角膜混浊对溶酶体贮积症患者眼压评估的影响。
Influence of Corneal Opacity on Intraocular Pressure Assessment in Patients with Lysosomal Storage Diseases.
作者信息
Wasielica-Poslednik Joanna, Politino Giuseppe, Schmidtmann Irene, Lorenz Katrin, Bell Katharina, Pfeiffer Norbert, Pitz Susanne
机构信息
Department of Ophthalmology, University Medical Center, Johannes Gutenberg- University Mainz, Germany.
Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University Mainz, Germany.
出版信息
PLoS One. 2017 Jan 12;12(1):e0168698. doi: 10.1371/journal.pone.0168698. eCollection 2017.
AIMS
To investigate an influence of mucopolysaccharidosis (MPS)- and Morbus Fabry-associated corneal opacities on intraocular pressure (IOP) measurements and to evaluate the concordance of the different tonometry methods.
METHODS
25 MPS patients with or without corneal clouding, 25 Fabry patients with cornea verticillata ≥ grade 2 and 25 healthy age matched controls were prospectively included into this study. Outcome measures: Goldmann applanation tonometry (GAT); palpatory assessment of IOP; Goldmann-correlated intraocular pressure (IOPg), corneal-compensated intraocular pressure (IOPcc), corneal resistance factor (CRF) and corneal hysteresis (CH) assessed by Ocular Response Analyzer (ORA); central corneal thickness (CCT) and density assessed with Pentacam. Statistical analysis was performed using linear mixed effect models and Spearman correlation coefficients. The concordance between tonometry methods was assessed using Bland-Altman analysis.
RESULTS
There was no relevant difference between study groups regarding median GAT, IOPg, IOPcc and CCT measurements. The limits of agreement between GAT and IOPcc/IOPg/palpatory IOP in MPS were: [-11.7 to 12.1mmHg], [-8.6 to 15.5 mmHg] and [- 5.4 to 10.1 mmHg] respectively. Limits of agreement were less wide in healthy subjects and Fabry patients. Palpatory IOP was higher in MPS than in healthy controls and Fabry patients. Corneal opacity correlated more strongly with GAT, IOPg, CH, CRF, CCT and corneal density in MPS (r = 0.4, 0.5, 0.5, 0.7, 0.6, 0.6 respectively) than in Fabry patients (r = 0.3, 0.2, -0.03, 0.1, 0.3, -0.2 respectively). In contrast, IOPcc revealed less correlation with corneal opacity than GAT in MPS (r = 0.2 vs. 0.4).
CONCLUSIONS
ORA and GAT render less comparable IOP-values in patients suffering from MPS-associated corneal opacity in comparison to Fabry and healthy controls. The IOP seems to be overestimated in opaque MPS-affected corneas. GAT, IOPg and biomechanical parameters of the cornea correlate more strongly with the corneal clouding than IOPcc in MPS patients.
TRIAL REGISTRATION
ClinicalTrials.gov NCT01695161.
目的
研究黏多糖贮积症（MPS）和法布里病相关的角膜混浊对眼压（IOP）测量的影响，并评估不同眼压测量方法的一致性。
方法
本研究前瞻性纳入了25例有或无角膜混浊的MPS患者、25例角膜涡状浑浊≥2级的法布里病患者以及25例年龄匹配的健康对照者。观察指标：Goldmann压平眼压计测量法（GAT）；眼压的触诊评估；通过眼反应分析仪（ORA）评估的Goldmann相关眼压（IOPg）、角膜补偿眼压（IOPcc）、角膜阻力因子（CRF）和角膜滞后（CH）；使用Pentacam测量中央角膜厚度（CCT）和角膜密度。采用线性混合效应模型和Spearman相关系数进行统计分析。使用Bland-Altman分析评估眼压测量方法之间的一致性。
结果
研究组之间在GAT、IOPg、IOPcc和CCT测量的中位数方面无显著差异。MPS患者中GAT与IOPcc/IOPg/触诊眼压之间的一致性界限分别为：[-11.7至12.1mmHg]、[-8.6至15.5 mmHg]和[-5.4至10.1 mmHg]。健康受试者和法布里病患者的一致性界限较窄。MPS患者的触诊眼压高于健康对照者和法布里病患者。与法布里病患者相比，MPS患者的角膜混浊与GAT、IOPg、CH、CRF、CCT和角膜密度的相关性更强（分别为r = 0.4、0.5、0.5、0.7、0.6、0.6）（法布里病患者分别为r = 0.3、0.2、-0.03、0.1、0.3、-0.2）。相比之下，在MPS患者中，IOPcc与角膜混浊的相关性低于GAT（r = 0.2对0.4）。
结论
与法布里病患者和健康对照者相比，ORA和GAT在患有MPS相关角膜混浊的患者中得出的眼压值可比性较差。在受MPS影响的混浊角膜中，眼压似乎被高估。在MPS患者中，GAT、IOPg和角膜生物力学参数与角膜混浊的相关性比IOPcc更强。
试验注册
ClinicalTrials.gov NCT01695161。
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