回弹式眼压计在正常人群眼压测量中的临床应用研究
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摘要
目的：研究回弹式眼压计(Rebound tonometer, RT) Icare (Icare rebound tonometer, Icare)及IOPen (IOPen tonometer, IOPen)在正常人群眼压测量中的准确性及可靠性,以及与中央角膜厚度(central corneal thickness,CCT)的相关性。
方法：收集2009年3月至2009年5月在我院门诊就诊的124例正常人的244只眼,随机采用Icare回弹式眼压计(Icare)、IOPen回弹式眼压计(IOPen)测量眼压后,再用Goldmann压平式眼压计(Goldmann applanation tonometry,GAT)测量眼压值,随后用超声角膜测厚仪(Pachymeter,SP-3000,TOMEY,Japan)测量中央角膜厚度(CCT),比较Icare、IOPen及GAT三种眼压计的测量结果,进行描述性分析,同时将三组眼压值分别与CCT进行相关性分析。
结果：124例受检者的年龄为16～76岁,平均年龄为40.22±14.47岁。Icare测得的眼压平均值为15.46±3.52mmHg, IOPen测得的眼压平均值为13.05±3.59mmHg, GAT测得的眼压平均值为15.64±2.57mmHg, IOPen测量值明显低于Icare与GAT测量值。经Wilcoxon配对秩检验,Icare与GAT的眼压测量值之间的平均差异为-0.19±2.68mmHg,差异无统计学意义(Z=-1.193,P=0.233>0.05)；IOPen与GAT的眼压测量值之间的平均差异为-2.60±4.17mmHg,差异有极显著统计学意义(Z=-8.437,P=0.000<0.01)。在一致性分析中,Icare与GAT差值的均值为-0.2mmHg,标准差为2.68mmHg,95%的一致性界限为(-5.4～5.1) mmHg;在一致性界限范围内,Icare与GAT的眼压测量值相比,差值的绝对值最大为5.4mmHg;差异分布频率显示Icare与GAT的差值84%在±3mmHg范围内,68%的差异值在±2mmHg范围内,47%的差异值在±1mmHg范围内。IOPen与GAT差值的均值为-2.6mmHg,标准差为4.17mmHg,95%的一致性界限为(-10.8～5.6)mmHg,在一致性界限范围内,IOPen与GAT的眼压测量值相比,差值的绝对值最大为10.8mmHg。差异分布频率显示IOPen与GAT的差值49%在±3mmHg范围内,34%的差异值在±2mmHg范围内,16%的差异值在1mmHg范围内。Icare与GAT之间存在直线相关关系,且呈正相关性(rs=0.656,p<0.01); IOPen与GAT之间无直线相关关系(rs=0.122,p>0.05)。CCT的平均值为539.90±31.85μm。Icare, GAT与CCT之间均呈正相关,相关系数分别为0.382(p<0.01)和0.342 (p<0.01)。IOPen与CCT之间无直线相关关系(rs=-0.073,P>0.05)。Icare与GAT差值与CCT之间有直线相关关系且两者呈正相关(rs=0.180,P<0.01),即角膜越厚,Icare与GAT差值越大。CCT每增加10μm, Icare与GAT差值则增加0.17mmHg。
结论：Icare与GAT的眼压测量值之间具有很好的相关性和一致性,Icare眼压计既容易操作又无需表面麻醉,但其测量值仍然受中央角膜厚度的影响,所以临床实践中要考虑CCT对Icare测量结果的影响,这样才能更加准确地反映真实的眼压值。而IOPen测量眼压的准确性稍差。
Objectives:To evaluate the accuracy of introcular pressure(IOP) measured by Icare rebound tonometer and IOPen rebound tonometer compared to Goldmann applanation tonometry,as well as to compare and analyze the influence of central corneal thickness (CCT) on the IOP measurements measured by rebound tonometer.
Method:We selected 244 eyes of 124 healthy individuals for intraocular pressure measurement from March to May in 2009 in a ran-dom order.First,Icare and IOPen tonometer was performed in a random order, followed by GAT tonometer.Central corneal thickness (CCT) was also measured by Hand-held ultrasonic corneal pachymeter in every eye. Then compared the measurements of the three tonomet-ries with each other and correlated them with CCT seperately.
