五种眼压计测量眼压的一致性比较及其与角膜生物力学的相关性

目的 比较非接触眼压计（气流眼压）、Goldmann压平眼压计（压平眼压）、Icare pro回弹眼压计（回弹眼压）、Tono-pen AVIA眼压计（笔式眼压）和可视化角膜生物力学分析仪（生物力学眼压）测量眼压的一致性，进一步分析眼压和角膜生物力学的相关性。设计 诊断方法评价。研究对象 健康志愿者44例。方法 同一医师每天同一时段分别应用上述五种眼压计测量受试者的左眼眼压。将眼压与中央角膜厚度、角膜第一压平时间进行Pearson相关分析。主要指标 眼压值、眼压差值的平均值、相关系数。结果 压平眼压、气流眼压、回弹眼压、笔式眼压和生物力学眼压5种眼压结果分别为（15.9±3.3）mmHg、（14.8±2.9）mmHg、（16.9±3.3）mmHg、（14.7±2.5）mmHg和（16.1±3.0）mmHg。其中，气流眼压、笔式眼压较压平眼压低（P=0.01，0.00）。气流眼压、回弹眼压、笔式眼压、生物力学眼压均与压平眼压正相关（r=0.63、0.37、0.63、0.55，P均＜0.05）；Bland-Altman分析两种测量方式眼压差值平均值分别为：气流眼压与压平眼压：-1.1 mmHg 95%一致性界限（95% LoA）为-6.4，4.2]，笔式眼压与压平眼压：-1.2 mmHg（95% LoA -6.3，3.9），回弹眼压与压平眼压：1.0 mmHg（95% LoA为-6.2，8.3），生物力学眼压与压平眼压：0.3 mmHg（95% LoA为-5.6，6.2）。所有研究对象中央角膜厚度（550.5±29.2）μm，角膜第一压平时间（7.63±0.36）ms。笔式眼压和中央角膜厚度呈正相关（r=0.40，P=0.01）。五种测试的眼压均与角膜第一压平时间呈正相关（r=0.53，0.64，0.55，0.46，0.99；P均＜0.05）。结论 Icare pro和Corvis ST测量眼压与Goldmann眼压计无明显差异，气流眼压、笔式眼压较压平眼压略低，Corvis ST与Goldmann眼压一致性最好。角膜第一压平时间是影响眼压测量结果的重要因素，时间越长，眼压测量值越高。（眼科， 2020， 29： 365-369）

Comparison of five devices to measure intraocular pressure and analysis correlation with corneal biomechanical properties

Objective To compare consistency of five methods of tomometry in normal subjects: non-contact tonometer (NCT), Goldmann applanation tonometer (GAT), Icare pro rebound tonometer (RBT), Tono-pen AVIA tonometer (TPT) and corneal visualization scheimpflug technology (CST), and to analyze the correlation between intraocular pressure (IOP) and corneal biomechanical properties. Design Diagnostic methods evaluation. Participants 44 healthy volunteers. Method All volunteers were measured IOP with five tomomers by one same doctor at the same time. Central cornea thickness（CCT） and cornea first applanation time (Time A1) were measured by CST. The IOP difference was measured by one way ANOVA and paired t test. Consistency test were measured with Bland-Altman test. The correlation between IOP and the CCT or Time A1 was analyzed with Pearson test. Main Outcome Measures IOP, average value of IOP differences, correlation coefficient. Results The mean IOP with the GAT, NCT, RBT, TPT, CST was 15.9±3.3 mmHg, 14.8±2.9 mmHg, 16.9±3.3 mmHg, 14.7±2.5 mmHg, and 16.1±3.0 mmHg, respectively. There was a statistically significant difference between NCT and GTA, TPT and GAT (P=0.01, 0.00). There was no statistically significant difference between RBT and GAT, CST and GAT(all P＞0.05). Greater NCT, TPT, RBT and CST were significantly associated with greater GAT(r=0.63, 0.37, 0.63, 0.55； all P＜0.05). Bland-Altman analysis showed that between NCT and GAT the 95% limits of agreement（95% LoA）were (-6.4, 4.2) mmHg, the mean difference were -1.1 mmHg; that between TPT and GAT the 95% LoA were (-6.3, 3.9) mmHg, the mean difference were -1.2 mmHg; that between RBT and GAT, the 95% LoA were (-6.2, 8.3) mmHg, the mean difference were 1.0 mmHg; that between CST and GAT, the 95% LoA were (-5.6, 6.2) mmHg, the mean difference were 0.3 mmHg. The mean CCT was 550.5±29.2 μm. The mean time A1 was 7.63±0.36 ms. Greater TPT significantly associated with greater CCT (r=0.40, P=0.01). Greater GAT, NCT, RBT, TPT and CST significantly associated with greater TIME A1 (r=0.53, 0.64, 0.55, 0.46, 0.99； all P＜0.05). Conclusions RBT and CST have no significant difference with GAT. NCT and TPT are slightly lower than GAT. CST has the best consistency with GAT. TIME A1 is an important factor that affects intraocular pressure measurement. Greater TIME A1 associates with greater intraocular pressure value. (Ophthalmol CHN, 2020, 29: 365-369)