非接触式眼压计与回弹式眼压计在眼压测量中的准确度分析

Accuracy of intraocular pressure measurements between non-contact tonometer and ICare rebound tonometer

目的:分析非接触式眼压计(non contact tonometer,NCT)、ICare回弹式眼压计(ICare rebound tonometer,RBT)在青光眼患者中眼压测量结果的准确性。方法:回顾性病例对照研究。选取青光眼患者113例185眼。用RBT、NCT和Goldmann眼压计(GAT)分别于9∶00、16∶00两次进行眼压测量并记录为两组数据,分别用秩和检验、国际标准8621指南评估其准确性,Bland-Altman一致性分析两组测量结果的一致性,并以GAT测量值作为标准将数据分为异常眼压组(<10mmHg或>21mmHg)和正常眼压组(10~21 mmHg),在不同组间分析其一致性。应用Spearman相关分析眼压计间的相关性。结果:GAT、NCT和RBT三组测量值间存在差异(P<0.01);GAT获得的眼压测量值与RBT和NCT测量值间存在相关性(r s=0.71、0.77,P<0.001)。NCT与GAT测量值接近(P=0.92),而RBT与GAT相比,眼压测量值较高(P<0.05)。然而NCT、RBT同GAT相比一致性界限范围均较宽,分别为-6.2~6.0、-5.2~7.6mmHg,在正常眼压组一致性界限范围分别为-5.9~5.9、-4.3~7.5mmHg,在非正常眼压组分别为-7.3~6.4、-7.5~5.6mmHg。根据ISO 8612指南进行评价,NCT和RBT在三组中超过95%的一致性限制的异常值分别为3.9%、11.3%、12.2%和26.3%、11.3%、12.2%。结论:NCT和RBT均不能简单代替GAT用于青光眼患者眼压的测量。在青光眼患者中,随着测量值偏离正常眼压范围,NCT和RBT的测量误差也有所增大。

AIM: To analyze the accuracy of non-contact tonometer (NCT) and ICare rebound tonometer (RBT) in measuring intraocular pressure in glaucoma patients. METHODS:A retrospective proportional control study. Totally 113 patients (185 eyes) with glaucoma were studied. Intraocular pressure was measured by RBT, NCT and Goldmann Applanation tonometer (GAT) at 9 ∶ 00 and 16 ∶ 00 and recorded as two sets of data, respectively. Their accuracy is evaluated by the rank sum test, and the international standard 8621 guide, Bland-Altman consistency analysis analyzed the consistency of the two groups of measurements, and the data were divided into two groups: abnormal intraocular pressure group (<10mmHg or >21mmHg) and normal intraocular pressure group (10-21mmHg). The consistency was analyzed between different groups. The spearman correlation analysis is adopted to analyze the correlation between ophthalmotonometers. RESULTS: There were differences among the GAT, NCT and RBT measurements ( P <0.01). There was a strong correlation between the intraocular pressure measured value obtained by GAT and measured values obtained by RBT and NCT ( r s =0.71, 0.77, P <0.001). The measured values of NCT and GAT are close to each other without statistically significant differences ( P =0.92). Compared with GAT, RBT has a higher intraocular pressure measured value, and there are significant differences ( P <0.05). However, compared with GAT, both NCT and RBT have a wide range of limits of agreement, and they are (-6.2 -6.0mmHg) and (-5.2-7.6mmHg) respectively. In normal intraocular pressure groups, the ranges of limits of agreement are (-5.9 -5.9mmHg) and (-4.3-7.5mmHg) respectively. In abnormal intraocular pressure groups, the ranges of limits of agreement are (-7.3- 6.4mmHg) and (-7.5-5.6mmHg) respectively. The evaluation carried out in accordance with ISO 8612 guides indicates that the abnormal values more than the 95% of consistency restriction of NCT and RBT in the three groups are (3.9%, 11.3%, 12.2%) and (26.3%, 11.3%, 12.2%) respectively. CONCLUSION: Both NCT and RBT cannot simply replace the GAT to measure the intraocular pressure of glaucoma patients. In glaucoma patients, with the deviation of the measured value from the normal intraocular pressure range, the measurement error of NCT and RBT also increase.