CASIA2、IOLMaster 700和Pentacam对白内障眼角膜屈光力及散光测量的比较

Comparison of corneal refractive power and astigmatism measured by CASIA2,IOLMaster 700 and Pentacam in cataract patients

目的比较CASIA2、IOLMaster 700和Pentacam测量年龄相关性白内障患者角膜前表面和全角膜屈光力及散光的差异性和一致性。方法采用诊断试验研究方法,收集2021年3—4月在天津医科大学眼科医院就诊的年龄相关性白内障患者200例200眼,分别采用CASIA2、IOLMaster 700和Pentacam测量角膜前表面及全角膜的陡峭轴角膜曲率(Ks)、平坦轴角膜曲率(Kf)及平均角膜曲率(Km)、散光度数及轴向。采用傅里叶转换公式将散光矢量转换成J0和J45。3种仪器测量值的差异和相关性分析分别采用重复测量单因素方差分析和Pearson相关分析,一致性评估采用Bland-Altman一致性检验。结果CASIA2、IOLMaster 700和Pentacam测量的角膜前表面Kf和J0总体比较差异均有统计学意义(F=18.563、16.172,均P=0.001),CASIA2测量Kf值大于IOLMaster 700,IOLMaster 700测量J0值明显大于Pentacam,差异均有统计学意义(均P<0.05)。各仪器测量全角膜Ks、Kf、Km、J0总体比较差异均有统计学意义(F=1300.447、1274.117、1609.713、10.372,均P=0.001),其中IOLMaster 700测量值最大,CASIA2次之,Pentacam最小,两两比较差异均有统计学意义(均P<0.05)。Pearson相关分析显示,3种仪器测量角膜屈光力具有较强的相关性(均r>0.935,P<0.01),散光度数值相关性均弱于角膜屈光力测量值(r=0.623~0.908,均P<0.01)。Bland-Altman分析显示3种仪器测量角膜前表面屈光力、角膜前表面散光及全角膜散光有较好的一致性,均在临床可接受范围,而测量全角膜屈光力的一致性较差。其中,IOLMaster 700与Pentacam测量全角膜屈光力值差异较大,CASIA2与Pentacam差异相对较小。结论CASIA2、IOLMaster 700和Pentacam测量年龄相关性白内障患者角膜前表面屈光力及散光一致性较好,可以互相参考,而测量全角膜屈光力的一致性较差,其中IOLMaster 700测量值最大,Pentacam测量值最小,临床上不建议互换。

Objective To compare the difference and consistency of anterior corneal surface and total corneal refractive power and astigmatism measured by CASIA2,IOLMaster 700 and Pentacam in patients with age-related cataract.Methods A diagnostic test was conducted.Two-hundred patients(200 eyes)with age-related cataract were enrolled in Tianjin Medical University Eye Hospital from March to April 2021.The steep keratometry(Ks),flat keratometry(Kf),mean keratometry(Km),degree and axis of astigmatism of the anterior and the total corneal surface of patients were measured by CASIA2,IOLMaster 700 and Pentacam,respectively.The astigmatism was transformed into J0 and J45 by Fourier transform formula.The differences and correlation of the measurements obtained with the three instruments were analyzed by one-way repeated measures analysis of variance and Pearson correlation analysis.The consistency was evaluated by Bland-Altman test.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Tianjin Medical University Eye Hospital(No.2021KY-07).Results There were statistically significant differences in anterior corneal surface Kf and J0 measured by the three instruments(F=18.563,16.172;both at P=0.001).The Kf measured by CASIA2 was significantly higher than that measured by IOLMaster 700,and the J0 measured by IOLMaster 700 was significantly higher than that measured by Pentacam(both at P<0.05).There were statistically significant differences in total corneal Ks,Kf,Km and J0 measured by the three instruments,which from IOLMaster 700 were the largest,followed by CASIA2,then Pentacam(F=1300.447,1274.117,1609.713,10.372;all at P=0.001).Pearson correlation analysis showed that the corneal refractive power measured by the three instruments was highly correlated(all at r>0.935,P<0.01),and the correlation of astigmatism values was weaker than the corneal refractive power(r=0.623-0.908,all at P<0.01).Bland-Altman analysis showed that the three instruments had good consistency in measuring the anterior corneal surface refractive power,anterior corneal surface astigmatism and total corneal astigmatism,which were clinically acceptable,while the consistency of total corneal refractive power measurement was poor.The difference in measuring total corneal refractive power was large between IOLMaster 700 and Pentacam,and relatively small between CASIA2 and Pentacam.Conclusions The consistency of CASIA2,IOLMaster 700 and Pentacam is good in measuring the anterior corneal surface refractive power of patients with age-related cataract,which can be substitutable,but poor in measuring the total corneal refractive power.The total corneal refractive power measurement from IOLMaster700 is the largest,the smallest from Pentacam,which is not recommended to be clinically exchangeable.