접촉식과 광학적 방식에 의한 전방깊이 측정값의 비교
Comparison of Anterior Chamber Depth Obtained from Applanation and Optical Principle Devices
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목적: 접촉식인 A-scan (Pacscan 300A, Sonomed Inc., Chicago, IL, USA)과 광학적 방식인 IOL masterⓇ (Carl Zeiss Meditec,Germany), PentacamⓇ (Oculus, Wetzlar, Germany), 그리고 Orbscan IIⓇ (Orbtek Inc., USA)를 이용하여 전방깊이를 측정한 후 각검사방법의 재현성 및 일치 정도를 비교하고자 하였다. 대상과 방법: 백내장수술 예정인 환자 94명(188안)에 대해 접촉식 방식인 A scan과 광학적 방식인 IOL masterⓇ, PentacamⓇ,Orbscan IIⓇ를 이용하여 전방깊이를 측정한 후 비교하였다. 네 기기의 신뢰성을 알아보기 위하여 변동계수, 표준편차, 그룹 내 변동계수를 계산하였고 기기간 전체 평균 차이를 반복측정 분산분석과 Bland-Altman plot를 이용하여 비교하였다. 결과: A-scan, IOL masterⓇ, PentacamⓇ, Orbscan IIⓇ로 측정한 평균 전방깊이는 각각 2.89 ± 0.49 mm, 3.25 ± 0.45 mm, 3.21± 0.46 mm, 3.19 ± 0.47 mm로 측정방식에 따라 유의한 차이가 있었다(p＜0.01). 네 가지 측정 방식의 변이계수는 각각 2.50%,0.87%, 1.25%, 1.04%로 A scan에 비해 IOL masterⓇ, PentacamⓇ, Orbscan IIⓇ이 더 재현성이 높았다. 상관계수는 IOL masterⓇ와A scan은 0.65, IOL masterⓇ와 PentacamⓇ은 0.91, IOL masterⓇ와 Orbscan IIⓇ은 0.90, A scan과 PentacamⓇ은 0.69, A scan과Orbscan IIⓇ는 0.71, PentacamⓇ과 Orbscan IIⓇ는 0.93이었다. 결론: 전방깊이의 측정방법에서 접촉식 방식인 A-scan보다 광학적 방식인 IOL masterⓇ, PentacamⓇ, Orbscan IIⓇ을 사용했을 경우전방깊이가 유의하게 깊게 측정되었다(p＜0.01). 광학적 측정방식들끼리는 상관계수가 높았고, 재현성 또한 높았으며 그 중에서 IOL masterⓇ가 가장 낮은 변이계수를 보였다.
Abstract
Purpose: To assess the reproducibility and reliability of applanation A-scan ultrasonography (Pacscan 300A, Sonomed Inc., Chicago, IL, USA) and optical measurements with IOL Master® (Carl Zeiss Meditec, Germany), Pentacam® (Oculus,Wetzlar, Germany), and Orbscan II® (Orbtek Inc., Laredo, TX, USA) when measuring anterior chamber depth (ACD). Methods: In this study of 188 eyes of 94 patients, ACD estimation prior to cataract surgery was preformed by the applanation A-scan method and IOL Master®, Pentacam®, and Orbscan II® optical methods. Repeatability from each device was evaluated by coefficient of variation, standard deviation, and intraclass correlation coefficient. RM-ANOVA on Ranks was used to compare the differences in ACD among the devices. The Bland-Altman plot was performed to assess agreement in measurements between the devices. Results: The mean ACD according to the applanation A-scan method and IOL Master®, Pentacam®, and Orbscan II® optical methods were 2.89 ± 0.49 mm, 3.25 ± 0.45 mm, 3.21 ± 0.46 mm, and 3.19 ± 0.47 mm, respectively, and the differences were statistically significant (p < 0.01). The coefficient of variation for the 4 methods was 2.50% in the A-scan, 0.87% in the IOL Master®, 1.25% in the Pentacam®, and 1.04% with Orbscan II®, and reproducibility was higher with the optical principle devices. The correlation coefficient between A-scan and IOL Master® was 0.65, between IOL Master® and Pentacam®0.91, between IOL Master® and Orbscan II® 0.90, between A-scan and Pentacam® 0.69, between A-scan and Orbscan II®0.71, and between Pentacam® and Orbscan II® 0.93. Conclusions: Applanation A-scan provided lower measurements for ACD compared with IOL Master®, Pentacam® and Orbscan II®. There was good agreement between results obtained with the latter 3 methods, and reproducibility was high with optical measurements. The coefficient of variation was low for IOL Master®.
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