Corvis ST 안압계와 타안압계와의 안압 비교 및 녹내장 환자에서의 임상적 유용성
Comparison of Corvis ST Tonometer to Other Tonometers and Clinical Usefulness of Corvis ST Tonometer
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목적: 공기분사에 따른 각막 변형을 보면서 동시에 안압을 측정할 수 있는 새로운 안압계인 Corvis ST 안압계(CST)와 골드만 압평안압계(GAT), 비접촉안압계(NCT), 리바운드안압계(RBT)로 측정된 안압을 비교하여 각 안압계의 일치성에 대해 알아보고, 녹내장 평가에 있어 임상적 유용성에 대해 알아보고자 하였다. 대상과 방법: 정상안 31안 녹내장환자 47안을 CST, GAT, NCT, RBT를 이용하여 안압을 측정하였다. 각 안압계로 측정한 안압의 일치도를 분석하기 위해 Bland-Altman plot을 이용하였으며 각 안압계의 상관관계를 조사하기 위해 Spearman 상관분석을 시행하였다. CST와 초음파를 이용하여 중심각막두께를 비교하였고 일치도를 분석하였다. 또한 녹내장환자와 정상안의 CST로 측정된 각막의 생체역학적 수치들을 비교분석하였다. 결과: 각 안압계로 측정한 모든 대상군의 안압은 CST: 13.28 ± 2.32 mmHg, GAT: 14.71 ± 2.95 mmHg, NCT: 14.44 ± 3.10 mmHg,RBT: 13.23 ± 2.89 mmHg이었다. 각 안압계 간에 안압은 통계학적으로 유의한 차이는 없었으며 Bland-Altman plot에서 CST는 GAT,NCT, RBT와 높은 일치도를 보였고 상관분석에서도 높은 상관관계를 보였다. CST와 초음파로 측정한 각막중심두께도 높은 일치도를보였다. 정상군과 녹내장환자에서 CST의 생체역학적 수치를 비교하였을 때 녹내장 환자에서 highest concavity time와 peak distance가통계학적으로 유의하게 감소하였다(16.93 ± 0.66 ms vs 16.48 ± 0.84 ms p=0.020, 4.23 ± 1.34 mm vs 3.41 ± 1.27 mm p=0.017). 결론: Corvis ST 안압계는 안압 및 중심각막두께 측정에 있어 기존의 안압계를 대체할 수 있으며 각막의 생체역학적 특성 역시 보여준다. Highest concavity time과 peak distance 수치가 녹내장 환자군에서 통계학적으로 유의하게 감소하는 것을 볼 때 녹내장환자에서각막 점도 및 탄성이 감소되는 것을 유추해 볼 수 있다.
Abstract
Purpose: To compare the accuracy and agreement of intraocular pressure (IOP) and central corneal thickness (CCT) measurementswith noncontact tonometer Corvis Scheimpflug Technology (Corvis ST) versus noncontact tonometer (NCT), Goldmannapplanation tonometer (GAT), rebound tonometer (RBT), and ultrasound-based corneal pachymetry (US-CCT). The secondaryobjective was to evaluate the corneal biomechanical values using Corvis ST tonometer in patients with glaucoma. Methods: Thirty-one healthy participants and 47 patients with primary open angle glaucoma and normal tension glaucoma wereenrolled in this study. One eye was selected randomly. In each participant, GAT, NCT, RBT, US-CCT and measurements withCorvis ST (Corvis-IOP and Corvis-CCT) were obtained. IOP and CCT measurements of each device were compared. Deviceagreement was calculated by Bland-Altman analysis. Additionally, corneal highest concavity parameters were compared betweenhealthy subjects and glaucoma patients. Results: Mean IOPs in all examined eyes were 13.28 ± 2.32 mm Hg for CST, 14.71 ± 2.95 mm Hg for GAT, 14.44 ± 3.10 mm Hgfor NCT, and 13.23 ± 2.89 mm Hg for RBT. There was no statistical difference in IOP measurements among tonometers. Correlation analysis showed a high correlation between each pair of tonometers (all p < 0.0001). Bland-Altman plots of all devicesrevealed good agreement of the IOP and CCT measurements. In glaucoma patients, highest concavity time and peak distanceof highest concavity parameters were statistically lower than in normal subjects (16.93 ± 0.66 ms vs. 16.48 ± 0.84 ms p =0.020, 4.23 ± 1.34 mm vs. 3.41 ± 1.27 mm p = 0.017, respectively). Conclusions: The CST, a newly-developed tonometer with features of visualization and measurement of the corneal deformationresponse to an air impulse, can be considered a reliable alternative method for measuring IOP and CCT in healthy subjects andglaucoma patients. Highest concavity parameters could be another important indicator identifying corneal viscosity or elasticityin patients with glaucoma.
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