Chapter Five Dr. Genalin A.

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Measurement of the Central Corneal Thickness Relevance in many clinical situations such as: A. Pre-Operative assessment of refractive surgery patients ( LASIK ) B. Diagnoses of corneal conditions , fitting of the contact lenses C. The accurate assessment of intra ocular pressure

. However, if the cornea is thinner than normal, then the eye will feel softer to the tonometer and the measured reading will actually be falsely low (i.e. the true pressure inside the eye is actually higher than what is being measured) If the CCT is thicker than normal, then the eye pressure number read by the tonometer, will be falsely high (i.e. the machine thinks that the eye is firmer (higher pressure) than it really is)

The surface of the eye (cornea) comes in different thicknesses just like all parts of our body vary from human to human. Devices that measure eye pressure (tonometers) are calibrated for the normal range of central corneal thickness (CCT).

A child who has had cataract surgery comes to see their eye doctor 6 months after surgery for a check-up. The eye doctor measures the eye pressure to be 30. The rest of the eye exam is completely normal. The eye has not gotten any bigger, the cornea is not cloudy, there is no swelling of the cornea (corneal edema), and the optic nerve shows no cup. In other words, there are absolutely no signs of glaucoma. But what about the high pressure of 30? The doctor measures the patients CCT to be well above normal.

Therefore, the doctor may safely conclude that this child does not have glaucoma and that the elevated pressure reading is an artifact brought on by the thicker cornea often seen in children who have had cataract surgery. Management : The doctor probably should not be absolutely certain and dismiss this outright.

It may be more prudent to see this child again in the not too distant future to recheck the value and make sure that none of the other signs of glaucoma (e.g. optic nerve cupping

A Child with severe congenital glaucoma has a routine follow-up examination. The child is on 3 different antiglaucoma eye drops, and has a pressure of only 15. Is the glaucoma well controlled? The CCT turns out to be low (thin cornea), and the optic nerve cup is bigger than the last visit. It may very well be that the glaucoma is not adequately controlled and that the pressure reading is a falsely low value due to the thin cornea. Further treatment may be required.

The use of corneal pachymetry in the management of patients at risk for or with glaucoma is becoming increasingly recognized as important and necessary. Interpretation of the information is complex and requires a careful consideration of all factors involved in assessing the childs disease.

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I s know risk factor for glaoucoma (Least than 555 micron)= thinner corneal ( Primary open angle gloucoma ) POAG Thickness of Corneal affect the tonometric reading.

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Device used to measure the apparent thickness of the cornea. Several Teachniques A. Optical B. Ultrasonic principle

Figure 6-4. Pachymeter. A pachymeter (Pocket Pachymeter, Quantel Medical, Bozeman, MT) is an ultrasound device that mthe easures cornea thickness by determining the time it takes for a sound wave to reflect off inner surface of the cornea. Measurements are taken by placing an anesthetic drop on the eye and gently touching the probe to the surface of the cornea.

figure6-5. Pachymetry. Corneal thickness is measured by administering an anesthetic drop to the eye and then gently placing the pachymeter probe against the outer surface of the cornea.