中华眼视光学与视觉科学杂志
中華眼視光學與視覺科學雜誌
중화안시광학여시각과학잡지
CHINESE JOURNAL OF OPTOMETRY OPHTHALMOLOGY AND VISUAL SCIENCE
2013年
3期
150-155
,共6页
体层摄影术,光学相干%角膜磨镶术,激光原位%角膜曲率%角膜厚度%重复性%一致性
體層攝影術,光學相榦%角膜磨鑲術,激光原位%角膜麯率%角膜厚度%重複性%一緻性
체층섭영술,광학상간%각막마양술,격광원위%각막곡솔%각막후도%중복성%일치성
Tomography,optical coherence%Keratomileusis,laser in situ%Corneal curvature%Corneal thickness%Repeatability%Agreement
目的 研究RTVue傅立叶域光学相干断层扫描仪(FD-OCT)测量准分子激光原位角膜磨镶术(LASIK)后角膜参数的重复性与准确性.方法 前瞻性研究.接受LASIK手术者58例(58眼),均选择右眼进行研究,术前及术后3个月行主觉验光.术前IOL Master测量角膜屈光力,术后3个月使用RTVue FD-OCT测量角膜中央3 mm直径范围内前表面曲率半径(Ranterior)、后表面曲率半径(Rposterior)、角膜后前表面曲率半径之比(Rposterior/Ranterior)、角膜中央厚度(CCT)、角膜总屈光力(Knet)、模拟角膜屈光力(SimK)、角膜前表面屈光力(Kanterior)、角膜后表面屈光力(Kposterior),IOL Master获得的角膜屈光力(Km),临床病史法计算LASIK术后角膜总屈光力(Kchm).连续测量3次.采用变异系数(CV)、Cronbach's Alpha系数及组内相关系数(ICC)评估重复性;Bonfferroni校正的多重比较分析SimK、Knet、Km与Kchm之间的差异;Pearson相关分析SimK、Knet、Km与Kchm之间的相关性;Bland-Altman分析SimK与Kchm,Knet与Kchm,Km与Kchm,SimK与Knet,SimK与Km一致性并计算95％一致性界限范围(LoA).结果 Ranterior、Rposterior、Rposterior/Ranterior、Kanterior、Kposterior、SimK、Knet和CCT分别为(8.560±0.292)mm、(6.525±0.159)mm、0.763±0.024、(43.98±1.48)D、(-6.13±0.15)D、(39.47±1.33)D、(37.93±1.42)D和(451.81±33.91)μm,各参数CV均小于1％,各参数Cronbach's Alpha系数和ICC均大于0.9.SimK比Kchm大(0.434±0.433)D,Knet比Kchm小(1.112±0.471)D,Km比Kohm大(0.334±0.379)D,SimK比Knet大(1.546±0.162)D,差异均有统计学意义(P＜0.01);SimK比Km大(0.100±0.287)D,差异无统计学意义.Pearson相关分析,SimK、Knet、Km、Kchm相互间均具有密切的相关性(r均≥0.944,P＜0.01).Bland-Alrman图分析SimK与Kchm,Knet与Kchm,Km与Kchm,SimK与Knet,SimK与Km差值的95％一致性区间分别为-0.41～1.28 D,-2.04～-1.11 D,-0.41～1.08 D,1.23～1.86 D,-0.46～0.66 D.结论 RTVue FD-OCT测量LASIK术后角膜曲率和中央角膜厚度具有良好的重复性;RTVue FD-OCT和IOL Master获得的LASIK术后模拟角膜屈光力比临床病史法获得的理论角膜总屈光力略大0.3～0.4 D;Knet可能是评估LASIK术后角膜屈光力的较准确方法,但用于LASIK术后人工晶状体屈光力的预测,还需进一步的临床研究.
