Scansys与Pentacam两种眼前节分析仪测量近视眼眼前节生物学参数的对比研究

Comparative study on the measurements of biological parameters of anterior segment by two anterior segment analyzers:Scansys and Pentacam

目的评估Scansys(上海美沃)与Pentacam(德国Oculus)两种三维眼前节分析仪测量近视患者眼前节生物学参数的差异性和一致性。设计一致性评价。研究对象随机选取2022年8月在中部战区总医院眼科近视手术中心就诊的初诊患者158例(158眼),均取右眼比较。方法由同一医师分别应用Scansys和Pentacam两种眼前节分析仪测量患者眼前节生物学参数。眼前节各项生物学参数的差异性和一致性使用Bland-Altman法评估,角膜散光(corneal astigmatism,CA)的比较采用矢量分析法。主要指标角膜前表面的平坦角膜曲率(K1)、陡峭角膜曲率(K2)、平均角膜曲率(Km)、平均角膜曲率半径(Rm)、CA、中央角膜厚度(central corneal thickness,CCT)、前房深度(anterior chamber depth,ACD)、角膜横径(white to white,WTW)、瞳孔直径(pupil diameter,PD)、前房容积(anterior chamber volume,ACV)及最小前房角(anterior chamber angle,ACA)。结果与Pentacam相比,Scansys测量的K1、K2、Km、CCT、ACD、WTW及ACV稍小,而Rm、PD及ACA稍偏大,两者测量K1、K2、Km、Rm、CCT、ACD、WTW、PD、ACV及ACA的差异分别为(-0.12±0.19)D、(-0.15±0.20)D、(-0.13±0.16)D、(0.03±0.03)mm、(-17±7.0)μm、(-0.04±0.18)mm、(-0.36±0.14)mm、(0.36±0.45)mm、(-21±20)mm3、(3.5±4.8)°,95%一致性界限(95%LoA)分别为(-0.48~0.25)D、(-0.54~0.24)D、(-0.45~0.18)D、(-0.03~0.08)mm、(-31~-3.5)μm、(-0.38~0.30)mm、(-0.64~-0.08)mm、(-0.52~1.2)mm、(-61~19)mm3、(-6~13)°,分别有94.3%、95.6%、95.6%、93.0%、98.1%、94.9%、96.2%、96.2%、95.6%、98.1%的数据分布在可信区间内;两种仪器测量的CA有一定差异,一致性分析显示95%LoA为-0.51~0.44 D,Bland-Altman图提示94.9%的数据分布在可信区间内;矢量分析结果显示,在角膜前表面,水平及垂直方向散光度数Pentacam测量值较Scansys测量值高约0.04 D,45°方向散光度数Pentacam测量值较Scansys测量值低约0.10 D,总屈光力Pentacam测量值较Scansys测量值高约0.30 D。结论Scansys测量的K2、Km及ACA与Pentacam相应测量值一致性较好,而在K1、Rm、ACD、CA、CCT、WTW、PD及ACV的测量中,两者存在一定差异,在不同的屈光手术方式选择中应结合不同方式的检测结果来综合分析。

Objective To evaluate the difference and consistency of biological parameters of anterior segment measured by two anterior segment analyzers:Scansys and Pentacam.Design Consistency evaluation study.Participants Randomly select 158 initial visit patients(158 eyes)who received myopia surgery at General Hospital of Central Theater Command in August 2022.The comparison will be based on the right eye.Methods The anterior segment biometric parameters were measured using both Scansys and Pentacam anterior segment analyzers by the same physician.The differences and agreements in the anterior segment biometric parameters were evaluated using the Bland-Altman method,while the comparison of corneal astigmatism(CA)was performed using vector analysis.Main Outcome Measures Parameters of anterior segment,including K1,K2,Km,Rm,CA,central corneal thickness(CCT),anterior chamber depth(ACD),corneal diameter(WTW),pupil diameter(PD),anterior chamber volume(ACV),anterior chamber angle(ACA).Results Compared to Pentacam,Scansys measured smaller values for K1,K2,Km,CCT,ACD,WTW,and ACV,while Rm,PD,and ACA were larger.The differences between the two instruments in measuring K1,K2,Km,Rm,CCT,ACD,WTW,PD,ACV,and ACA were(-0.12±0.19)D,(-0.15±0.20)D,(-0.13±0.16)D,(0.03±0.03)mm,(-17±7.0)μm,(-0.04±0.18)mm,(-0.36±0.14)mm,(0.36±0.45)mm,(-21±20)mm3,and(3.5±4.8)°,respectively.The 95%limits of agreement(95%LoA)were(-0.48~0.25)D,(-0.54~0.24)D,(-0.45~0.18)D,(-0.03~0.08)mm,(-31~-3.5)μm,(-0.38~0.30)mm,(-0.64~-0.08)mm,(-0.52~1.2)mm,(-61~19)mm3,and(-6~13)°,with 94.3%,95.6%,95.6%,93.0%,98.1%,94.9%,96.2%,96.2%,95.6%and 98.1%of the data falling within the confidence intervals.There were some differences in CA measurements between the two instruments,with a 95%LoA ranging from-0.51~0.44 D,and the Bland-Altman plot showing that 94.9%of the data fell within the confidence interval.The vector analysis results showed that on the anterior corneal surface,the horizontal and vertical astigmatism values measured by Pentacam were approximately 0.04 D higher than those measured by Scansys,while the 45°axis astigmatism value measured by Pentacam was approximately 0.10 D lower than that measured by Scansys.The total refractive power measured by Pentacam was approximately 0.30 D higher than that measured by Scansys.Conclusion Scansys has a good consistency with Pentacam on the measurement of K2,Km,CCT,WTW,PD,ACV and ACA.However,in the measurement of K1,Rm,ACD and CA,there are significantly differences between Scansys and Pentacam,which should be comprehensively analyzed combined with more examination results in the application of different refractive surgeries.