3 OCT应用的可重复性
目前,应用于市场的OCT有很多种型号,包括各种适用于眼后节的和眼前节的各种波长和采用不同分析软件的OCT。国内外多有学者用不同的参数及参数所选用的不同数值对OCT的可重复性做出了评价。有报道称不同扫描记录的选择会影响OCT的检测结果和检测的可重复性[18]。Budenz等[19]采用类内相关系数(ICC)评价Stratus OCT测量正常眼和各期青光眼的可重复性。由同一操作者对每位受试者进行6次RNFL厚度测量,3次扫描按标准RNFL厚度方法记录,3种扫描按快速分类RNFL厚度方法记录,然后再交换两种记录方法。标准RNFL均值ICC在正常眼和青光眼分别是0.97(0.96CI)和0.98(0.97CI)。快速分类RNFL厚度均值ICC在二者分别是0.95(0.93CI)和0.97(0.95CI)。各象限RNFL厚度ICC波动于0.79~0.97。两种方法均显示鼻侧象限在4个象限中可重复性最小。结果表明使用Stratus OCT在青光眼中测量RNFL厚度有非常好的可重复性。Mohamed等[20]进行了ASOCT测量CCT的可重复性研究。结果显示测量者内的变异系数在正常组和白内障组分别<2%和3%,测量者间的变异系数在两组<2%和4%。类内相关系数在两组均>0.99和0.97。ASOCT测量CCT的一致性很高,中央和周围角膜厚度的测量是可重复的。香港学者Li等[21]评价了OCT测量前房角的可重复性。他们对25例正常受试者随机选择1眼,在1wk内完成3次OCT对前房角的检测。第1次检测中每只眼在室内灯下和暗室分别接受3次检测,第2,3次只分别接受1次检测。由同一测量者测试AOD和TIA,仅分析鼻侧象限的房角。测量的指标有同一时间测试和不同时间测试的AOD和TIA的标准差、精确度、变异系数和类内相关系数。结果,同一测试时间的室内灯光下AOD/TIA的以上指标是:45μm/24°,88μm/4.7°,5.8%/4.8%和0.97/0.95,暗室的AOD/TIA的指标是:45μm/2.1°,88μm/4.2°,7.0%/5.0%和0.98/0.97。不同测试时间室内灯光下AOD/TIA的指标是:79μm/3.5°,155μm/6.8°,10.0%/7.0%和0.91/0.89,暗室是:64μm/3.4°,124μm/6.4°,9.9%/7.8%和0.95/0.92。诸多数据分析可知,OCT测量前房角在不同的灯光条件下以及在不同的时间有很好的可重复性。
4小结
目前,OCT已广泛的应用于青光眼的诊断,尤其是对视网膜神经纤维层厚度和前房角的测量。各种型号机型,各种扫描记录方法和不同的图像分析软件不断的涌现。各种配置的OCT功能特性各异。将前、后节OCT结合,制定出一整套诊断青光眼的标准,提高青光眼的诊断水平,尚需进一步探索。
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