Results:The average age of 124 subjects was 40.22±14.47 years (range,16-76 years). The mean IOP readings obtained by Icare, IOPen and GAT tonometer were 15.46±3.52mmHg,13.05±3.59mmHg, and 15.64±2.57mmHg,respectively IOP readings by IOPen tonometer were consistently lower than those by Icare and Goldmann tonometer. The IOP readings between Icare and GAT was not significantly different(Z=-1.193,P=0.233>0.05),the mean difference was-0.19±2.68 mmHg. There was a significant difference between IOPen and GAT (Z=-8.437,P=0.000<0.01),the mean difference was-2.60±4.17mmHg. Comparison with IOP readings of Goldmann applanation tonometry (GAT),Icare tonometer show good agreement,whereas IOPen tonom- eter understimate IOP readings.The differences between corresponding measures (Icare value minus GAT value) had a mean of-0.2mmHg, a standard deviation of 2.68mmHg, a 95% limits of agreement of-5.4 to 5.1mmHg. The maximum of absolute value of difference was 5.4mmHg. In almost 84% of differences between Icare and GAT measurements were within±3mmHg,68% were within±2 mmHg, and 47% within±1 mmHg. The differences between corresponding measures (IOPen value minus GAT value) had a mean of-2.6mmHg, a standard deviation of 4.17mmHg, a 95% limits of agreement of-10.8 to 5.6mmHg. The maximum of absolute value of difference was 10.8mmHg. The IOPen readings were within±3mmHg of the GAT readings in 49% of eyes, within±2mmHg in 34% of eyes, and within±1mm Hg in 16% of eyes. Icare and GAT displayed good correlation (rs=0.656,p<0.01), and no significantly correlation between IOPen and GAT (rs=0.122,p>0.05). The mean CCT values was 539.90±31.85μm The linear correlation showed Icare and GAT were influenced by CCT, the correlation coefficient were 0.382 and 0.342 (P<0.01). IOPen and CCT had no significant linear correlation(rs=-0.073,P>0.05).The readings of the Icare minus GAT were correlated with the CCT readings(rs=0.180, P<0.01). For every 10mm increase in CCT, the difference (Icare-GAT) increased by 0.17mmHg.
Conclusion:There are good correlation and agreement with IOP readings between Icare and GAT tonometer. The Icare instrument is easy to use and without topical anesthesia,but it is still affected by CCT. However, the accuracy of IOPen tonometer was not good.
方法：收集2009年3月至2009年5月在我院门诊就诊的124例正常人的244只眼,随机采用Icare回弹式眼压计(Icare)、IOPen回弹式眼压计(IOPen)测量眼压后,再用Goldmann压平式眼压计(Goldmann applanation tonometry,GAT)测量眼压值,随后用超声角膜测厚仪(Pachymeter,SP-3000,TOMEY,Japan)测量中央角膜厚度(CCT),比较Icare、IOPen及GAT三种眼压计的测量结果,进行描述性分析,同时将三组眼压值分别与CCT进行相关性分析。
结果：124例受检者的年龄为16～76岁,平均年龄为40.22±14.47岁。Icare测得的眼压平均值为15.46±3.52mmHg, IOPen测得的眼压平均值为13.05±3.59mmHg, GAT测得的眼压平均值为15.64±2.57mmHg, IOPen测量值明显低于Icare与GAT测量值。经Wilcoxon配对秩检验,Icare与GAT的眼压测量值之间的平均差异为-0.19±2.68mmHg,差异无统计学意义(Z=-1.193,P=0.233>0.05)；IOPen与GAT的眼压测量值之间的平均差异为-2.60±4.17mmHg,差异有极显著统计学意义(Z=-8.437,P=0.000<0.01)。在一致性分析中,Icare与GAT差值的均值为-0.2mmHg,标准差为2.68mmHg,95%的一致性界限为(-5.4～5.1) mmHg;在一致性界限范围内,Icare与GAT的眼压测量值相比,差值的绝对值最大为5.4mmHg;差异分布频率显示Icare与GAT的差值84%在±3mmHg范围内,68%的差异值在±2mmHg范围内,47%的差异值在±1mmHg范围内。IOPen与GAT差值的均值为-2.6mmHg,标准差为4.17mmHg,95%的一致性界限为(-10.8～5.6)mmHg,在一致性界限范围内,IOPen与GAT的眼压测量值相比,差值的绝对值最大为10.8mmHg。差异分布频率显示IOPen与GAT的差值49%在±3mmHg范围内,34%的差异值在±2mmHg范围内,16%的差异值在1mmHg范围内。Icare与GAT之间存在直线相关关系,且呈正相关性(rs=0.656,p<0.01); IOPen与GAT之间无直线相关关系(rs=0.122,p>0.05)。CCT的平均值为539.90±31.85μm。Icare, GAT与CCT之间均呈正相关,相关系数分别为0.382(p<0.01)和0.342 (p<0.01)。IOPen与CCT之间无直线相关关系(rs=-0.073,P>0.05)。Icare与GAT差值与CCT之间有直线相关关系且两者呈正相关(rs=0.180,P<0.01),即角膜越厚,Icare与GAT差值越大。CCT每增加10μm, Icare与GAT差值则增加0.17mmHg。
