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(1)Journal of the Korean Glaucoma Society 2016;5(2):27-31. Original Article. ,FDUH‫ࠅݼ‬੎‫ڙ‬৒৊ӆܾௐી‫ټ‬৊৒ਁ‫ف‬ഡӵघ‫ބ‬௃ૂઅਕല Effect of Topical Anesthesia on Intraocular Pressure Measured by iCare Rebound Tonometer 정 윤, 이종연, 유정권, 김용연 Yun Jung, MD1, Jong Yeon Lee, MD1, Chungkwon Yoo, MD2, Yong Yeon Kim, MD2 a⃽᮹‫ᦩݡ‬ŝ⦺Ʊᝅ Łಅ᮹‫ᦩݡ‬ŝ⦺Ʊᝅ 1 Department of Ophthalmology, Gachon University, Gil Medical Center, Incheon, Korea 2 Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea. Purpose: To investigate whether topical anesthesia affects intraocular pressure (IOP) reading obtained with iCare rebound tonometer (RT). Methods: A total of eighty eyes of 40 healthy subjects were included. Both eyes were divided into two groups (0.5% proparacaine hydrochloride or 0.5% carboxymethylcellulose sodium). Central cornea thickness (CCT) was obtained with specular microscopy and IOP was measured with RT at baseline. CCT and IOP were measured at 1 minute after instillation of either of the two eye drops. Results: IOPs measured by RT decreased significantly after instillation of a single drop of 0.5% proparacaine hydrochloride (13.00 to 12.00 mmHg, median value, p < 0.001) or, 0.5% carboxymethylcellulose sodium (13.00 to 12.75 mmHg, median value, p = 0.02) compared to the pre-instillation IOP readings. The magnitude of IOP reduction seen after instillation of 0.5% proparacaine hydrochloride was significantly greater than CMC group. (1 mmHg vs. 0.25 mmHg, median value, p < 0.001). No significant changes in CCT change was observed in both groups. Conclusions: When instilled prior to rebound tonometry, both 0.5% proparacaine hydrochloride and 0.5% carboxymethylcellulose sodium eye drops decreased IOPs. The 0.5% proparacaine hydrochloride may have a greater IOP-lowering effect than 0.5% carboxymethylcellulose sodium eye drop. Key words: Intraocular pressure, Anesthesia. Introduction. that RT tends to slightly overestimate intraocular pressure !ˆ‰

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(24) . IOP readings measured by RT. This study did not found any significant change of IOP after topical anesthesia in. Received: 2016. 8. 15. Accepted: 2016. 11. 1.. Revised: 2016. 10. 20.. Corresponding Author: Jong Yeon Lee, MD, PhD Department of Ophthalmology, Gachon University Gil Hospital, #21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea Tel: +82-32-460-3210, Fax: +82-32-460-3358 E-mail: jongyeonlee@gmail.com * None of the authors have any commercial or proprietary interests in any of the instruments or materials used in this work.. www.koreanglaucoma.org. children.16  

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(188) Y Jung, et al. : Topical anesthesia and iCare rebound tonometer. 29. Table 1. Median intraocular pressure (IOP) measured by iCare rebound tonometer before, and after instillation of two different eye. drops Proparacaine hydrochloride (n = 40). CMC (n =4 0). p -value*. 13.0 (12.0, 14.0). 13.0 (12.0, 14.0). 0.808. RT2 (mmHg). 12.0 (11.5, 12.0). 12.75 (11.63, 13.50). RT1-RT2 (mmHg). 1.00 (0.5, 2.0). RT1 (mmHg). p-value†. <0.001†. 0.25 (0.00,1.00). 0.038 <0.001. 0.020†. Data was presented as median (interquartile range) RT1: IOP measured by iCare rebound tonometer before each eye drop use, RT2: IOP measured by iCare rebound tonometer after each eye drop use, RT1-RT2: difference between RT1 and RT2. CMC=carboxymethyl cellulose 0.5% (Refresh plus, Allergan, Irvine, CA, USA). * p-value comparison between proparacaine hydrochloride and CMC using Mann-Whitney U test; †p-value: comparison between RT1 and RT2 in each eye drop group using Wilcoxon signed-rank test. Table 2. Comparisons of intraocular pressure differences between Goldmann applanation tonometer and rebound tonometer before and after two different eye drops. Proparacaine hydrochloride (n = 40) GAT (mmHg). CMC (n = 40). p -value*. 12.0 (11.0. 12.0). 12.0 (11.63, 12.0). 0.211. RT1-GAT (mmHg). 1.0 (1.0, 2.0). 1.0 (0.00,1.00). 0.007. RT2-GAT (mmHg). 0.0 (0.0, 0.5). 0.5 (0.0, 1.0). 0.011. p-value†. <0.001. <0.001. p-value‡. 0.006. <0.001. Data was presented as median (interquartile range). RT1: IOP measured by iCare rebound tonometer before each eye drop use, RT2: IOP measured by iCare rebound tonometer after each eye drop use. CMC=carboxymethyl cellulose 0.5% (Refresh plus, Allergan, Irvine, CA, USA). * p-value comparisons between proparacaine hydrochloride and CMC using Mann-Whitney U test; †p-value comparison between RT1 and GAT (RT1-GAT) using Wilcoxon signed-rank test; ‡p-value: comparison between RT2 and GAT (RT2-GAT) using Wilcoxon signed-rank test.. in carboxymethylcellulose sodium group (p < 0.001). The. \^'˜¤‡'

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(282)   . eye drops. A previous study indicated that the IOP reduc-. a normal population. Ophthalmic Physiol Opt 2005;25:436-. tion by topical anesthetics did not appear to be associated. 40..  

