자세에 따른 리바운드 안압계의 안압측정치 비교
Comparison of Intraocular Pressures According to Position Using Icare Rebound Tonometer
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목적: 누운 자세에서 안압을 측정할 수 있는 리바운드 안압계로 자세 변화에 따른 안압측정치를 비교하고자 한다. 또한 리바운드 안압계 측정치를 비접촉 안압계, 골드만 압평안압계와 비교해 상관 관계를 알아보고자 하였다. 대상과 방법: 건강한 지원자 20명, 총 40안에 대해 앉은 자세와 바로 누운 자세, 옆으로 누운 자세에서 리바운드 안압계로 안압을 측정하고 이를 대응 2 표본으로 비교하였다. 앉은 자세에서의 안압은 리바운드 안압계, 비접촉 안압계, 골드만 압평안압계로 측정하여 독립K 표본과 spearman 상관분석을 시행하였다. 세 가지 안압계로 측정된 안압의 상관성을 알아보기 위해 Bland-Altman plot을 시행하였다. 결과: 리바운드 안압계로 측정한 누운 자세에서의 안압은 앉은 자세보다 통계적으로 평균 1.03 ± 1.95 mmHg 높았다. 바로 누운 자세와 옆으로 누운 자세에서 측정한 안압은 모두 통계적으로 유의한 차이가 없었다. 옆으로 누운 자세에서 dependent eye와non-dependent eye에서 측정한 안압 사이에도 통계적으로 유의한 차이는 없었다. 앉은 자세에서 측정한 리바운드 안압계의 안압은비접촉 안압계, 골드만 압평안압계의 안압과 높은 양의 상관관계를 보였다. 결론: 정상인에서 리바운드 안압계로 측정한 안압은 누운 자세에서 앉은 자세보다 높게 측정되었지만, 바로 누운 자세와 옆으로 누운자세 간에는 유의한 차이를 보이지 않았다. 거동이 불편하거나 협조가 되지 않는 환자에서 리바운드 안압계가 임상적으로 유용할것으로 생각하며, 자세에 따른 안압 해석에 주의가 필요하다.
Abstract
Purpose: To evaluate changes in intraocular pressure (IOP) according to position using a portable rebound tonometer. Methods: We measured the IOP values of 20 healthy volunteers (40 eyes) in the sitting, supine, right lateral decubitus and leftdecubitus positions with a portable rebound tonometer, and then analyzed using the Wilcoxon signed rank test. IOP in sitting positionwas also measured with a non-contact tonometer and a Goldmann applanation tonometer, and analyzed with Kruskal-Wallistest and Spearman correlation analysis. Agreement among the 3 tonometers was calculated using the Bland-Altman method. Results: The IOP measured with rebound tonometer in the supine position was significantly higher than in the sitting position (p= 0.002). However, there was no significant difference in IOP between the supine and decubitus positions. In the decubitus position,there was no significant difference in IOP between the dependent and non-dependent eyes. IOP measurement using the reboundtonometer showed positive correlation with that of the noncontact and Goldmann applanation tonometers. Conclusions: In normal subjects, IOP measurement obtained with a rebound tonometer in the supine position was significantlyhigher than in the sitting position, but there was no significant difference in IOP between the supine and decubitus positions. A reboundtonometer may be useful for patients whose intraocular pressure measurement with Goldmann applanation tonometer ornon-contact tonometer is impossible. When using a portable rebound tonometer in bed-ridden or pediatric patients, we shouldpay attention to the interpretation of IOP in the supine position.
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