目的 研究RTVue傅立葉域光學相榦斷層掃描儀(FD-OCT)測量準分子激光原位角膜磨鑲術(LASIK)後角膜參數的重複性與準確性.方法 前瞻性研究.接受LASIK手術者58例(58眼),均選擇右眼進行研究,術前及術後3箇月行主覺驗光.術前IOL Master測量角膜屈光力,術後3箇月使用RTVue FD-OCT測量角膜中央3 mm直徑範圍內前錶麵麯率半徑(Ranterior)、後錶麵麯率半徑(Rposterior)、角膜後前錶麵麯率半徑之比(Rposterior/Ranterior)、角膜中央厚度(CCT)、角膜總屈光力(Knet)、模擬角膜屈光力(SimK)、角膜前錶麵屈光力(Kanterior)、角膜後錶麵屈光力(Kposterior),IOL Master穫得的角膜屈光力(Km),臨床病史法計算LASIK術後角膜總屈光力(Kchm).連續測量3次.採用變異繫數(CV)、Cronbach's Alpha繫數及組內相關繫數(ICC)評估重複性;Bonfferroni校正的多重比較分析SimK、Knet、Km與Kchm之間的差異;Pearson相關分析SimK、Knet、Km與Kchm之間的相關性;Bland-Altman分析SimK與Kchm,Knet與Kchm,Km與Kchm,SimK與Knet,SimK與Km一緻性併計算95％一緻性界限範圍(LoA).結果 Ranterior、Rposterior、Rposterior/Ranterior、Kanterior、Kposterior、SimK、Knet和CCT分彆為(8.560±0.292)mm、(6.525±0.159)mm、0.763±0.024、(43.98±1.48)D、(-6.13±0.15)D、(39.47±1.33)D、(37.93±1.42)D和(451.81±33.91)μm,各參數CV均小于1％,各參數Cronbach's Alpha繫數和ICC均大于0.9.SimK比Kchm大(0.434±0.433)D,Knet比Kchm小(1.112±0.471)D,Km比Kohm大(0.334±0.379)D,SimK比Knet大(1.546±0.162)D,差異均有統計學意義(P＜0.01);SimK比Km大(0.100±0.287)D,差異無統計學意義.Pearson相關分析,SimK、Knet、Km、Kchm相互間均具有密切的相關性(r均≥0.944,P＜0.01).Bland-Alrman圖分析SimK與Kchm,Knet與Kchm,Km與Kchm,SimK與Knet,SimK與Km差值的95％一緻性區間分彆為-0.41～1.28 D,-2.04～-1.11 D,-0.41～1.08 D,1.23～1.86 D,-0.46～0.66 D.結論 RTVue FD-OCT測量LASIK術後角膜麯率和中央角膜厚度具有良好的重複性;RTVue FD-OCT和IOL Master穫得的LASIK術後模擬角膜屈光力比臨床病史法穫得的理論角膜總屈光力略大0.3～0.4 D;Knet可能是評估LASIK術後角膜屈光力的較準確方法,但用于LASIK術後人工晶狀體屈光力的預測,還需進一步的臨床研究.
목적 연구RTVue부립협역광학상간단층소묘의(FD-OCT)측량준분자격광원위각막마양술(LASIK)후각막삼수적중복성여준학성.방법 전첨성연구.접수LASIK수술자58례(58안),균선택우안진행연구,술전급술후3개월행주각험광.술전IOL Master측량각막굴광력,술후3개월사용RTVue FD-OCT측량각막중앙3 mm직경범위내전표면곡솔반경(Ranterior)、후표면곡솔반경(Rposterior)、각막후전표면곡솔반경지비(Rposterior/Ranterior)、각막중앙후도(CCT)、각막총굴광력(Knet)、모의각막굴광력(SimK)、각막전표면굴광력(Kanterior)、각막후표면굴광력(Kposterior),IOL Master획득적각막굴광력(Km),림상병사법계산LASIK술후각막총굴광력(Kchm).련속측량3차.채용변이계수(CV)、Cronbach's Alpha계수급조내상관계수(ICC)평고중복성;Bonfferroni교정적다중비교분석SimK、Knet、Km여Kchm지간적차이;Pearson상관분석SimK、Knet、Km여Kchm지간적상관성;Bland-Altman분석SimK여Kchm,Knet여Kchm,Km여Kchm,SimK여Knet,SimK여Km일치성병계산95％일치성계한범위(LoA).결과 Ranterior、Rposterior、Rposterior/Ranterior、Kanterior、Kposterior、SimK、Knet화CCT분별위(8.560±0.292)mm、(6.525±0.159)mm、0.763±0.024、(43.98±1.48)D、(-6.13±0.15)D、(39.47±1.33)D、(37.93±1.42)D화(451.81±33.91)μm,각삼수CV균소우1％,각삼수Cronbach's Alpha계수화ICC균대우0.9.SimK비Kchm대(0.434±0.433)D,Knet비Kchm소(1.112±0.471)D,Km비Kohm대(0.334±0.379)D,SimK비Knet대(1.546±0.162)D,차이균유통계학의의(P＜0.01);SimK비Km대(0.100±0.287)D,차이무통계학의의.Pearson상관분석,SimK、Knet、Km、Kchm상호간균구유밀절적상관성(r균≥0.944,P＜0.01).Bland-Alrman도분석SimK여Kchm,Knet여Kchm,Km여Kchm,SimK여Knet,SimK여Km차치적95％일치성구간분별위-0.41～1.28 D,-2.04～-1.11 D,-0.41～1.08 D,1.23～1.86 D,-0.46～0.66 D.결론 RTVue FD-OCT측량LASIK술후각막곡솔화중앙각막후도구유량호적중복성;RTVue FD-OCT화IOL Master획득적LASIK술후모의각막굴광력비림상병사법획득적이론각막총굴광력략대0.3～0.4 D;Knet가능시평고LASIK술후각막굴광력적교준학방법,단용우LASIK술후인공정상체굴광력적예측,환수진일보적림상연구.