结论：Icare与GAT的眼压测量值之间具有很好的相关性和一致性,Icare眼压计既容易操作又无需表面麻醉,但其测量值仍然受中央角膜厚度的影响,所以临床实践中要考虑CCT对Icare测量结果的影响,这样才能更加准确地反映真实的眼压值。而IOPen测量眼压的准确性稍差。
Objectives:To evaluate the accuracy of introcular pressure(IOP) measured by Icare rebound tonometer and IOPen rebound tonometer compared to Goldmann applanation tonometry,as well as to compare and analyze the influence of central corneal thickness (CCT) on the IOP measurements measured by rebound tonometer.
Method:We selected 244 eyes of 124 healthy individuals for intraocular pressure measurement from March to May in 2009 in a ran-dom order.First,Icare and IOPen tonometer was performed in a random order, followed by GAT tonometer.Central corneal thickness (CCT) was also measured by Hand-held ultrasonic corneal pachymeter in every eye. Then compared the measurements of the three tonomet-ries with each other and correlated them with CCT seperately.
Results:The average age of 124 subjects was 40.22±14.47 years (range,16-76 years). The mean IOP readings obtained by Icare, IOPen and GAT tonometer were 15.46±3.52mmHg,13.05±3.59mmHg, and 15.64±2.57mmHg,respectively IOP readings by IOPen tonometer were consistently lower than those by Icare and Goldmann tonometer. The IOP readings between Icare and GAT was not significantly different(Z=-1.193,P=0.233>0.05),the mean difference was-0.19±2.68 mmHg. There was a significant difference between IOPen and GAT (Z=-8.437,P=0.000<0.01),the mean difference was-2.60±4.17mmHg. Comparison with IOP readings of Goldmann applanation tonometry (GAT),Icare tonometer show good agreement,whereas IOPen tonom- eter understimate IOP readings.The differences between corresponding measures (Icare value minus GAT value) had a mean of-0.2mmHg, a standard deviation of 2.68mmHg, a 95% limits of agreement of-5.4 to 5.1mmHg. The maximum of absolute value of difference was 5.4mmHg. In almost 84% of differences between Icare and GAT measurements were within±3mmHg,68% were within±2 mmHg, and 47% within±1 mmHg. The differences between corresponding measures (IOPen value minus GAT value) had a mean of-2.6mmHg, a standard deviation of 4.17mmHg, a 95% limits of agreement of-10.8 to 5.6mmHg. The maximum of absolute value of difference was 10.8mmHg. The IOPen readings were within±3mmHg of the GAT readings in 49% of eyes, within±2mmHg in 34% of eyes, and within±1mm Hg in 16% of eyes. Icare and GAT displayed good correlation (rs=0.656,p<0.01), and no significantly correlation between IOPen and GAT (rs=0.122,p>0.05). The mean CCT values was 539.90±31.85μm The linear correlation showed Icare and GAT were influenced by CCT, the correlation coefficient were 0.382 and 0.342 (P<0.01). IOPen and CCT had no significant linear correlation(rs=-0.073,P>0.05).The readings of the Icare minus GAT were correlated with the CCT readings(rs=0.180, P<0.01). For every 10mm increase in CCT, the difference (Icare-GAT) increased by 0.17mmHg.
Conclusion:There are good correlation and agreement with IOP readings between Icare and GAT tonometer. The Icare instrument is easy to use and without topical anesthesia,but it is still affected by CCT. However, the accuracy of IOPen tonometer was not good.
引文
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