【摘要】 目的：验证动态轮廓眼压计（DCT）的临床性能。方法：对81例143眼青光眼及可疑病例青光眼患者用DCT测量眼内压（IOP）；132眼同时用Goldmann压平眼压计（GAT）测量眼压，部分病例同时用NIDEK UP1000型角膜测厚仪测量中央角膜厚度（CCT）。GAT与DCT测量结果采用配对t检验，GAT、DCT测量值与CCT的关系及DCT测量值与眼脉动振幅（OPA）的相关关系采用Spearman双变量相关分析。结果：①DCT和GAT测得的眼压均数分别为(18.6±3.9)mmHg和(17.4±4.1)mmHg；DCT测得的眼压值高于GAT，其差值均数为（1.1±2.3）mmHg；两种眼压计测得的眼压值呈正相关（r=0.83,P<0.01）。②116眼同时完成了DCT眼压测量及CCT测量，两者相关系数r=0.03,P=0.77；113眼同时完成了GAT眼压测量及CCT测量，两者相关系数r=0.28,P=0.003。③143眼同时记录了DCT眼压值和眼脉动振幅（OPA），其均数分别为(18.6±3.9)mmHg和(2.6±1.1)mmHg，两者的相关系数r=0.32,P<0.01。结论：以上结果初步证实:①DCT眼压计测量值与GAT眼压测量值高度相关，但DCT测量值略高于GAT测量值，提示DCT可用于临床诊断。②DCT测量值与CCT不相关，GAT测量值与CCT显著相关，提示DCT在青光眼诊断中有独特优势。③DCT测量的OPA与IOP值显著相关，相关的机制及临床意义有待探讨。
【关键词】 眼压测量；动态轮廓眼压计；Goldmann压平眼压计；中央角膜厚度
Preliminary report on use of dynamic contour tonometer in clinic
Jin Wang, HeZheng Zhou, Fan Yang3, Bo Zeng
1Southern Medical University, Guangzhou 510515, Guangdong Province, China;2Department of Ophthalmology, Wuhan General Hospital of Guangzhou Military Command, Wuhan 430070, Hubei Province, China;3 95091 Troop, Zhongxiang 431917, Hubei Province, China
Correspondence to: HeZheng Zhou. Department of Ophthalmology, Wuhan General Hospital of Guangzhou Military Command, Wuhan 430070, Hubei Province, China. [email protected]
Abstract AIM: To validate the clinical natures of dynamic contour tonometer (DCT).METHODS: Intraocular pressure (IOP) obtained by DCT on 143 eyes of 81 patients who were diagnosed glaucoma or suspected glaucoma; 132 eyes had a measurement of IOP by Goldmann Applanation Tonometer (GAT) simultaneously. Otherwise, central cornea thickness (CCT) was measured by NIEDK UP1000 on some eyes. The IOP measurements of DCT and GAT were compared by pairedsamples ttest. The relationship of DCTCCT, GATCCT and DCTOPA (ocular pulse amplitude) adopted the Spearman bivariate analysis.RESULTS: There was a positive correlation between the IOP readings obtained by DCT and GAT (r=0.83, P<0.01). However, IOP readings were consistently higher with DCT than those with GAT (mean difference:1.1±2.3 mmHg). 116 eyes underwent DCT and CCT measurements (r=0.03, P=0.77) while 113 eyes underwent GAT and CCT measurements simultaneously (r=0.28, P=0.003). The ocular pulse amplitude (OPA) readings had a significant correlation with IOP readings by DCT (r=0.32,P<0.01). CONCLUSION: IOP measurements by DCT are highly correlated with IOP readings obtained from GAT but have no correlation with CCT. DCT has unique advantages in the diagnosis of glaucoma and DCT seems to be an appropriate method of tonometry for routine clinical use.
KEYWORDS: intraocular pressure measurement; dynamic contour tonometer; goldmann applanation tonometer; central cornea thickness
引言
眼压（intraocular pressure， IOP）升高是青光眼发病的主要危险因素，眼压测量在青光眼的诊治中占有特别重要的地位[1]；测定眼压的方法和工具很多，既往认为Goldmann压平眼压计（goldmann applanation tonometer,GAT）是眼压测量的金标准，但中央角膜厚度（central corneal thickness ,CCT）对GAT眼压测量值有重大影响的事实使得GAT的金标准地位发生了动摇[2]。新近研发的动态轮廓眼压计（dynamic contour tonometer，DCT）采用轮廓匹配原理和压力传感器来测量眼压，理论上可克服GAT的缺陷[3]。为验证DCT的临床性能，我们进行了以下研究。
1对象和方法
1.1对象
200704/10就诊我院，并确诊为青光眼患者36例59眼及可疑青光眼45例84眼，其中男41例，女40例；年龄12～78（平均46.4±19.4）岁。
1.2方法
入选病例均取坐位，4g/L倍诺喜（盐酸奥布卡因滴眼液）行表面麻醉，调整坐姿至合适位置并告知患者注视方向。采用瑞士Ziemer公司生产的PASCAL DCT和瑞士产GAT进行眼压测量。根据患者的就诊次序采用随机数法由两名眼科专业技术人员分别对其进行不同仪器的眼压测量，测量的时间间隔为5～10min。DCT测量时通过无线打印机记录IOP值和眼脉动振幅（ocular pulse amplitude，OPA），GAT用手工记录其测量结果。DCT测量过程中若连续3次测量均未取得满意的测量值（Q>3）则休息5min后重新测量；GAT取3个差值≤2mmHg的测量值的均数作为测量结果。部分病例于眼压测量后1wk内用NIDEK UP－1000型角膜测厚仪测定CCT。数据纳入标准：(1)经普通视力、裂隙灯、眼底、眼压、视野、前房角镜、UBM等检查确诊为青光眼患者：包括原发性开角型、闭角型青光眼33例55眼，激素性青光眼2例3眼，晶状体溶解性青光眼1例1眼；(2)将有以下表现之一者列为可疑青光眼[4]：①青光眼家族史；②青光眼症状史，如眼胀、头痛、虹视及一过性视物模糊；③眼压≥22mmHg，或双眼眼压之差≥5mmHg；④杯盘比值(C/D)≥0.5，或双眼杯盘比之差≥0.2；⑤前房浅，周边前房深度<1/4CT。(3)DCT测量过程中Q≤3。
统计学处理：所有数据均采用SPSS11.5统计软件进行分析，DCT与GAT眼压测量值的比较采用配对t检验，DCT、GAT眼压测量值与CCT的相关性及DCT与OPA测量值的相关性采用Spearman双变量相关分析。
2结果
2.1 DCT和GAT眼压测量结果的比较
DCT和GAT测得的眼压均数分别为(18.6±3.9)mmHg和(17.4±4.1)mmHg；DCT测得的眼压值高于GAT，其差值均数为1.1mmHg；图1显示两种眼压计测得的眼压值高度相关（r=0.83,P<0.01）。
2.2 DCT、GAT眼压测量结果与CCT的相关分析
116眼同时完成了DCT眼压测量及CCT测量，两者相关系数r=0.03,P=0.77；113眼同时完成了GAT眼压测量及CCT测量，两者相关系数r=0.28,P=0.003。统计结果表明DCT的眼压测量值与CCT不相关；而GAT的眼压测量值与CCT显著相关。
2.3 DCT眼压测量值与OPA的相关分析
143眼同时记录了DCT眼压值和眼脉动振幅（OPA），其均数分别为(18.6±3.9)mmHg和(2.6±1.1)mmHg，两者的相关系数r=0.32,P<0.01。统计结果表明DCT眼压测量值与OPA值显著相关。
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