한국인에서 리바운드안압계의 임상적 유용성
Usefulness of the Icare ic200 Rebound Tonometer in Korean
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목적: 리바운드안압계 Icare ic200으로 측정한 안압을 골드만압평안압계로 측정한 안압과 비교하여 임상에서 Icare ic200의 유용성을 확인하고자 하였다. 대상과 방법: 전체 한국인 294명, 294안이 연구에 포함되었다. 모든 환자에서 Icare ic200으로 안압을 측정한 뒤 골드만압평안압계로 안압을 측정하였다. 두 안압계의 안압 일치도를 평가하였으며, 골드만압평안압계의 22 mmHg 이상에 대한 Icare ic200의 진단능을 분석하였다. 생체계측을 포함한 임상인자들이 두 안압계로 측정된 안압의 차이에 영향을 미치는지 분석하였다. 결과: Icare ic200의 안압과 골드만압평안압계의 안압은 강한 양의 상관관계를 보였다(r=0.875, p＜0.001). Icare ic200의 안압이 골드만압평안압계의 안압보다 평균 3.07 ± 2.67 mmHg 낮았고, Bland-Altman plots에서 95.24%의 환자가 95% 일치한계(-2.16 to 8.30 mmHg) 안에 분포했다. 22 mmHg 이상의 고안압에 대한 Icare ic200의 진단능은 0.959 (area under the receiver operating characterisitic)였다. 다변량회귀분석 결과 나이가 많은 것(β=0.034, p=0.020)과 각막곡률이 높은 것(β=0.213, p=0.030)이 두 안압계의 차이가 큰 것과 연관된 것으로 나타났다. 결론: Icare ic200은 골드만압평안압계와 좋은 일치도 및 고안압에 대한 높은 진단능을 보였으나, 평균 3 mmHg 낮게 측정되었다. 따라서 Icare ic200은 임상에서 골드만압평안압계를 대체해서 사용하기보다는 고안압에 대한 선별검사에 유용하게 사용될 수 있을 것으로 보인다.
Abstract
Purpose: To evaluate the efficacy of the Icare ic200 in clinical practice by comparing the intraocular pressure (IOP) measured with the Icare ic200 rebound tonometer to the IOP measured with the Goldmann applanation tonometer (GAT). Methods: A total of 294 eyes of 294 Korean patients were included. IOP was measured with the Icare ic200 and then measured again with a GAT in all patients. We evaluated the degree of IOP agreement between the two tonometers and analyzed the diagnostic ability of the Icare ic200 for a reading ≥ 22 mmHg with the GAT. We also analyzed whether clinical factors including biometry affected the difference in IOP measured by the two tonometers. Results: The IOP values measured with the Icare ic200 and GAT were strongly correlated (r = 0.875, p < 0.001). The IOP measured with the Icare ic200 was lower than the IOP measured with GAT. The mean difference was 3.07 ± 2.67 mmHg, and 95.24% of patients were distributed within the 95% limits of agreement (-2.16 to 8.30 mmHg) on Bland-Altman plots. The diagnostic ability of the Icare ic200 for IOP ≥ 22 mmHg was 0.959 (area under the receiver operating characterisitic). In multivariate regression analyses, older age (β = 0.034, p = 0.020) and greater corneal curvature (β = 0.213, p = 0.030) were correlated with larger IOP differences between the two tonometers. Conclusions: Although the Icare ic200 was more consistent than the GAT with reasonable diagnostic ability for ≥ 22 mmHg, the IOP measured 3 mmHg lower than the GAT. Therefore, the Icare ic200 might be more useful as a screening test to increase IOP rather than replacing GAT in clinical practice.
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