Effect of central corneal thickness and corneal hysteresis on tonometry as measured by dynamic contour tonometry, ocular response analyzer, and Goldmann tonometry in glaucomatous eyes.

PURPOSE: The dynamic contour tonometer (DCT; Pascal tonometer) and the Ocular Response Analyzer (ORA) are novel tonometers designed to measure intraocular pressure (IOP) independent of corneal properties and central corneal thickness (CCT), respectively. We wanted to compare the corneal compensated IOP (IOPcc) as measured by ORA with IOP values measured by DCT and Goldmann applanation tonometry (GAT) with respect to IOP readings and the influence of corneal hysteresis (CH) and CCT in glaucoma patients. PATIENTS AND METHODS: In a study of 94 glaucomatous eyes, IOP measurements by ORA, DCT, and GAT were compared, and the effects of CCT and CH were analyzed. All measurements were taken by 1 of the authors only. RESULTS: The Mean CCT was 550+/-44 mum and mean CH 10.24+/-3.3 mm Hg. The mean value for IOPcc was 17.94+/-5.9 mm Hg, 15.14+/-3.7 mm Hg for DCT, and 14.3+/-4.3 mm Hg for GAT. The mean difference was 3.65+/-3.85 mm Hg between IOPcc and GAT and 2.80+/-4.9 mm Hg between IOPcc and DCT (P<0.001) and -0.85+/-3.3 mm Hg between GAT and DCT (P=0.015). None of the methods was related to CCT. In contrast, CH was highly statistically significant related to IOPcc (P<0.0001), whereas GAT and DCT showed only weak relation to CH (P=0.05). CONCLUSIONS: IOP measurements with the ORA are significantly higher than DCT or GAT with no apparent linear correction factor. To date, we cannot estimate the impact of differences in CH in relation to IOP and its measurement.

Changes in corneal hysteresis after clear corneal cataract surgery.

PURPOSE: To assess the changes in corneal hysteresis (CH) as measured by the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments, Buffalo, New York, USA) to describe the influence of clear corneal cataract surgery on corneal viscoelastic properties and intraocular pressure (IOP) measured by noncontact tonometry (NCT) and Goldmann applanation tonometry (GAT). DESIGN: Retrospective, interventional, comparative study. METHODS: One hundred and one eyes of 101 consecutive patients who underwent routine clear corneal cataract surgery were evaluated. CH, NCT, and central corneal thickness (CCT) were measured by ORA before surgery and at postoperative day 1. A control group of 48 pseudophakic eyes (surgery >3 months previously) was included. RESULTS: CCT increased from 556.82 +/- 32.5 microm before surgery to 580.26 +/- 45.5 microm after surgery (P < .001; control, 555.16 +/- 42.33 microm). Mean CH decreased from 10.35 +/- 2.5 mm Hg before surgery to 9.20 +/- 1.9 mm Hg after surgery (P < .001; control, 10.47 +/- 1.63 mm Hg). NCT values rose from 17.85 +/- 3.8 mm Hg before surgery to 20.10 +/- 6.3 mm Hg after surgery. GAT values were 14.85 +/- 2.8 mm Hg before surgery and 15.24 +/- 4.1 mm Hg after surgery (P = .52). There was no significant difference of CCT or CH between the preoperative values and the values of the control group (CCT, P = .986; CH, P = .166), in contrast to the difference between postoperative values and the values of the control group (CCT, P = .005; CH, P = .031). CONCLUSIONS: At day 1 after clear corneal cataract surgery, CH is diminished, whereas CCT is increased significantly. Postoperative corneal edema leads to a change of corneal viscoelastic properties, resulting in a lower damping capacity of the cornea. It is supposed that GAT and NCT measurements are significantly different because of postoperative changes in viscoelastic properties of the cornea.