American Journal of Medicine and Medical Sciences 2024, 14(4): 867-868
DOI: 10.5923/j.ajmms.20241404.14
New Ways to Measure Intraocular Pressure in Children
with Microphthalmia and Blepharophimosis
Khamraeva Lola Salimovna, Narzullaeva Dildora Uktamovna
*
,
Bobokha Lyubava Yurevna, Makhmudova Dilorom Teshaevna
Department of Ophthalmology, Pediatric Ophthalmology Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
Abstract
Childhood glaucoma is a chronic vision-threatening condition that may significantly impact an individual’s
psychosocial well-being. The prognosis of glaucoma largely depends on early and accurate diagnosis and successful
treatment, including control of increased. The purpose is to determine the effectiveness of modified tonometers
(Maklakova) NGm2-"OF TP" in performing tonometry and tonography in infants and children with microphthalmos and
blepharophimosis. We have proposed modified models of Maklakoff tonometers weighing 5, 10, and 15 g, made of silver, the
weights on both sides have contact plates, which are made of medical plastic and have a diameter of the applanation area d=8
mm. Methods: Tonometry and tonography using the simplified method of Nesterov A.P. were carried out in 30 (60 eyes)
children aged from birth (0) to 16 years. Results: Our recommended design of weights showed results that do not differ from
those obtained using standard Maklakov tonometers. At the same time, modified weights provide the opportunity to
determine tonometric IOP and eye hydrodynamics in newborns and patients with microphthalmia and/or blepharophimosis,
which greatly facilitates the work of pediatric ophthalmologists and reduces examination time.
Keywords
Childhood glaucoma, Intraocular pressure, Maklakoff tonometers
1. Introduction
The prognosis of glaucoma largely depends on early and
accurate diagnosis and successful treatment, including
control of increased (IOP). At the same time, it is important
to carry out tonometry (study of tonometric pressure P
10
) and
tonography (determination of true IOP - P
0
, production of
intraocular fluid - F, outflow of intraocular fluid - C, Becker
coefficient - BС). The first reasonably accurate instrument
was the Maklakoff applanation tonometer
[1].
Particularly
difficult is the technique of measuring IOP with existing
Maklakoff tonometers NGm2-"OFT-P" in infants and
children with microphthalmia (congenital reduction of the
eyeball and cornea, when the horizontal diameter of the
cornea is less than 10 mm, and the vertical diameter is less
than 9 mm) and/or blepharophimosis (small size of the
palpebral fissure, when at maximum opening: the horizontal
size of the palpebral fissure is less than 20 mm, and the
vertical size is less than 10 mm), since these tonometers,
having an applanation plate diameter of 10 mm, allow their
use only in adults and children with the dimensions of the
cornea and palpebral fissure the same as in adult patients [2].
* Corresponding author:
diladora@mail.ru (Narzullaeva Dildora Uktamovna)
Received: Mar. 3, 2024; Accepted: Mar. 29, 2024; Published: Apr. 2, 2024
Published online at http://journal.sapub.org/ajmms
The well-known Goldmann tonometers and Filatov-Kalf
elastotonometers NGm5-“0FT-P” also cannot be used for
tonometry and tonography in newborns and in patients with
reduced biometric parameters of the eyes [3].
Existing IGD devices also do not allow to determine
tonometric and tonographic indicators of the eye in newborns.
The use of different methods in children for measuring
IOP in newborns leads to a huge range of values from
relative hypotension (Icare Tiolat tonometer) to hypertension
(tonometer by Maklakoff) [4].
The purpose
is to determine the effectiveness of modified
tonometers (Maklakova) NGm2-"OFT-P" in performing
tonometry and tonography in infants and children with
microphthalmos and blepharophimosis.
2. Material and Methods
To achieve this goal, we have proposed modified models
of Maklakoff tonometers weighing 5, 10, and 15 g (Fig. 1),
made of silver, made in the form of hollow cylindrical
columns (1), ending through a neck (4) with smooth contact
plates (2). Two marks (3) are applied to the cylindrical
posts of the weights, corresponding to 1/3 of their height.
The weights on both sides have contact plates (2), which
are made of medical plastic and have a diameter of the
applanation area d=8 mm.
868
Khamraeva Lola Salimovna
et al.
: New Ways to Measure Intraocular
Pressure in Children with Microphthalmia and Blepharophimosis
Figure 1.
Modified models tonometers by Maklacoff weighing 5 g (A), 10g (B) and 15g (C) (main view, isometric projection)
The compliance of the manufactured weights with the
required weight of 5, 10 and 15 g was confirmed by the
Department of Metrology and Standardization of Measuring
Instruments (protocol No. 37 dated June 12, 2023, mass
measurement department of the State Institution “UzNIM”).
Making marks on the cylindrical columns of weights
corresponding to 1/3 of their height increases the accuracy of
measuring IOP and hydrodynamics of the eye, because
According to the standard, at the time of measurement, when
the weight is on the surface of the cornea, the holder must be
lowered to 1/3 of the height of the weight column, and then,
raise the holder to the neck with a simultaneous lifting of the
weight from the cornea, which will determine the duration of
contact of the surface of the applanation area with the surface
of the cornea. At the same time, the duration of contact
determines the level of applanation (flattening) of the cornea
and affects the accuracy of the measurement [4]. Rebound
tonometry appears to correlate well with Goldmann tonometry.
However, data using tonometer data is difficult to measure [5].
3. Result and Discussion
Table 1.
Indicators of tonometry and tonography in the examined children
(M±m)
Indicators
1 group
(n=60 eyes)
2nd group
(n=60 eyes)
Student's
t-tests
P10 (mmHg)
20,3±1,6
20,7±1,8
t =0.17
p > 0,05
P0 (mm Hg)
18,35±4,7
18.8±2.5
t =0.08
p > 0,05
C (mm3 in 1 min
mmHg)
0,89±0,03
0.91±0.01
t =0.63
p > 0,05
F (mm in 1 min
mmHg)
3,96±0,5
3.55±0.65
t =0.5
p > 0,05
BC
63±3,2
64.5±2.5
t =0.37
p > 0,05
Tonometry and tonography using the simplified method of
Nesterov A.P. were carried out in 30 (60 eyes) children aged
from birth (0) to 16 years. Of these, 17 (34 eyes) were infants,
14 (28 eyes) had anterior microphthalmia 2, 3 degrees, and
9 (18 eyes) had blepharophimosis. The first stage was
measurements with modified tonometers (group 1), then
after 10-15 minutes - with standard Maklakov tonometers
(group 2). The measurement results are shown in Table 1.
A comparative analysis did not reveal a statistically
significant difference in the indicators of groups 1 and 2.
4. Conclusions
Thus, our recommended design of weights showed
results that do not differ from those obtained using standard
Maklakov tonometers. At the same time, modified weights
provide the opportunity to determine tonometric IOP and eye
hydrodynamics in newborns and patients with microphthalmia
and/or blepharophimosis, which greatly facilitates the work
of pediatric ophthalmologists and reduces examination time.
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The Author(s).
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