不同测量工具下FS-LASIK手术前后眼压测量值一致性及测量变化值影响因素分析  

Relative factor analysis and consistency study of intraocular pressure measurement before and after FS-LASIK operation with different measuring instruments

作　　者：纪康康 张学勇[2] 廖荣丰[1] JI Kangkang;ZHANG Xueyong;LIAO Rongfeng(Department ofOphthalmology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院眼科,合肥230022 [2]安徽建筑大学,合肥230022

出　　处：《安徽医学》2018年第9期1039-1043,共5页Anhui Medical Journal

基　　金：国家自然科学基金(项目编号:61471003)

摘　　要：目的对比分析Goldmann眼压计(GAT)和非接触眼压计(NCT)在FS-LASIK手术前后眼压测量值一致性及其变化。方法选取2016年12月至2017年9月于安徽医科大学第一附属医院行FS-LASIK手术的近视患者154例(303只眼),采用横断面研究,对比评估手术前后GAT测量值(IOP-GAT)和NCT测量值(IOP-NCT)的变化及一致性,分析该眼压测量变化值与年龄、术前等效球镜绝对值(|SE_(pre)|)、术前眼压测量值(IOP-GAT_(pre)、IOP-NCT_(pre))、术前中央角膜厚度(CCT_(pre))、切削深度(AD)、切削比(AR)及术前曲率半径(R_(pre))的相关性,并给出逐步回归公式。结果 154患者的IOP-GAT_(pre)平均为(15. 60±2. 39) mm Hg、IOP-NCT_(pre)的平均为(15. 49±2. 58) mm Hg,两者差异无统计学意义(P=0. 192),而Bland-Altman分析IOP-GAT_(pre)与IOP-NCT_(pre)平均值差值为0. 11 mm Hg,其95%一致性界值为(-2. 83,3. 06) mm Hg。术后IOP-GAT、IOP-NCT均较术前下降,差异有统计学意义(P <0. 05),IOP-NCT下降程度更大。手术前后GAT测量变化值(ΔIOP-GAT)与|SE_(pre)|、IOP-GAT_(pre)、CCT_(pre)、AD、AR呈正相关(P <0. 05),与年龄、R_(pre)无明显相关(P> 0. 05)。回归方程为:ΔIOP-GAT=0. 635×IOP-GAT_(pre)+15. 633×AR-8. 554 (R2=0. 504,F=204. 163,P <0. 05); NCT测量变化值(ΔIOP-NCT)与年龄、|SE_(pre)|、IOP-NCT_(pre)、CCT_(pre)、AD、AR呈正相关(P <0. 05),与R_(pre)无明显相关,回归方程:ΔIOP-NCT=0. 603×IOP-NCT_(pre)+20. 493×AR-5. 994(R^2=0. 653,F=274. 921,P <0. 05)。结论FS-LASIK手术前后IOP-GAT、IOP-NCT均不具有较好一致性,术后两者均明显下降,IOP-NCT下降程度更大,两者下降程度与多种因素相关,但均与术前眼压测量值的相关性最高。Objective To evaluate and compare the consistency and changes of IOP measured by Goldmann applanation tonometer （GAT） and Non - contact tonometer（ NCT） before and after FS - LASIK. Methods Cross - sectional study was used, IOP of GAT （IOP - GAT） and NCT（ IOP - NCT） were measured in 303 eyes of 154 consecutive patients who underwent FS - LASIK in our hospital from Dec 2016 to Sept 2017. Besides, patients age, absolute value of preoperative spherical equivalent（ ISE^ I ） , preoperative radius of curva-ture （Rpre ） , preoperative central comeal thickness （CCTpre） , preoperative IOP （IOP - GATpre, IOP - NCTpre） , ablation depth （ AD） , ablation rate（ AR） were studied to determine their influence on underestimation of IOP, and the stepwise regression formula should be obtained in the meantime. Results There was no statistical difference（P =0.192） between the average of IOP - GATpre and IOP - NCTp^ 15.60 ±2.39 ws 15.49 ±2.58） mmHg. Meanwhile, Bland - Altman analysis showed the 95% limit of consistency value was 2. 83 mmHg to 3. 06 mmHg, postoperative IOP - GAT and IOP - NCT significantly decreased after FS - LASIK, but the reduction of IOP - NCT was much higher. There was a positive correlation of AIOP - GAT with I SEpre I , IOP - GATpre, CCT , AD, AR（ P 〈 0. 05 ） and no correlation with age and Rpre. The regression formula was： AIOP - GAT = 0. 635 x IOP - GAT ＋ 15. 633 x AR - 8. 5 5 4（R 2 = 0 .5 0 4 , F = 204. 163, P 〈 0. 0 5 ）; meanwhile,there was a positive correlation between the reduction of AIOP - NCT with age, I SEp I , IOP - NCTpre, CCTpjg, AD, AR and no correlation with Rpre. The regression formula was ： AIOP - NCT = 0. 603 x IOP - NCT ＋ 20. 493 x AR - 5. 994 （ T？2 = 0 . 653, F = 274.921, P〈0. 05）. Conclusion There exists a remarkable disagreement between IOP of GAT and NCT before and after FS - LASIK.Both I0P - GAT and IOP - NCT significantly decrease after FS - LASIK, but the reduction of IOP - NCT is much

关 键 词：GOLDMANN眼压计 飞秒激光辅助准分子激光原位角膜磨镶术 非接触眼压计 眼压 弹性模量 

分 类 号：R779.63[医药卫生—眼科]