两种频域眼前节OCT测量角膜厚度和角膜上皮厚度的差异和一致性比较

王闯; 王浩; 庞辰久

doi:10.3760/cma.j.cn115989-20210209-00104

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中华实验眼科杂志

• 临床研究 •

ENGLISH ABSTRACT

两种频域眼前节OCT测量角膜厚度和角膜上皮厚度的差异和一致性比较

作者及单位信息

出版日期： 2022 -02 -10 ·

DOI： 10.3760/cma.j.cn115989-20210209-00104

Differences in corneal thickness and corneal epithelial thickness measured by two kinds of frequency domain anterior segment OCT and the consistency between them

Authors Info & Affiliations

Wang Chuang

Department of Ophthalmology, People's Hospital of Henan University, Henan Provincial People's Hospital, Henan Eye Hospital, Zhengzhou 450003, China

Wang Hao

Department of Ophthalmology, People's Hospital of Henan University, Henan Provincial People's Hospital, Henan Eye Hospital, Zhengzhou 450003, China

Pang Chenjiu

Department of Ophthalmology, People's Hospital of Henan University, Henan Provincial People's Hospital, Henan Eye Hospital, Zhengzhou 450003, China

Published： 2022 -02 -10 ·

DOI： 10.3760/cma.j.cn115989-20210209-00104

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摘要

目的比较2种高分辨率频域眼前节光相干断层扫描(OCT)RTVue XR-OCT和Cirrus 5000 HD-OCT测量角膜厚度和角膜上皮厚度的差异和一致性。

方法采用横断面研究方法，选取2019年7—9月于河南省立眼科医院就诊的近视及近视散光患者52例52眼，由同一检查者分别使用RTVue XR-OCT和Cirrus 5000 HD-OCT测量角膜中央直径0~2 mm范围中心区(C区)，距角膜中央2~5 mm范围内上方(S区)、鼻上方(SN区)、鼻侧(N区)、鼻下方(IN区)、下方(I区)、颞下方(IT区)、颞侧(T区)及颞上方(ST区)的角膜厚度和角膜上皮厚度，比较2种眼前节OCT测量相应区域的角膜厚度和角膜上皮厚度的差异，分析其相关性和一致性。

结果RTVue XR-OCT测量角膜C区、S区、SN区、N区、IN区、I区、IT区、T区和ST区的角膜厚度分别为(521.73±29.85)、(554.31±32.38)、(553.54±33.30)、(546.96±32.05)、(537.54±32.10)、(532.13±31.51)、(528.42±30.38)、(532.25±30.08)和(544.85±30.70)μm，Cirrus 5000 HD-OCT测量的各区域角膜厚度分别为(526.77±30.62)、(555.13±33.32)、(558.08±32.57)、(554.46±31.42)、(548.29±31.84)、(539.69±32.74)、(536.19±32.40)、(533.38±31.90)和(543.83±32.02)μm，2种OCT测量各个区域的角膜厚度差异均无统计学意义(均 P>0.05)；2种OCT测量的各区域角膜厚度值均呈强的正相关( r＝0.99、0.89、0.95、0.97、0.95、0.93、0.96、0.97、0.92，均 P<0.01)；Bland-Altman分析显示，2种OCT测量角膜厚度具有良好的一致性。RTVue XR-OCT测量的各区域角膜上皮厚度分别为(52.06±3.26)、(52.58±3.48)、(53.06±3.56)、(53.75±3.49)、(53.81±3.40)、(53.48±3.35)、(52.96±3.32)、(52.67±3.19)和(53.12±3.15)μm，Cirrus 5000 HD-OCT测量结果分别为(46.75±3.25)、(47.40±3.36)、(47.58±3.64)、(48.85±4.48)、(48.46±4.54)、(48.40±4.96)、(48.06±5.12)、(47.46±3.91)和(48.79±3.90)μm，2种OCT测量的各区域角膜上皮厚度比较差异均有统计学意义(均 P<0.05)；2种OCT测量的各区域角膜上皮厚度均无明显相关性( r＝0.17、0.08、0.16、0.28、0.20、0.24、0.19、0.21、0.13，均 P>0.05)；Bland-Altman分析显示，2种OCT测量角膜上皮厚度的一致性欠佳。

结论RTVue XR-OCT和Cirrus 5000 HD-OCT对角膜厚度测量差异较小，一致性较高，可相互替代；对角膜上皮厚度测量差异较大，一致性较差，不可相互替代。

关键词：角膜;角膜上皮;厚度;眼前节;光相干断层扫描;差异性;一致性

ABSTRACT

ObjectiveTo investigate the differences in corneal thickness and corneal epithelial thickness measurements by two kinds of high-resolution frequency domain anterior segment optical coherence tomography (OCT), RTVue XR-OCT and Cirrus 5000 HD-OCT, and to analyze the consistency between them.

