Die Rolle der Pachymetrie in der täglichen Glaukomdiagnostik

J. von Eicken; M. Kohlhaas; R. Stodtmeister; H. Höh

doi:10.1055/s-2005-858724

Klinische Monatsblätter für Augenheilkunde, Table of Contents

Klin Monbl Augenheilkd 2006; 223(2): 117-130
DOI: 10.1055/s-2005-858724

Übersicht

Die Rolle der Pachymetrie in der täglichen Glaukomdiagnostik

The Role of Pachymetry in Routine Glaucoma DiagnosisJ. von Eicken¹ , M. Kohlhaas² , R. Stodtmeister³ , H. Höh¹

¹Dietrich Bonhoeffer-Klinikum, Augenklinik (Chefarzt: Prof. Dr. med. Helmut Höh), Neubrandenburg
²Univ.-Augenklinik der Gustav Carus-Universität Dresden (Dir.: Prof. Dr. med. L. Pillunat), Dresden
³Gemeinschaftspraxis und Belegabteilung am St.-Elisabeth-Krankenhaus Rodalben, Pirmasens

Abstract

Zusammenfassung

Bis heute wird kontrovers diskutiert, ob die Hornhautdicke die Messgenauigkeit der Goldmann-Applanationstonometrie entscheidend beeinflusst. Goldmann und Schmidt sind beim Erarbeiten der Applanationstonometrie zwar davon ausgegangen, dass die Hornhautdicke in ihrer „physiologischen Schwankungsbreite” keinen Einfluss auf das Messergebnis hat. Sie wiesen aber darauf hin, dass abweichende Hornhautdicken das Messergebnis beeinflussen können. In den letzten 30 Jahren sind Arbeiten veröffentlicht worden, die verlässlich belegen, dass ein Zusammenhang in der Weise besteht, dass bei dicken Hornhäuten ein zu hoher und bei dünnen Hornhäuten ein zu niedriger Applanationswert abgelesen wird. Das Ausmaß des Zusammenhanges beträgt 1 mm Hg je 25 µm Hornhautdickenänderung. Da die exakte Messung des intraokularen Druckes für die Diagnose und das Screening von Glaukompatienten von erheblicher Bedeutung ist, sollten bei jedem Patienten die Applanationswerte pachymetrisch korrigiert werden. Dies gilt besonders auch für die Patienten, deren Hornhautdicke refraktiv-chirurgisch verändert wurde. Für das Verständnis der Problematik ist es wichtig, sich stets vor Augen zu halten, dass wir mit dem Applanationstonometer eine Kraft messen. Aus diesem Messwert schließen wir auf den „wahren” Augeninnendruck unter der Annahme, dass die Theorie der Goldmann-Applanationstonometrie stimmt. Zwischen der Vorderfläche des Tonometerkopfes und der Vorderkammer liegt eine Hornhaut mit individuellen Eigenschaften, wie Dicke, Rigidität, Krümmung etc., die den Messwert beeinflussen kann. Es ist dann eingängig, warum die Kenntnis der Hornhautdicke die Genauigkeit dieses Schlusses verbessern kann und es auch sinnvoll ist, die Pachymetrie einzusetzen. Es ist ebenso eingängig, dass andere individuelle Hornhauteigenschaften, die wir derzeit nicht messen oder gar kennen, die Messung ebenfalls beeinflussen, was bedeutet, dass die Hornhautdicke nicht die einzige „Störgröße” ist. Die Pachymetrie erlaubt uns eine genauere Schätzung des Augeninnendrucks aus den Applanationswerten und sollte klinisch auch routinemäßig durchgeführt werden.

Abstract

The influence of corneal thickness on the precision of Goldman applanation tonometry is highly disputed. Goldmann and Schmidt assumed that the physiological variation of corneal thickness does not influence the measurement. But they indicated that an “abnormal” deviation of corneal thickness can lead to a false measurement. In the last 30 years many investigations have reliably demonstrated that thick corneas produce elevated applanation values and thin corneas lower values. The correction value is 1 mm Hg per 25 µm change in corneal thickness. The accuracy of intraocular pressure measurement is important for the detection and monitoring of glaucoma. Therefore it is necessary to recalculate applanation values based on corneal thickness in every patient, especially after refractive surgery. It is also necessary to keep in mind that with applanation tonometry we measure a force. From the force readings we deduce the value of the intraocular pressure. This conclusion is only correct if the theory of Goldmann applanation tonometry is right. But between force measurement and intraocular pressure there is the individual cornea with special properties like thickness, rigidity and astigmatism which can influence the correctness of the measurement. So we can understand why knowledge of corneal thickness can improve the deduction from force measurement of intraocular pressure. It is also reasonable that other individual corneal properties we do not measure or do not know so far can influence the deduction. This means that the corneal thickness is not the only variable. Pachymetry allows us to estimate the intraocular pressure with higher precision. Therefore it should be clinically used.

Schlüsselwörter

Goldmann-Applanationstonometrie - Pachymetrie - Hornhautdicke - okuläre Hypertension - Glaukom - Normaldruckglaukom - refraktive Chirurgie

Key words

Goldmann applanation tonometry - pachymetry - corneal thickness - ocular hypertension - glaucoma - normal tension glaucoma - refractive surgery

Full Text

References

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Dr. Jörn von Eicken

Dietrich Bonhoeffer-Klinikum, Augenklinik

Salvador-Allende-Straße 30

17 036 Neubrandenburg