三种仪器测量角膜曲率、直径及散光的一致性研究

Consistency study of three instruments for measuring,corneal curvature,diameter and astigmatism

目的 比较电脑验光仪、角膜地形图和眼前节分析系统(Pentacam HR)三种仪器对角膜曲率、角膜直径、角膜散光的测量结果的一致性,为临床应用提供依据。方法 选取西安医学院2019年7—12月在校大学生142例(284眼),分别使用电脑验光仪、角膜地形图和Pentacam HR进行角膜曲率(Rf、Rs)、角膜直径(HVID)及散光轴向的测量,并计算出散光矢量水平及垂直方向的散光(J0),45°方向的斜散光(J45),多组间均值比较采用单因素方差分析,多组间两两比较采用LSD检验,相关性分析采用Pearson系数检验分析,一致性评价采用Bland-Altman分析。结果 在测量Rf、Rs时,三种仪器均差异无统计学意义(P>0.05),测量HVID、J0、J45时,差异有统计学意义(P<0.05);经过Pearson相关分析,其结果显示三种仪器在测量Rf、Rs、HVID时有一定相关性(P<0.05),测量J0时相关性均差异无统计学意义(P>0.05),测量J45时发现电脑验光仪与Pentacam HR差异有统计学意义(P<0.05);Bland-Altman散点图中,其结果显示三种仪器测量Rf时一致性较好,在测量Rs时,Pentacam HR与另外两种仪器的一致性较差、测量HVID、J0及J45时,三种仪器间的一致性较差。结论 电脑验光仪、角膜地形图和眼前节分析系统在测量Rf时相关性高且一致性较好,在测量角膜直径HVID、J0及J45时一致性较差;电脑验光仪与角膜地形图在测量Rs时相关性高且一致性较好,眼前节分析系统与另外两种仪器的测量结果一致性较差。使用时需根据仪器原理、临床要求进行选择。

Objective To compare the measuring results of corneal curvature,diameter and astigmatism by computer optometry instrument,corneal topography and anterior segment analysis system(Pentacam HR) to investigate the consistencies between three instruments,so as to provide basis for clinical application.Methods 142 students(284 eyes) at Xi’an Medical University from July to December 2019 were selected,and the corneal curvature(Rf,Rs),corneal diameter(HVID) and astigmatism axis were measured by computer optometry instrument,corneal topography and Pentacam HR,the astigmatism parameters J0and J45were calculated.One-way analysis of variance(ANOVA) was used for the mean comparism between multiple groups.LSD test was used for pairwise comparison between multiple groups.Pearson coefficient test was used for correlation analysis.The agreements between the instruments were analyzed using the Bland-Altm statistical method.Results When Rfand Rswere measured,there was no statistically significant difference between this three instruments(P>0.05).The HVID,J0and J45were measured,and the difference was statistically significant(P<0.05).The results of Pearson correlation analysis showed that the three instruments had a certain correlation when measuring Rf,Rsand HVID(P<0.05).There was no statistical significance when measuring J0(P>0.05).It was found that the computer optometry had a certain correlation with the Pentacam on J45,and the difference was statistically significant(P<0.05).The results of Bland-Altman statistical method indicated that the three instruments had good consistency in measuring Rf,and Pentacam HR and the other two instrumentshad poor consistency in measuring Rs.There was poor consistency among the three instruments in measuring HVID,J0and J45.Conclusions Computer optometry instrument,corneal topography and Pentacam HR have high correlation and good consistency in measuring Rf,the consistency is poor in measuring corneal diameter of HVID,J0and J45.The computer optometry instrument and corneal topography have high correlation and good consistency in Rsmeasurement.But the Pentacam HR has poor consistency with the other two instruments,it should be based on the principle of the instrument,clinical requirements for selection when we use it.