治疗性角膜接触镜对Tono-pen眼压计测量角膜病变患者眼压的影响  

Intraocular Pressure Measured by Tono-pen Tonometer in Corneal Abnormalities with and without Therapeutic Contact Lens

作　　者：王忠浩[1] 梁轩伟[1] 曾阳发[1] 杨晓[1] 蔡小于[1] 刘杏[1] 

机构地区：[1]中山大学中山眼科中心//眼科学国家重点实验室,广东广州510060

出　　处：《中山大学学报（医学科学版）》2014年第1期100-104,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2011B080701033);广州市科技计划项目(2013Z4500019)

摘　　要：[目的]比较配戴治疗性角膜接触镜（TCL）前后Tono-pen眼压计测量角膜病变患者眼压测量的差异,分析治疗性角膜接触对Tono-pen眼压计测量值的影响.[方法]连续纳入2012年4月至2012年10月我院就诊的33例（33眼）角膜病变患者,包括大泡性角膜病变11眼、眼化学伤8眼、单疱病毒性角膜炎5眼、继发性青光眼4眼、前部角膜营养不良2眼、穿透性角膜移植术后2眼、复发性胬肉l眼.应用Tono-pen眼压计测量患者未配戴TCL和配戴TCL两种状态下的眼压,每种测量方式各重复测2次.用组内相关系数ICC计算每一种测量方法的重复性,计算重复测量间差异的95％可信限;配对t检验比较两种眼压测量方法的差异,计算差异的可信限95％LoA,并绘制Bland-Altman散点图.[结果]Tono-pen眼压计直接重复测量的ICC为0.986,两次测量的平均差值为（0.42± 1.98） mmHg,95％可信限为-4.30 ～ 3.46 mmHg,其中90.9％的测量差值≤3 mmHg;配戴治疗性角膜接触镜后重复测量的ICC为0.983,两次测量的平均差值为（0.12±2.19）mmHg,95％可信限为-4.46 ～ 4.22 mmHg,90.9％的测量差值≤3 mmHg.配戴治疗性角膜接触镜后Tono-pen眼压测量值平均减小（0.68±3.39）mmHg,差异无统计学意义（P=0.257）,两种测量结果的一致性系数ICC为0.959,差值的95％可信限为-7.32～5.96 mmHg,其中70％测量的差值≤3 mmHg;在平均眼压＜21 mmHg的患者中,82.4％的测量差值≤3 mmHg,在平均眼压≥21 mmHg的患者中,56.3％的测量差值≤3 mmHg.[结论]Tono-pen眼压计测量角膜病变患者的眼压有较好的重复性,配戴治疗性角膜接触镜对测量的重复性和总体的测量均值无影响.但配戴角膜接触镜前后眼压测量值存在一定程度的差异,高眼压者比正常眼压者的差异大,临床应用时应对测量结果进行客观的评价.[ Objective ] To compare the intraocular pressure measured by Tono-pen tonometer in corneal abnormalities with and without therapeutic contact lens （TCL）. [Methods] 33 patients （33 eyes） of corneal abnormalities were consecutively enrolled from April to October 2012 in our hospital, including bullous keratopathy （lleyes）, chemical injury （8 eyes）, herpes simplex keratitis （5 eyes）, cornea edema caused by secondary glaucoma （4 eyes）, anterior cornea dystrophy （2 eyes）, penetrating keratoplasty （2 eyes） and recurrent pterygium （1 eyes）. The intraoclular pressure （IOP） of all the 33 eyes were repeatedly measured twice by Tono-pen tonometer with and without TCL. Repeatability of repeat measurements was calculated by intraclass correlation coefficient （ICC）. 95% limit of agreement （95%LoA） for repeat measurements were calculated. Paired-t test were used to compare the IOP measured with and without TCL. 95% LoA of the difference were calculated and Bland-Altman scatter plot were also drawn. [Results] ICC of the repeat measurements without TCL were 0.986, with 95% LoA from -4.30 to 3.46 mmHg. 90.9% of the difference was less than 3 mmHg. ICC of the repeat measurements with TCL were 0.983, with 95% LoA from -4.46 to 4.22 mmHg. Also, 90.9% of the difference was less than 3 mmHg. IOP measured with TCL were 0.68 mmHg smaller than without TCL, but the difference were not significantly （P = 0.257）. ICC of measurements with and without TCL were 0.959, with 95% LoA from -7.32 to 5.96 mmHg. There were 70% of all 33 eyes were less than 3 mmHg, which were 82.4% and 56.3% in eyes with IOP 〈 21 mmHg and eyes with mean IOP ≥21 mmHg respectively. [ Conclusions ] Tono-pen tonometer were highly repeatable for IOP measurement in corneal abnormalities. TCL had no effect on the repeatability and total mean IOP. Measurements difference with and without TCL were exist in a certain extent as much in eyes with higher IOP than in eyes with normal IOP, which should be objectively evaluated

关 键 词：眼压 TONO-PEN眼压计 治疗性角膜接触镜 角膜病变 

分 类 号：R775.2[医药卫生—眼科]