Selbsttonometrie mit einem telemetrischen, intraokularen Drucksensor bei Patienten mit Glaukom

 

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Zusammenfassung

Hintergrund: Bei der Betreuung von Glaukompatienten spielt die gute Erfassung der Augendruckwerte und insbesondere deren mögliche Kurzzeit- aber auch Langzeitschwankungen eine wichtige Rolle. Die nicht invasive Selbsttonometrie durch die Patienten mit einem telemetrischen intraokularen Drucksensor kann wichtige Daten zum individuellen Augendruckprofil liefern. Patienten/Material und Methoden: Im Rahmen einer prospektiven klinischen monozentrischen Pilotstudie wurde bei 6 Patienten mit Offenwinkelglaukom die Implantation eines telemetrischen Drucksensors (ARGOS01) im Rahmen der Kataraktchirurgie in den Sulcus ciliaris durchgeführt. Im 5. Monat nach der Implantation wurde gemäß dem Studienprotokoll ein Lesegerät zur Selbsttonometrie für 1 Monat den Patienten mitgegeben. Die Patienten wurden aufgefordert, mindestens 1-mal pro Tag bzw. möglichst mehrfach zu messen. Ausgewertet wurde einerseits die 1. Messung des Tages (wobei 1 Messung pro Tag an 20 Tagen innerhalb des Intervalls erfasst wurde) sowie andererseits die Aufteilung der Werte nach Frühphase (5–11 Uhr), Mittagsphase (11–16 Uhr) und Spätphase (16–23 Uhr) (Einschluss von Patienten mit mindestens 10 Werten und max. 20 Werten). Es erfolgte eine deskriptive Statistik mit Erfassung der Perzentile und Erstellung von Boxplots. Dabei wurden die Originalwerte des ARGOS-Systems verwendet. Ergebnisse: Bei allen Patienten konnte die Selbsttonometrie nach kurzer Anleitung problemlos durchgeführt werden. Bei der Auswertung der 1. Messung des Tages konnte eine sehr heterogene interindividuelle Spannweite der Augendruckwerte festgestellt werden (zwischen 3,1 mmHg bei Patient 5 und 21,7 mmHg bei Patient 4). Bei der Auswertung der Aufteilung der Werte nach der Tagesphase zeigten sich bei Patient 1 signifikant erhöhte Druckwerte in der Spätphase. Bei Patient 5 waren die Mittagswerte im Vergleich zur Früh- und Spätphase signifikant erhöht. Bei Patient 3 und Patient 4 konnten keine signifikanten Schwankungen während des Tages festgestellt werden. Schlussfolgerung: Die Selbsttonometrie ermöglicht eine aktive Beteiligung des Patienten bei seiner Erkrankung und ermöglicht nicht invasiv eine gute Erfassung der Augendruckwerte zu verschiedenen Uhrzeiten und Aktivitäten. Wir müssen aber diese neuen Daten und deren klinische Bedeutung in Relation zur Goldmann-Applanationstonometrie interpretieren lernen.

Abstract

Background: Accurate acquisition of intraocular pressure (IOP) data, particularly short-term and long-term fluctuations, plays an important role in the medical care of glaucoma patients. Non-invasive self-tonometry with a telemetric IOP sensor can provide important data on the individual IOP profile. Methods: Within the framework of a prospective, single-centre pilot clinical trial, a ring-shaped telemetric IOP sensor was inserted into the ciliary sulcus after implantation of the intracapsular lens during planned cataract surgery. In accordance with the protocol, at the 5-month visit, all patients received a reading unit for one-month self-tonometry assessment. All patients were asked to measure the IOP at least once daily, and, if possible, at many different times. The first IOP measurement of each day was evaluated (covering one measurement daily per patient on 20 different days within the assessment interval). Furthermore, IOP data were analysed according to the time of day, divided into early phase (5 am to 11 am), midday (11 am to 4 pm) and late phase (4 am to 11 pm) (patients with at least 10 measurements and max. 20 measurements were included). Descriptive statistics of the original ARGOS system values were calculated, with evaluation of the percentiles and presentation in box plots. Results: All patients successfully performed self-tonometry at home after receiving brief instructions. The first IOP measurement of each day covered a very wide interindividual range (between 3.1 mmHg in patient 5 and 21.7 mmHg in patient 4). Analysis of IOP values by time of day showed that patient 1 had significantly higher IOP values in the late day phase. For patient 5, the highest values were at midday. Patients 3 and 4 showed no significant fluctuations during the day. Conclusions: Self-tonometry encourages patients to be actively involved in the management of their own illness and allows non-invasive assessment of IOP at different times and during diverse activities. However, the analysis and interpretation of these new data require further study, especially in relation to Goldmann applanation tonometry.

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