目的探讨Pentacam HR测量不同严重程度圆锥角膜患者角膜地形图参数的重复性。
方法采用诊断试验研究设计，纳入2019年1月至2022年3月就诊于河南省立眼科医院的亚临床圆锥角膜或圆锥角膜患者98例120眼，将患者分为亚临床圆锥角膜组、轻度圆锥角膜组、中度圆锥角膜组和重度圆锥角膜组，每组各30眼。另选取拟行角膜屈光手术者30例30眼作为对照组。由同一医师对每眼进行3次Pentacam HR测量，记录包含角膜前表面、后表面、厚度、综合指数及光密度5个方面共53个参数。通过计算组内标准差、重复性限( r)及公差指数(TI)来比较不同分期圆锥角膜组与对照组间角膜地形图参数的重复性。
结果亚临床、轻度、中度及重度圆锥角膜组与对照组所有参数的 r值相比，分别有54.71%(29/53)、66.04%(35/53)、90.57%(48/53)、94.34%(50/53)参数TI>0.31。其中角膜前表面垂直中央曲率(Ks)、角膜前表面最大曲率(Kmax)、角膜前表面曲率半径、角膜后表面水平中央曲率(Kf)、角膜后表面曲率半径(PRC)、角膜最薄点厚度(TCT)、0－2 mm、2－6 mm区域角膜前表面光密度(A.0－2 mm、A.2－6 mm)、2－6 mm区域角膜中央层光密度(C.2－6 mm)、0－2 mm及2－6 mm区域全层角膜平均光密度(T.0－2 mm、T.2－6 mm)在亚临床及轻度圆锥角膜组表现出良好的重复性(TI<0.31)；围绕Kmax最陡点3 mm区域的平均屈光力、角膜后表面平均曲率、中央圆锥角膜指数参数在亚临床、轻度及中度圆锥角膜组表现出良好的重复性(TI<0.31)；围绕Kmax最陡点4 mm、5 mm区域的平均屈光力参数在各组间均表现出良好的重复性(TI<0.31)。
结论对于亚临床与轻度圆锥角膜患者，推荐使用角膜后表面Kf、PRC和TCT来监测病情进展；对于监测中度与重度圆锥角膜患者病情，可重点检测围绕Kmax最陡点4 mm、5 mm区域的平均屈光力测量参数。
ObjectiveTo investigate the repeatability of corneal topographic parameters with the Pentacam HR in patients with keratoconus of different severity.
MethodsA diagnostic test study was performed.A total of 120 eyes from 98 patients with subclinical keratoconus or keratoconus were enrolled at Henan Eye Hospital from January 2019 to March 2022.The patients were divided into subclinical keratoconus group, mild keratoconus group, moderate keratoconus group and severe keratoconus group, with 30 eyes in each group.An additional 30 eyes of 30 subjects undergoing refractive surgery were selected as a control group.Three consecutive Pentacam HR measurements were performed by the same clinician.The recordings included a total of 53 parameters in anterior corneal surface, posterior corneal surface, thickness, composite index, and corneal densitometry.The within-subject standard deviation (Sw), repeatability limit ( r) and tolerance index (TI) were calculated to evaluate the repeatability of the parameters between different groups.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2019[5]).All subjects were informed of the purpose and significance of the study and signed an informed consent form before enrollment.
ResultsCompared with the control group, the TI of the subclinical, mild, moderate and severe keratoconus groups were 54.71%(29/53), 66.04%(35/53), 90.57%(48/53) and 94.34%(50/53), respectively, higher than 0.31.The steep keratometry (Ks), the maximum keratometry (Kmax) of the anterior corneal surface, the anterior corneal radius of curvature, the flat keratometry (Kf) of the posterior corneal surface, the posterior corneal radius of curvature (PRC), the thinnest corneal thickness (TCT), the average densitometry for the anterior 120 μm in the 0-2 mm area (A.0-2 mm), average densitometry for the anterior 120 μm in the 2-6 mm area (A.2-6 mm), average densitometry for the central tissue in the 0-2 mm area (C.2-6 mm), average densitometry for the total cornea in the 0-2 mm area (T.0-2 mm) and average densitometry for the total cornea in the 2-6 mm area (T.2-6 mm) showed good repeatability in the subclinical and mild keratoconus groups (TI<0.31).Kmax Zonal Mean 3 mm, posterior corneal surface mean keratometry, central keratoconus index showed good repeatability in subclinical, mild and moderate keratoconus groups.Kmax Zonal Mean 4 mm and Kmax Zonal Mean 5 mm showed good repeatability in all groups (TI<0.31).
ConclusionsFor patients with subclinical and mild keratoconus, Kf of the posterior corneal surface, PRC and TCT are recommended to monitor disease progression.To monitor the condition of patients with moderate and severe keratoconus, we may focus on the detection of Kmax Zonal Mean 4 mm and Kmax Zonal Mean 5 mm.
王晴,杨凯丽,徐丽妍,等. Pentacam HR测量圆锥角膜患者角膜地形图参数的重复性[J]. 中华实验眼科杂志,2024,42(09)：835-846.
DOI:10.3760/cma.j.cn115989-20211022-00575版权归中华医学会所有。
未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。
除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。
王晴：采集数据、文章撰写及修改；杨凯丽：采集、分析/解释数据、文章修改；徐丽妍、顾宇伟、范棋：采集数据、实施研究、文章修改；任胜卫：酝酿和设计试验、对文章的知识性内容作批评性审阅；赵东卿：酝酿和设计试验、对文章的知识性内容作批评性审阅及定稿
文档即答
智问智答
机器翻译
你好，我可以帮助您更好的了解本文，请向我提问您关注的问题。
