四种非接触式光学仪器测量中央角膜厚度一致性的研究  

Comparative study of central corneal thickness measurements with four non-contact optical instruments

作　　者：张丛[1] 杨文利[1] 姚宁[1] 刁莉莉 李蕾[1] 张涵 康立华[1] 刘宸琛 Zhang Cong;Yang Wenli;Yao Ning;Diao Lili;Li Lei;Zhang Han;Kang Lihua;Liu Chenchen(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Science,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院、北京同仁眼科中心眼科学与视觉科学北京市重点实验室,100730

出　　处：《眼科》2022年第6期440-445,共6页Ophthalmology in China

摘　　要：目的比较Pentacam HR三维眼前节分析系统、角膜光学显微镜SP-3000P、扫频源光学生物测量仪OA-2000及相干光眼前段成像仪(Optovue Angiovue OCT)测量中央角膜厚度(CCT)的一致性。设计诊断技术评价。研究对象2021年9-11月北京同仁医院眼科角膜正常的白内障患者118例(118眼)。方法分别采用上述4种仪器测量角膜厚度,比较角膜顶点CCT值的差异性和一致性,并比较Pentacam HR测量角膜顶点及瞳孔中央CCT值的差异,以及Optovue OCT测量角膜顶点及中央2 mm直径平均CCT值的差异。主要指标CCT值、组内相关系数(ICC)、Bland-Altman图中平均值差值及95%一致性界限(LoA)。结果Pentacam HR、SP-3000P、OA-2000及Optovue OCT测量角膜顶点CCT值分别为(532.29±30.35)μm、(512.20±30.88)μm、(516.89±31.25)μm、(515.58±29.78)μm;4种仪器比较差异具有统计学意义(F=559.469,P<0.001);其中OA2000测得CCT与Optovue OCT比较有差异(P=0.022);其余各组比较P均<0.001。Pentacam HR测量瞳孔中心CCT值为(531.25±30.75)μm,与角膜顶点CCT值比较差异具有统计学意义(t=6.275,P<0.001);Optovue OCT测量中央2 mm直径平均CCT值为(516.75±29.72)μm,与角膜顶点CCT值比较差异具有统计学意义(t=4.364,P<0.001)。Pentacam HR与其他3种仪器的ICC值为0.806~0.878,Bland-Altman分析显示平均值差值为15.40~20.09μm,95%LoA为5.9~32.4μm:SP-3000P与OA-2000和Optovue OCT的ICC值为0.973和0.974,平均值差值为-4.69μm和-3.38μm,95%LoA范围为-15.6~8.6μm。OA-2000与Optovue OCT的ICC值为0.986,平均值差值为1.31μm,95%LoA为-8.3~10.9μm。结论角膜顶点CCT测量值SP-3000P、OA-2000与Optovue OCT测量值相关性和一致性好,差异在临床可接受范围内,临床上可以相互换用。Penctacam HR测量值高于其他3种仪器,一致性较差,不建议直接相互替换。Objective To compare the central corneal thickness(CCT)measurements obstained by Pentacam HR,specular microscopy(SP-3000P),swept-source optical coherence biometry(OA-2000)and optical coherence tomograhpy(Optovue Angiovue OCT with anterior segment lens).Design Diagnostic technique evaluation.Participants 118 eyes of 118 patients with healthy cornea at cataract clinic of Beijing Tongren Hospital from September to Novermber 2021.Method CCT values were obtained by these four instruments.The differences among CCT values of cornea apex from these four instruments,and the agreement between each two were evaluated.CCT values of cornea apex and pupil center from Pentacam HR,and CCT of cornea apex and average CCT of central 2 mm zone from Optovue OCT were also compared.Main Outcome Measures CCT,intraclass correlation coefficient(ICC),the mean difference and 95%limits of agreement(LoA)of Bland-Altman diagram.Results CCT of cornea apex obtained by Pentacam HR,SP-3000P,OA-2000 and Optovue OCT was 532.29±30.35μm,512.20±30.88μm,516.89±31.25μm and 515.58±29.78μm respectively.CCT of pupil center obtained by Pentacam HR was 531.25±30.75μm,and average CCT of central 2 mm zone with Optovue OCT was 516.75±29.72μm.Significant difference was found between CCT of cornea apex and CCT of pupil center from Pentacam HR(t=6.275,P<0.001),and also between CCT of cornea apex and average CCT of central 2 mm zone from Optovue OCT(t=4.364,P<0.001).There was significant difference among CCT of cornea apex obtained by these four optical instruments(F=559.469,P<0.001)and between each two values with further pairwise comparison(OA 2000-Optovue OCT:P=0.022;other each two values:all P<0.001).ICC between Pentacam HR and other devices was 0.806-0.878,and Bland-Altman diagram showed that the mean difference was 15.40~20.09μm,with 95%LoA 5.9~32.4μm.ICC between SP-3000P and OA-2000,and between SP-3000P and Optovue OCT was 0.973 and 0.974,while the mean difference was-4.69μm and-3.38μm,and 95%LoA-15.6~8.6μm.ICC between OA-2000 and Optovue OCT

关 键 词：中央角膜厚度 Pentacam HR 角膜光学显微镜 扫频源光学生物测量 相干光断层扫描 

分 类 号：R772.2[医药卫生—眼科]