散瞳对IOLMaster700和OA-2000测量白内障患者眼球生物结构参数的影响

The Effect of Cycloplegia on the IOLMaster 700 and OA-2000 Biometry in Cataract Patients

目的:评估新型光学生物测量仪IOLMaster700和OA-2000散瞳前后测量白内障患者眼球生物结构参数的差异性和一致性。方法:前瞻性临床研究。应用IOLMaster700和OA-2000分别对133例(133眼)年龄相关性白内障患者散瞳前后的眼轴长度(AL)、平均角膜曲率(Km)、前房深度(ACD)、晶状体厚度(LT)、中央角膜厚度(CCT)和角膜横径(WTW)进行测量。由同一位医师完成所有测量,2种仪器的测量先后顺序根据随机数字表决定。同一种仪器散瞳前后的测量参数比较采用配对t检验,散瞳前、后2种仪器测量结果的差异性和一致性分别做配对t检验和Bland-Altman分析。结果:IOLMaster700和OA-2000散瞳前后AL和Km测量值差异无统计学意义。2种仪器均显示散瞳会使ACD测量值增加0.06mm左右,CCT增厚2~3μm。此外,散瞳后IOLMaster700的LT测量值变小0.01mm(t=-6.26,P<0.001),WTW增加0.12mm(t=7.06,P<0.001)。散瞳前后2种状态下,OA-2000测量的ACD和LT均分别较IOLMaster700大约0.04mm(t=-13.36,P<0.001;t=-15.08,P<0.001)和0.07mm(t=-11.11,P<0.001;t=-8.42,P<0.001),而CCT较IOLMaster700薄约17μm(t=30.55,P<0.001;t=28.80,P<0.001),差异均有统计学意义。2种仪器测量的WTW的95%一致性区间散瞳前为-0.79~0.81mm,散瞳后为-0.44~0.81mm,一致性相对较差,其余参数一致性良好。结论:散瞳不会影响IOLMaster700和OA-2000测量AL和Km,但会使ACD和CCT测量值变大,而且散瞳后IOLMaster700的LT测量值变小,WTW测量值变大。散瞳前后2种仪器除WTW一致性相对较差外,其余参数在临床上可以相互替代。

Objective: To evaluate the effect of cycloplegiaon new ocular biometry measurements using the IOLMaster 700 and OA-2000 biometers and assess the differences and agreements between the two devices. Methods: In this prospective, comparative, observational study of ocular measurements on 133 cataracts, measurements of axial length (AL), mean keratometry (Km), anterior chamber depth (ACD), lens thickness (LT), central corneal thickness (CCT) and white-to-white (WTW) were performed by a single operator using the two devices before and after pupil dilation. The measurement order of the two devices was determined according to the random number table. A paired t-test was applied to evaluate the differences with and without cycloplegia on each device. Bland-Altman plots and a paired t-test were used to evaluate the agreements and differences between the two devices with and without cycloplegia. Results: Cycloplegia had no significant effect on AL or Km. However, ACD and CCT significantly increased by 0.06 mm and 2-3 μm post-cycloplegia on both devices. The IOLMaster 700 LT measurements significantly decreased by 0.01 mm (t=-6.26, P<0.001) and WTW increased by 0.12 mm (t=7.06, P<0.001) after pupil dilation. ACD measurements with OA-2000 were higher by 0.04 mm (t=-13.36, P<0.001;t=-15.08, P<0.001) and LT by 0.07 mm (t=-11.11, P<0.001;t=-8.42, P<0.001), which were statistically significant, compared to the IOLMaster 700 before and after pupil dilation, while CCT was smaller by 17 μm (t=30.55, P<0.001;t=28.80, P<0.001). The 95% limits of agreement in both devices were -0.79 to 0.81 mm pre-cycloplegia and -0.44 to 0.81 mm post-cycloplegia. All measurements had good agreements between the two devices, except for WTW. Conclusions: Cycloplegia affects ACD and CCT, but not AL or Km measurements. LT decreased and WTW increased on the IOLMaster 700 after pupil dilation. Generally, there is good agreement between the IOLMaster 700 and OA-2000, except for WTW. Thus, either can be used for the preoperative examination of cataracts.