(283) •• '17 We did not observe a significant CCT change in topical eye drops, either. Finally, the RT. 2. Martinez-de-la-Casa JM, Garcia-Feijoo J, Castillo A, GarciaSanchez J. Reproducibility and clinical evaluation of rebound tonometry. Invest Ophthalmol Vis Sci 2005;46:4578-80.. 

(284)  Ÿ

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(287)  . 3. Davies LN, Bartlett H, Mallen EA, Wolffsohn JS. Clinical. probe is bounced off the cornea, and the deceleration of the. evaluation of rebound tonometer. Acta Ophthalmol Scand. probe caused by the eye is used to calculate the IOP. Since

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(293) ˆ‰  „ this result suggests induction-based method might be affect-. 2006;84:206-9. 4. Brusini P, Salvetat ML, Zeppieri M, et al. Comparison of ˆ•

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(298)     glaucoma patients. J Glaucoma 2006;15:213-7.. „„Ÿ 

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(301) . 5. Sahin A, Niyaz L, Yildirim N. Comparison of the rebound. physical property changes in precorneal tear film such as.     Z

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(312)   . coma patients. Clin Exp Ophthalmol 2007;35:335-9. 6. Grigorian F, Grigorian AP, Li A, et al. Comparison of the ˆ

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(317)  nometry in a pediatric population. J AAPOS 2015;19:572-4. ž' =‡

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(323)       . tive errors on IOP measurement by rebound tonometry (ICare).  Š

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(326) † —. and Goldmann applanation tonometry. Graefes Arch Clin Exp. 

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(329) '= ‡

(330)   

(331)  

(332) „

(333) ‡„  Š'=ternatively, the mean IOP differences induced by instillation. Ophthalmol 2010;248:585-91. 8. Flemmons MS, Hsiao YC, Dzau J, et al. Icare rebound to „    

(334)  

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(336) '$ AAPOS 2011;15:153-7.. of eye drops may be not clinically relevant. Nevertheless,. 9. Lambert SR, Melia M, Buffenn AN, et al. Rebound tonom-.  

(337) 

(338)  

(339) „     

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(341) . etry in children: a report by the American Academy of Oph-. used an eye drops before rebound tonometery for precise. thalmology. Ophthalmology 2013;120:e21-7.. Journal of the Korean Glaucoma Society.

(342) Y Jung, et al. : Topical anesthesia and iCare rebound tonometer. 10. Jóhannesson G, Hallberg P, Eklund A, Lindén C. Pascal, ICare and Goldmann applanation tonometry--a comparative study. Acta Ophthalmol 2008;86:614-21. 11. Tamcelik N, Atalay E, Cicik E, Ozkok A. Comparability of. 31. thalmol 2007;1:305-9. 15. Baudouin C, Gastaud P. Influence of topical anesthesia on tonometric values of intraocular pressure. Ophthalmologica 1994;208:309-13.. 

(343)     Z

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(348) . 16. Dosunmu EO, Marcus I, Tung I, et al. The effect of repeated. 

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(353) . measurements and the use of topical anesthetic on rebound. and central corneal thickness. Ophthalmic Res 2015;54:1825. 12. Salvetat ML, Zeppieri M, Miani F, et al. Comparison of iCare tonometer and Goldmann applanation tonometry in normal 

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(361)  keratoplasty. Eye (London) 2011;25:642-50. 13. Halkiadakis I, Stratos A, Stergiopoulos G, et al. Evaluation of. tonometry values in children. J AAPOS 2014;18:619-21. 17. Montero JA, Ruiz-Moreno JM, Fernandez-Munoz M, Rodriguez-Palacios MI. Effect of topical anesthetics on intraocular pressure and pachymetry. Eur J Ophthalmol 2008;18:748-50. —'   ‚    #   

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(370)     moderate dry eye disease. Cornea 2015;34:421-6.. the Icare-ONE rebound tonometer as a self-measuring intra-. 19. Hotujac Grqurevi§ M, Jureti§ M, Hafner A, Lovric J, et al.. ocular pressure device in normal subjects. Graefes Arch Clin. 

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(374) . Exp Ophthalmol 2012;250:1207-11.. tension. Drug Dev Ind Pharm 2016 Oct 6:1-8. [Epub ahead of. 14. Almubrad TM, Ogbuehi KC. Clinical investigation of the effect of topical anesthesia on intraocular pressure. Clin Oph-. www.koreanglaucoma.org. print].

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