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Objetivos: Determinar la concordancia entre la presión intraocular (PIO) medida mediante tonometría de aplanación de Goldmann (TAG) y tonometría de contorno dinámico (TCD). Métodos: La PIO se midió mediante TAG y TCD en 63 ojos de 63 voluntarios sanos. La concordancia se determinó mediante coeficiente de correlación intraclase (CCI). Se empleó el método de Passing-Bablok para establecer la presencia de sesgos proporcionales y/o sistemáticos. El análisis de regresión multvariable se empleó para determinar si las diferencias estaban condicionadas por la potencia de los ejes mayor y menor de la córnea, por su orientación, por el grosor corneal central (GCC) y por la edad. Resultados: El CCI fue 0,57 (intervalo de confianza [IC] al 95%: 0,29-0,74). La diferencia media entre los dos instrumentos fue 1,68 mmHg (TCD menos TAG) (IC 95%: 0,92-2,44). El análisis de Passing-Bablok (X=DCT, Y=GAT) reveló la presencia de un sesgo sistemático (A=-14,35, IC 95%: -24,51-[-9,14]) y otro proporcional (B=1,74, IC 95%: 1,43-2,26). El análisis de regresión multivariable mostró una total independencia del TCD de las características corneales mientras que la TAG estaba afectada por el GCC (B=0,042 CI 95%: 0,002-0,082). Conclusiones: La TCD se mostró independiente de las características morfométricas de la córnea mientras que la TAG se afectó por el GCC. Objectives: To compare intraocular pressure (IOP) measurements made by Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT). Methods: IOPs were measured by GAT and DCT in 63 eyes of 63 healthy subjects. A comparison was made by intraclass correlation coefficient. Passing-Bablok plot was constructed to establish the existence of systematic and/or proportional biases. Multivariate regression analysis was used to examine whether the measurements of both instruments were affected by the power of the steepest and flattest corneal axes, their orientation, age or central corneal thickness (CCT). Results: The intra-class correlations (ICCs) were 0.57 (95% confidence interval (95% CI): 0.29-0.74). Mean differences were 1.68 (DCT minus GAT) (95% CI: 0.92-2.44). Passing-Bablok analysis (X=DCT, Y=GAT) revealed a systematic bias (A=-14.35, 95% CI: -24.51-[-9.14]) and a proportional bias (B=1.74, 95% CI: 1.43-2.26). Multivariate regression analysis revealed that the DCT was independent of the corneal characteristics analysed while GAT was biased by CCT (B=0.042, 95% CI: 0.002-0.082). Conclusions: While GAT was biased by corneal CCT; DCT readings were independent of corneal morphometry.

espanolCaso clinico: Varon de 65 que consulta por perdida de agudeza visual bilateral. Habia sido diagnosticado de leucemia linfocitica cronica hacia 2 anos y se encontraba sin tratamiento. Su agudeza visual era de 20/200 en el ojo derecho y 20/63 en el izquierdo y presentaba edema bilateral de papila. Se realizaron tomografia axial computerizada y resonancia magnetica orbital y cerebral encontrandose una masa orbitaria con extension al etmoides e infiltracion de ambos nervios opticos cuya biopsia revelo leucemia linfocitica cronica. Discusion: La infiltracion leucemica del nervio optico y del sistema nervioso central es extremadamente rara en la leucemia linfocitica cronica al contrario de lo que sucede en las formas agudas. La infiltracion del nervio optico es la manifestacion oftalmologica leucemica que implica mayor trascendencia clinica y terapeutica por amenazar seriamente la funcion visual y ser tratable. EnglishCase report: We present the case of a 65-year-old man who was seen in the casualty department complaining of bilateral visual loss. His past medical history was unremarkable except for chronic lymphocytic leukaemia diagnosed two years previously: he was no longer receiving treatment for this disorder. His visual acuity was 20/200 in the right eye and 20/63 in the left eye and he had a bilateral papilledema. Computed tomography and magnetic resonance imaging of the brain and orbit were performed and showed an infiltrative mass in the orbit with extension to the ethmoid bone and both optic nerves. Biopsy of the mass was compatible with chronic lymphocytic leukaemia. Discussion: Leukaemic infiltration of the optic nerve and central nervous system is a rare complication of chronic lymphocytic leukaemia, although it is common in the acute forms of this disease. Optic nerve infiltration is the most important ophthalmologic manifestation of leukaemia because it threatens vision and it is treatable.