CAJ | 학술논문

目的比较Pentacam及OrbscanⅡ在正常人及各期圆锥角膜的测量值及形态学特点,并进一步分析两者早期筛查可疑圆锥角膜的敏感性及有效性.方法选取正常人196只眼、可疑圆锥角膜50只眼、完成期圆锥角膜73只眼,分别行两种角膜地形图检查.观察角膜前、后表面曲率、最佳拟合球面(BFS)、I-S值(Inferior-Superior)(3及5 mm)、高度图分类、高度值、角膜厚度等指标变化.采用单因素方差分析及秩和检验对数据进行统计学分析.结果 Pentacam和OrbscanⅡ测量正常人角膜后表面的Kmax分别为(-6.5±0.2)、(-6.7±0.8)D,Kmin分别为(-6.0±0.9)、(-6.1±0.5)D,差异有统计学意义(Z=-10.5,-5.1;P ＜0.05)；其他如角膜前后表面BFS、高度值、厚度值等的测量值Pentacam也较小.高度图形态Pentacam正常组、可疑组均以递减为主,其递增型前表面分别为14.4％ (28/196)及20.0％ (10/50),后表面为2.0％ (4/196)及26.0％(13/50);完成期组前表面91.7％(67/73)、后表面94.5％ (69/73)为递增型.Orbscan正常组80.4％(165/196)递增型,可疑、完成期圆锥角膜组全递增型.ROC曲线敏感指标及cutoff值:Orbscan角膜前、后表面I-S值(3 mm及5 mm)对可疑圆锥角膜的诊断灵敏,角膜前表面5 mm的cutoff值为1.15 D,后表面为0.65 D.Pentacam除I-S值敏感外,角膜前、后表面高度值亦具良好的诊断价值；角膜前表面高度cutoff值4.5 μm,角膜后表面7.5 μm.结论两仪器在正常人多个指标差异有统计学意义,Pentacam数值小.两仪器I-S值对可疑圆锥角膜筛查灵敏,而结合高度图形态及高度值Pentacam诊断价值更高,高度图递增型角膜前突危险增大.
목적 비교Pentacam급OrbscanⅡ재정상인급각기원추각막적측량치급형태학특점,병진일보분석량자조기사사가의원추각막적민감성급유효성.방법 선취정상인196지안、가의원추각막50지안、완성기원추각막73지안,분별행량충각막지형도검사.관찰각막전、후표면곡솔、최가의합구면(BFS)、I-S치(Inferior-Superior)(3급5 mm)、고도도분류、고도치、각막후도등지표변화.채용단인소방차분석급질화검험대수거진행통계학분석.결과 Pentacam화OrbscanⅡ측량정상인각막후표면적Kmax분별위(-6.5±0.2)、(-6.7±0.8)D,Kmin분별위(-6.0±0.9)、(-6.1±0.5)D,차이유통계학의의(Z=-10.5,-5.1;P ＜0.05)；기타여각막전후표면BFS、고도치、후도치등적측량치Pentacam야교소.고도도형태Pentacam정상조、가의조균이체감위주,기체증형전표면분별위14.4％ (28/196)급20.0％ (10/50),후표면위2.0％ (4/196)급26.0％(13/50);완성기조전표면91.7％(67/73)、후표면94.5％ (69/73)위체증형.Orbscan정상조80.4％(165/196)체증형,가의、완성기원추각막조전체증형.ROC곡선민감지표급cutoff치:Orbscan각막전、후표면I-S치(3 mm급5 mm)대가의원추각막적진단령민,각막전표면5 mm적cutoff치위1.15 D,후표면위0.65 D.Pentacam제I-S치민감외,각막전、후표면고도치역구량호적진단개치；각막전표면고도cutoff치4.5 μm,각막후표면7.5 μm.결론 량의기재정상인다개지표차이유통계학의의,Pentacam수치소.량의기I-S치대가의원추각막사사령민,이결합고도도형태급고도치Pentacam진단개치경고,고도도체증형각막전돌위험증대.
Objective To compare the sensitivity of Pentacam and Orbscan Ⅱ and to analyze the morphology characteristic of topography in normal eyes and different stages of keratoconus,to provide the basis for early screening of keratoconus suspects. Methods One hundred and ninety six normal eyes,50 eyes with keratoconus suspect and 73 eyes with clinical keratoconus were enrolled.The changes of corneal anterior/posterior curvature,best fitting sphere (BFS).Inferior-Superior value ( I-S ) ( 3 mm and 5 mm),classification of elevation maps and corneal thickness were measured. Results There were significant differences including posterior curvature,anterior/posterior BFS,elevation value and corneal thickness in normal eyes between the data measured by these two different instruments,values obtained by Pentacam were less than those by Orbscan.Concerning the elevation maps pattern,the progressively decreasing pattern was dominant in Pentacam with normal eyes and keratocomus suspects,with the progressively increasing pattern accounting for 14.4％ (28/196) and 20.0％ (10/50) respectively in anterior surface,and 2.0％ (41/96)and 26.0％ (13/50) in posterior surface.The progressively increasing pattern was in dominant with clinical keratoconus,accounting for 91.7％ (67/73) and 94.5％ (69/73) respectively in anterior and posterior surface.Progressively increasing pattern in Orbscan was presented in 80.4％ ( 165/196 ) normal eyes and suspected or clinical stage keratoconus.As to the receiver-operating-characteristic (ROC) curves and cutoff value,Orbscan I-S value (3 mm and 5 mm) of anterior and posterior surface was sensitive for the diagnosis of keratoconus suspects,with the cutoff value of anterior and posterior 5 mm I-S at 1.15 D and 0.65 D,respectively.In addition to the sensitivity of I-S values in Pentacam,the elevation value of anterior and posterior surface also displayed important diagnostic meaning. The cutoff of anterior,posterior elevation values was 4.5 μm and 7.5 μm,respectively. Conclusions Numerous measured indicators revealed obviously difference between the two instruments in normal eyes,with slightly smaller values in Pentacam.In addition to I-S values,pattern changes and elevation values in elevation map of Pentacam represent remarkable advantages for the screening of keratoconus suspects. There is an incremental risk of corneal ectasia in the increasing pattern of elevation map.