iCare回弹式眼压计的临床应用评价

Clinical evaluation of iCare rebound tonometer

目的比较iCare回弹式眼压计(RBT)测量的眼压值与Goldmann压平眼压计(GAT)测量眼压值的差异,评价RBT测量眼压的可靠性及可重复性。方法对正常志愿者9例9眼同时使用iCareRBT和GAT进行测量,比较二者眼压测量结果的重复性。对GAT眼压在正常范围内的受试者(包括可疑青光眼患者和眼压控制良好的青光眼患者)45例45眼分别用RBT和GAT进行测量,使用配对t检验、相关分析及Bland-Altman图一致性检验等方法比较二者测量结果的一致性。由2位操作者使用同一台RBT对13位正常志愿者13眼进行测量,通过组内相关系数比较各自测量结果的重复性,从而评价不同操作者对iCareRBT测量结果的影响,模拟真实临床工作环境。结果 RBT组眼压读数的组内相关系数为0.821(95%CI:0.553～0.952),GAT组眼压读数的组内相关系数为0.846(95%CI:0.604～0.959),表明2种仪器的测量重复性均较好,但尚不能说明何种更好。RBT和GAT测得的眼压分别为(14.42±3.49)mmHg和(16.18±2.68)mmHg,二者呈正相关(r=0.684,P<0.01);但RBT所测的眼压读数略低于GAT,差异有统计学意义(t=4.601,P<0.01)。Bland-Altman图显示二者的差值为(-1.76±2.56)mmHg,95%CI:(-6.77～3.26)。使用RBT所测眼压值的组内相关系数分别为0.827(95%CI:0.626～0.938)和0.697(95%CI:0.413～0.884)。结论 RBT与GAT所测得的眼压值在正常范围内,具有较好的相关性,2种眼压计测量的重复性均较好,而不同操作者测量的重复性不完全一致。

Background Intraocular pressure（IOP）measurement plays an important role in the diagnosis,classification and follow up of glaucoma patients.Though being a gold standard,Goldmann tonometer（GAT）shows its limitation in usage.ICare rebound tonometer（RBT）provides us a new method of IOP measurement,but its reproducibility and reliable is still not confirmed.ObjectiveThe aim of this study was to evaluate the reliability and reproducibility of measurement of IOP with iCare RBT.MethodsFirstly,IOP was measured in 9 eyes of 9 normal volunteers using iCare RBT and GAT.The reproducibilitg of IOP readings by iCare RBT was evaluated.Secondly,IOP was measured with the iCare RBT in 45 eyes of 45 subjects with normal IOP by GAT respectively to compare the agreement of the two methods.Furthermore,IOP readings were obtained from another 13 eyes of 13 normal subjects by two operators with the same iCare RBT under the double-masked condition for the contrast of reproducibility of two operators.This trial was approved by the Ethics Committee of Peking University First Hospital.Written informed consent was obtained from each individual prior to any medical examination.ResultsIntraclass correlation coefficient of the IOP readings obtained by iCare RBT and GAT were 0.821（95%CI：0.553-0.952）and 0.846（95%CI：0.604-0.959）,respectively,showing a good reproducibility in iCare RBT and GAT measurement.IOP readings obtained by iCare RBT and GAT were（14.42 ±3.49）mmHg and（16.18±2.68）mmHg respectively,presenting a good correlation between the 2 measurement methods（r=0.684,P0.001）.However,a significant difference of IOP readings was found between the two methods（t=4.601,P0.01）.iCare RBT underestimated the IOP in comparison with GAT.Intraclass correlation coefficient of the IOP readings obtained by two operators were 0.827（95%CI：0.626-0.938）and 0.697（95%CI：0.413-0.884）.ConclusionThe measuring results of iCare RBT and GAT have preferable correlation.A good reproducibility is proved in both iCare RBT and GAT methods.However,the reproducibility of the measurement by two different operators is not in accordance with each other.