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題名 | 運用反彈式眼壓計測量兒童眼壓=Intraocular Pressure Measurement by Rebound Tonometry in Children |
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作 者 | 蕭雅娟; 蔡宜倫; 郭麗琳; 蔡景耀; 劉秀雯; 翁林仲; | 書刊名 | 北市醫學雜誌 |
卷期 | 12:2 2015.06[民104.06] |
頁次 | 頁123-129 |
分類號 | 416.7056 |
關鍵詞 | 兒童眼壓; 反彈式眼壓計; 近視; 居家眼壓測量; iCARE反彈式眼壓計; Intraocular pressure in children; IOP; Rebound tonometry; Myopia; Home tonometer; iCARE rebound tonometer; |
語文 | 中文(Chinese) |
中文摘要 | 對於所有的眼科醫師或眼壓測量人員而言,兒童眼壓的測量極具挑戰性。傳統的壓平式眼壓計(GAT)直接接觸角膜,需要患者的高度配合,進行測量時兒童往往閉眼或向後移動,延長檢查時間並需要重複嘗試,經常導致兒童與家長的焦慮。利用不同原理的反彈式眼壓計(ICARE)應用磁化探針的前後運動引起其電壓改變換算眼壓,對角膜的影響非常輕微,不需要麻醉藥的使用,從而避免引起測量之前兒童或家長的焦慮。文獻回顧中,在健康成人或青光眼病人眼壓的每次測量之間具有良好的再現性。在小兒眼科的報告中,在健康學童的身上,使用反彈式眼壓計的眼壓測量呈現良好的再現性和舒適性。在兒童青光眼病人的研究,ICARE與GAT之間的平均差異為2.3mmHg。兩者眼壓GAT and ICARE差距在3mmHg之內的為63%。在健康兒童的研究,反彈式眼壓計與非接觸式氣壓式眼壓計比較,在3歲及以下具有顯著更高的成功率,4至6歲兒童成功率也較高,分別為86%對71%。此外,反彈式眼壓計更應用在兒童青光眼病患與健康兒童的居家眼壓監測上,可成功紀錄居家晝夜眼壓波動情況,有助青光眼病人用藥與治療方向之參考。反彈式眼壓計在兒童眼壓的監測有良好的應用,與現有的眼壓計結果有高度相關性,且耐受性良好,護理技術人員容易進行,測量時顯示可信度的訊息,未來更同時具有近視兒童眼壓定期檢查與居家眼壓監測的潛力。 |
英文摘要 | For all practitioners, intraocular pressure (IOP) measurements in children are challenging. IOP monitoring is crucial during glaucoma treatment. It is difficult to discover the subtle changes in optic disc head and to obtain a reliable visual field result from a pediatric glaucoma patient. Traditional applanation tonometry by direct contact on the cornea requires patient's close cooperation. Children tend to close their eyes or move backward during standard procedure of IOP measurement. Repeat attempts are frequently needed, resulted in anxiety of the children and prolonged examination. A new technology, the rebound tonometer (ICARE), using a dynamic electromechanical method for measuring IOP, became available in 2003. It is a portable tonometer that does not require the instillation of topical anaesthestics and eye drops before measurement, hence avoids the anxiety of children or parents. Many investigators have reported good correlation between rebound tonometry and traditional tonometry in healthy adults and those with glaucoma. Studies in pediatric ophthalmology have reported favorable reproducibility and comfort with rebound tonometer in healthy school children. The rebound tonometry had a marked higher success rate in children aged 3 or under as compared with noncontact air-puff tonometry (79% vs. 30%, P<0.001), as well as in children aged 4 to 6 (86% vs. 71%). Regarding the application of home tonometry in pediatric glaucoma patients or healthy subjects, all parents succeeded in obtaining IOP measurements at home. Rebound tonometry was well tolerated by all subjects and caused no complaints, discomfort, or adverse events. Rebound tonometry has good correlation with standard applanation tonometry, but tends to overestimate the pressure and should be used with cautions. |
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