摘要
目的探讨可视化角膜生物力学分析仪(Corvis ST)联合Pentacam角膜地形图在圆锥角膜诊断中的意义。设计诊断试验。研究对象圆锥角膜患者36例(63眼),根据病情程度分为亚临床期圆锥角膜(SKC)组(21眼)和临床期圆锥角膜(KC)组(42眼);选取同时期接受角膜屈光手术的正常近视眼患者30例(60眼)作为对照组。方法每眼使用Corvis ST、Pentacam角膜地形图检查,得到Corvis生物力学指数(CBI)、角膜地形图和生物力学指数(TBI)及角膜地形图的Belin/Ambrosio综合偏差值(BAD-D)3个参数。采用方差分析、秩和检验对数据进行统计分析,依据受试者工作特征曲线(ROC)探寻各参数诊断阈值,再根据曲线下面积(AUC)评估各参数的诊断价值。主要指标CBI、BAD-D及TBI。结果 SKC组BAD-D(3.32±2.18)、TBI(0.76±0.32)高于对照组的(1.64±0.52)、(0.37±0.32)(P=0.040,P<0.001);KC组CBI(0.99±0.03)、BAD-D(13.00±8.21)、TBI(1.00±0.00)均高于对照组的(0.46±0.36)、(1.64±0.52)、(0.37±0.32)(P均<0.001)。在SKC组,BAD-D、TBI具有中等诊断效果,其诊断阈值分别为2.44、0.58,AUC分别为0.759(敏感度66.7%、特异度95.0%)、0.804(敏感度71.4%、特异度78.3%);在KC组,BAD-D、CBI、TBI均具有良好诊断效果,其诊断阈值分别为3.77、0.97、0.99,AUC分别为1.000(敏感度100%、特异度100%)、0.988(敏感度92.9%、特异度96.7%)、0.950(敏感度100%、特异度90.0%)。结论 TBI对亚临床期圆锥角膜的诊断效率最高,其次是BAD-D,而CBI对亚临床期圆锥角膜诊断效率不高;BAD-D、CBI和TBI对成熟期圆锥角膜都有良好诊断效果。(眼科,2019, 28:150-154)
Objective To investigate the role of combining corneal visualization Scheimpflug technology (Corvis ST) and Pentacam HR in the diagnosis of keratoconus. Design Diagnosis test. Participants Twenty-one eyes with diagnosis of subclinical keratoconus (SKC group), forty-two eyes with keratoconus (KC group) and sixty normal eyes (control group) were included. Methods Tomography and biomechanical parameters of all eyes were obtained with the Pentacam HR and Corvis ST (Oculus Optikgerate GmbH, Wetzlar, Germany), respectively. BAD-D, CBI (Corvis biomechanical index) and TBI (tomographic and biomechanical index) were compared between the KC group, SKC group and control group. ANOVA and Kruskal-Wallis H rank sum test were used for statistical analysis. The receiver operating characteristic (ROC) curves were plotted to distinguish keratoconus and subclinical keratoconus from normal controls. Main Outcome Measures CBI, BAD-D and TBI. Results BAD-D and TBI were significantly different between the SKC group and the control group (P<0.05 for each parameters). The cut-off point of BAD-D, TBI was 2.44 and 0.58, respectively. For these two parameters, the AUC value was 0.759 (sensitivity 66.7%, specificity 95.0%) and 0.804 (sensitivity 71.4%, specificity 78.3%), respectively. Three parameters were significantly different between the KC group and the control group (P<0.001 for each parameters). The cut-off point of BAD-D, CBI and TBI was 3.77, 0.97 and 0.99, respectively. For these three parameters, the AUC value was 1.000 (sensitivity 100%, specificity 100%), 0.988 (sensitivity 92.9%, specificity 96.7%) and 0.950 (sensitivity 100%, specificity 90.0%), respectively. Conclusion Among the three parameters, TBI has the highest sensitivity for detecting subclinical keratoconus, followed by BAD-D. But CBI was not useful in detecting subclinical keratoconus. All the three parameters, BAD-D, TBI and CBI have good diagnostic power for keratoconus.
作者
肖明
马代金
XIAO Ming;MA Dai-jin(Aier School of Ophthalmology,Central South University,Changsha 410015,China;Changsha Aier Eye Hospital,Changsha 410015,China)
出处
《眼科》
CAS
2019年第2期150-154,共5页
Ophthalmology in China
