背景 新型眼前节分析系统Sirius是结合单Scheimpflug成像与Placido盘的原理用于观察眼前节结构的设备,已用于眼科临床,但目前尚缺乏其与Pentacam系统重复性和一致性的对比研究. 目的 分析新型三维眼前节分析仪Sirius与Pentacam系统测最准分子激光角膜原位磨镶术(LASIK)术后角膜曲率、角膜厚度、前房深度(ACD)及前房容积(ACV)的重复性、差异性、相关性及一致性,为临床使用提供依据.方法 选取2010年5-7月在温州医学院眼视光医院屈光手术中心行LASIK术后的患者35例35眼,分别应用Sirius和Pentacam系统对受试眼的平坦子午线角膜曲率(Kf)值、陡峭子午线角膜曲率(Ks)值,平均SimK(Km)值,角膜最薄点厚度(TCT)及位置,中央ACD及ACV进行测量,并对结果进行统计学分析. 结果 Sirius和Pentacam测量LASIK术后患者眼前节参数具有高度的重复性,除角膜最薄点的位置坐标(X,Y)外,其他参数的组内相关系数(ICC)和克隆巴赫系数(CoA)均大于0.90.测量角膜曲率Kf、Ks时,两种方法测量的结果差异均无统计学意义(t=-1.533、-1.750,P＞0.05).Sirius测量的Km值为(39.14±1.95)D,高于Pentacam测量的(39.05±1.91)D,二者间差异有统计学意义(t=3.572,P=0.001).Sirius测量的TCT为(457.6±40.9)μm,明显低于Pentacam测量的(465.4±37.5) μm,差异有统计学意义(t=-6.689,P＜0.001),二者的测量值呈明显正相关(r=0.988,P＜0.001),Bland-Altman分析的TCT 95％可信区间(CI)为-21 ～6 μm.两种测量系统测得的角膜最薄点定位X、Y的值差异均有统计学意义(t=-4.132、-5.696,P＜0.001),但二者的相关性均一般(r=0.751、0.775,P＜0.001),95％Cl亦较宽(-0.36 ～0.17 mm,-0.35～0.12mm).两种测量方法测量ACD和ACV值的差异均有统计学意义(t=9.103、-7.378,P＜0.001),Bland-Altman一致性分析显示,两种测量方法测量的ACD结果一致性较好,95％CI为-0.02 ～0.12 mm,而测量ACV时二者的结果一致性欠佳,95％CI为-27.70～6.20 mm3. 结论 Sirius和Pentacam测量LASIK术后眼前房参数结果的重复性和稳定性好,此外两种方法测量的角膜曲率、角膜厚度和ACD具有很好的一致性,两种测量结果的差异在临床上可以接受,二者可以互相替代使用,但在测量角膜最薄点位置及ACV时两种方法的测量结果差异较大,临床上相互替代使用时需谨慎.%Background Sirius system,a new Scheimpflug camera combined with Placido topography,improved the capability of imaging the anterior eye segment significantly.However,the study of assessing the repeatability and agreement between Sirius and Pentacam is still lack up to now.Objective This study was to evaluate the repeatability and agreement of the anterior ocular segment measuring parameters by Sirius and Pentacam in myopia received laser in situ keratomileusis (LASIK).Methods Thirty-five myopic eyes of 35 patients received LASIK were included in School of Optometry and Ophthalmology Eye Hospital from 2010 May through 2010 July.Corneal power flat keratometry (Kf),step keratometry (Ks),mean keratometry (Km),thinnest corneal thickness(TCT),the location of TCT,anterior chamber depth (ACD) and anterior chamber volume (ACV) were measured by Sirius and Pentacam in all the eyes,respectively.The repeatability of the measuring results were evaluated using intraclass correlation coefficients (ICC) and Cronbach's coefficient alpha (CoA),and the agreement of measuring parameters between Sirius and Pentacam was analyzed using Bland-Altman plot.Results Both Sirius and Pentacam demonstrated high intraobserver repeatability,with all ICC and CoA more than 0.90.No significant differences were found in Kf values and Ks values between the two methods (t =-1.533,-1.750,P＞0.05).Km value was (39.14 ± 1.95) D by Sirius measurement,which was sígnificantly higher than (39.05 ± 1.91) D by Pentacam measurement (t =3.572,P =0.001).The TCT was (457.6 ± 40.9) μm by Sirius method,showing a significant reduce in comparison with (465.4±37.5) μm of Pentacam method (t =-6.689,P＜0.001).A positive correlation was seen in the TCT between the two methods (r=0.988,P＜0.001).The Bland-Alrman plots showed the 95％ CI-21 μm to 6 pm in the TCT value between the two devices.Pairwise comparison of the location of TCT measurements showed significant differences between the two devices (t =-4.132,-5.696,P＜0.001),with a good correlation (r=0.751,0.775) and the 95％ CI (-0.36-0.17 mm,-0.35-0.12 mm).A very good agreement was seen in ACD between the two devices (-0.02-0.12 mm),but the agreement result was not very well in the ACV between the two devices with the 95％ CI (-27.70-6.20 mm3).Conclusions Sirius and Pentacam measurements for anterior ocular segment parameters have a very good repeatability in post-LASIK eyes.In addition,good agreement results are exhibited in corneal power,TCT and ACD between Sirius and Pentacam with an acceptable maximal different value between them.Sirius and Pentacam can be used interchangeably in clinical examination.However,the two devices can not interchangeably for ACV measurement and TCT location.
展开▼