Objective To evaluate the repeatability and accuracy of corneal parameters in post-laser in situ keratomileusis (LASIK) eyes obtained by RTVue Fourier-domain optical coherence topography (FD-OCT).Methods In this prospective study,58 right eyes of 58 persons who agreed to undergo LASIK were included.Subjective refractions were performed before LASIK and 3 months after LASIK.IOL Master was used to evaluate corneal power before LASIK.Three months after LASIK,RTVue FD-OCT was used to evaluate the anterior corneal curvature in a 3 mm central zone (Ranterior),posterior corneal curvature in a 3 mm zone (Rposterior),the ratio of posterior and anterior curvature (Rposterior/Ranterior),central corneal thickness (CCT),total corneal power (Knet),simulated corneal power (SimK),anterior corneal power (Kanterior),and posterior corneal power (Kposterior).Km was obtained with IOL Master 3 months after the surgery.Kchm was calculated from the patient's clinical history.Repeatability of corneal parameters was assessed using the coefficient of variation (CV),Cronbach's alpha,and intra-class correlation coefficient (ICC).Bonferroni corrected multiple comparisons analyzed the differences between SimK,Knet,Km and Kchm.A Pearson correlation analyzed the correlations between SimK,Knet,Km and Kchm.Bland-Altman plots analyzed the agreements between SimK and Kchm,Knet and Kchm,Km and Kchm,SimK and Knet,and SimK and Km.Results The Ranterior,Rposterior,Rposterior/Ranterior,Kanterior,Kposterior,SimK,Knet and CCT were (8.560±0.292)mm,(6.525±0.159)mm,0.763±0.024,(43.98±1.48)D,(-6.13±0.15)D,(39.47±1.33)D,(37.93±1.42)D and (451.81±33.91)μm,respectively.The CVs of all parameters were lower than 1％.Cronbach's alpha and ICC were both higher than 0.9.SimK was (0.434±0.433)D higher than Kchm Knet was (1.112±0.471)D lower than Kchm,Km was (0.334±0.379)D higher than Kchm,and SimK was (1.546±0.162)D higher than Kchm.All the differences were statistically significant (P＜0.01).SimK was (0.100±0.287)D higher than Km but the difference was not statistically significant.There were close correlations among SimK,Knet,Km and Kchm (r≥0.944,P＜0.01).The Bland-Altman analysis showed that the 95％ limit of agreements between SimK and Kchm,Knet and Kchm,Km and Kchm,SimK and Knet,and SimK and Km were-0.41～1.28 D,-2.04～-1.11 D,-0.41～1.08 D,1.23～1.86 D,-0.46～0.66 D,respectively.Conclusion The RTVue Fourier-domain OCT had high repeatability on corneal curvature and CCT measurements in post-LASIK eyes.The SimK obtained by RTVue Fourier-domain OCT and IOL Master were 0.3 to 0.4 D higher than those obtained by clinical history.Knet may be a more accurate method to assess corneal power in post-LASIK eyes,but further clinical studies are needed for the prediction of post-LASIK intraocular lens power.
