Intraocular pressure measurement after DSAEK by iCare, Goldmann applanation and dynamic contour tonometry: A comparative study

Purpose Corneal thickness inevitably increases following Descemet's stripping automated endothelial keratoplasty (DSAEK), owing to the addition of a donor graft. The current study compares different devices in assessing post-DSAEK intraocular pressure (IOP). Methods We compared IOP values measured by the Goldmann tonometry (GAT), iCare rebound tonometry (iCare) and Pascal dynamic contour tonometry (PDCT) in eyes following DSAEK. Agreement between measurements was calculated with correlation analysis and Bland-Altman plots. Effects of keratometry, central, thickness (CCT), endothelial cell density (ECD) and axial length on IOP measurements were assessed with Pearson's correlation. Results Twenty eyes of 20 patients (mean age 74.3 ± 14.4, 14 females) post-DSAEK were included in this study. There was a high concordance between the IOP readings obtained by the three devices: a strong and significant correlation was found between GAT and PDCT (r = 0.94, P < 0.001) GAT and iCare (r = 0.86, P < 0.001) and iCare with PDCT (r = 0.81, P < 0.001). However, the iCare measurements were significantly and consistently lower than that obtained with GAT (ΔIOP = 1.68 ± 2.0, P = 0.002, 95% CI: 0.7–2.6) and with PDCT (ΔIOP = 1.61 ± 2.5, P = 0.01, 95% CI: 0.4–2.8). CCT, ECD, CCT, AXL, corneal curvature or astigmatism did not influence IOP measurement by any instrument. Conclusions IOP measurement with three different techniques (applanation, rebound and dynamic contour) showed good correlations, despite an increased corneal thickness following DSAEK. However, the iCare, which is based on a rebound tonometry showed significant lower IOP then the two other methods. This should be taken into account when evaluating patients post DSAEK.