonometry. Optom Vis Sci 2008;8(6)5:451-456.
36. Oh JH, Yoo C, Kim YY, et al. The effect of contact lens-induced corneal edema on Goldmann applanation tonometry and dynamic contour tonometry. Graefes Arch Clin Exp Ophthalmol 2009;247(3):371-375.
37.Ceruti P, Morbio R, MarraffaM, Marchini G. Comparison of Goldmann applanation tonometry and dynamic contour tonometry in healthy and glaucomatous eyes. Eye 2009;23(2):262-269.
38. Doyle A, Lachkar Y. Comparison of dynamic contour tonometry with Goldman applanation tonometry over a wide range of central corneal thickness. J Glaucoma 2005;14(4):288-292.
39. Knecht PB, Bosch MM, Michels S, et al. The ocular pulse amplitude at different intraocular pressure: a prospective study. Acta ophthalmologica 2011;89(5):e466-e471.
40. Guan H, Mick A, Porco T, et al. Preoperative factors associated with IOP reduction after cataract surgery. Optom Vis Sci 2013;90(2):179-184.
41. Issa SA, Pacheco J, Mahmood U, et al. A novel index for predicting intraocular pressure reduction following cataract surgery. Br J Ophthalmol 2005;89(5):543-546.
42. Bhallil S, Andalloussi IB, Chraibi F, et al. Changes in intraocular pressure after clear corneal phacoemulsification in normal patients. Oman J Ophthalmol 2009;2(3):111-113.
43. Huang G, Gonzalez E, Peng PH, et al. Anterior chamber depth, iridocorneal angle width and intraocular pressure changes after phacoemulsification: narrow vs open iridocorneal angles. Arch Ophthalmol 2011;129(10):1283-1290.
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