MethodsA cross-sectional study was conducted.Fifty-two patients (52 eyes) who were admitted to Henan Eye Hospital from July to September 2019 were enrolled.The corneal thickness and corneal epithelial thickness in various areas including the central area (C area) (2-mm diameter), and 8 concentric corneal areas of 2 to 5-mm diameter, which were the superior area (S area), the superior nasal (SN area), the nasal side area (N area), the inferior nasal area (IN area), the inferior area (I area), the inferior temporal area (IT area), the temporal area (T area) and the superior temporal area (ST area) above the temporal, were measured by the same examiner using RTVue XR-OCT and Cirrus 5000 HD-OCT.The corneal thickness and corneal epithelial thickness measurements were compared to analyze the difference, correlation and consistency between the two kinds of OCT.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Henan Eye Hospital (No.HNEECKY-2021[06]). Written informed consent was obtained from each subject prior to any medical examination.

ResultsThe corneal thickness measured by RTVue XR-OCT in C, S, SN, N, IN, I, IT, T, ST areas were (521.73±29.85), (554.31±32.38), (553.54±33.30), (546.96±32.05), (537.54±32.10), (532.13±31.51), (528.42±30.38), (532.25±30.08), (544.85±30.70)μm, respectively, and the corneal thickness in the 9 areas measured by Cirrus 5000 HD-OCT were (526.77±30.62), (555.13±33.32), (558.08±32.57), (554.46±31.42), (548.29±31.84), (539.69±32.74), (536.19±32.40), (533.38±31.90), (543.83±32.02)μm, respectively.There was no significant difference in corneal thickness of various areas between the two kinds of OCT (all at P>0.05), and there were positive correlations between them ( r=0.99, 0.89, 0.95, 0.97, 0.95, 0.93, 0.96, 0.97, 0.92; all at P<0.01). Bland-Altman analysis showed that there was a good consistency of corneal thickness measurements by the two kinds of OCT.The corneal epithelial thickness in C, S, SN, N, IN, I, IT, T, ST areas measured by RTVue XR-OCT were (52.06±3.26), (52.58±3.48), (53.06±3.56), (53.75±3.49), (53.81±3.40), (53.48±3.35), (52.96±3.32), (52.67±3.19), (53.12±3.15) μm, respectively, and the corneal epithelial thickness in the 9 areas measured by Cirrus 5000 HD-OCT were (46.75±3.25), (47.40±3.36), (47.58±3.64), (48.85±4.48), (48.46±4.54), (48.40±4.96), (48.06±5.12), (47.46±3.91), (48.79±3.90)μm, respectively.There were statistically significant differences in the corneal epithelial thickness of various areas measured by the two kinds of OCT (all at P<0.05), and there was no significant correlation between them ( r=0.17, 0.08, 0.16, 0.28, 0.20, 0.24, 0.19, 0.21, 0.13; all at P>0.05). Bland-Altman analysis showed poor consistency of corneal epithelial thickness measurements between the two kinds of OCT.

ConclusionsThere is no significant difference in measuring corneal thickness between the two kinds of OCT and the consistency is high, which means that they can be replaced by each other.There are significant differences in corneal epithelial thickness measurement between them and the consistency is poor, so they are not interchangeable.

KEYWORDS： Cornea;Epithelium, corneal;Thickness;Anterior eye segment;Tomography, optical coherence;Difference;Consistency

Corresponding author: Pang Chenjiu, Email: mocdef.3ab61999jcgnap

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引用本文

王闯,王浩,庞辰久. 两种频域眼前节OCT测量角膜厚度和角膜上皮厚度的差异和一致性比较[J]. 中华实验眼科杂志,2022,40(02)：151-156.

DOI:10.3760/cma.j.cn115989-20210209-00104

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角膜上皮厚度并非均匀一致，角膜自身可以通过改变角膜上皮的再分布补偿基质表面的不规则。研究表明，在圆锥角膜早期，角膜上皮层即有改变，因此，对角膜上皮厚度的精确测量可以为圆锥角膜的早期诊断提供帮助 ^{[
1
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]}。评估角膜上皮厚度的方法有高频超声生物显微镜、激光扫描共焦显微镜以及眼前节光相干断层扫描(optical coherence tomography，OCT)，前两者均为接触性成像技术，增加了角膜上皮损伤和感染的风险，且因为压迫作用也影响测量的准确性。眼前节OCT技术是基于低相干光原理，可提供角膜的横断面影像，通过其内置的测量工具对上皮厚度进行测量，有较快的扫描速度和较高的分辨率，是一种可靠的无侵入性上皮成像方法，对患者配合程度的要求较低。目前有RTVue XR-OCT(美国Optovue公司)和Cirrus 5000 HD-OCT(德国Carl Zeiss公司)2种频域眼前节OCT可以对角膜上皮厚度进行测量，这2种OCT均有较高的图像分辨率和较快的扫描速度，可对角膜厚度和角膜上皮厚度进行客观、定量测量 ^{[
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]}，对屈光手术适应证的筛选、手术方式选择和圆锥角膜早期诊断具有重要意义，目前尚无这2种OCT对角膜厚度和角膜上皮厚度测量的比较研究。本研究拟采用2种OCT对近视及近视散光患者的角膜厚度和角膜上皮厚度进行测量，对2种仪器测量结果的差异和一致性进行比较分析，以期为临床应用提供依据。

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摘要
参考文献

参考文献

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Temstet C ， Sandali O ， Bouheraoua N ，et al. Corneal epithelial thickness mapping using Fourier-domain optical coherence tomography for detection of form fruste keratoconus[J]．J Cataract Refract Surg， 2015，41(4)∶812-820. DOI： 10.1016/j.jcrs.2014.06.043 .