非接触式眼压计与Goldmann压平眼压计测量眼压值一致性的Meta分析

摘要

背景 非接触式眼压计(NCT)是临床常见的眼压测量设备,其测量值受角膜参数等多种因素的影响,近年有临床研究针对NCT与“金标准”Goldmann眼压计(GAT)测量眼压值一致性的报道,但尚缺乏循证评价. 目的 从循证医学的角度评价NCT与GAT测量眼压值的一致性. 方法 采用严密制定的检索策略检索MEDLINE、EMbase、中国生物医学文献数据库、中国期刊全文数据库文献,检索年限为从各数据库建库至2016年6月.按照纳入和排除标准筛选文献,提取样本量、平均年龄、样本特征、随访时间、NCT与GAT眼压测量等数据.使用Cochrane协作网提供的Review Manager 5.3.0软件进行合并效应量的检测,6篇文献间经I2检验存在异质性,采用随机效应模型校正后对NCT与GAT测量的眼压值进行分析. 结果 初步检索共获得24篇文献,筛选后共纳入NCT与GAT测量眼压值的比较研究6篇,总样本量为478眼.采用随机效应模型校正后,NCT的眼压测量值较GAT眼压测量值高0.02 mmHg(1 mmHg=0.133 kPa),差异无统计学意义[加权均数差(WMD)=0.02,95％可信区间(CI):-0.59 ～ 0.63,P=0.95].漏斗图法显示文献存在发表偏倚.结论 NCT与GAT测量正常人群眼压结果具有较好的一致性,但尚需更多大样本比较研究提供支持.%Background Noncontact tonometer (NCT) is a common application in clinical ophthalmology,while its measured value is influenced by corneal parameter.In recent years,there existed some clinical trials discussing the agreement between NCT and gold standard Goldmann applanation tonometer (GAT),but there was still lack of evidence.Objective This study was to evaluate the agreement between NCT and GAT by applying evidence based medicine (EBM) method.Metbods A systematic literature retrieval was conducted from the MEDLINE,EMbase,CBM disc and CNKI database with the limitation of publishing time until June 2016.The literatures were screened according to the inclusion and exclusion criteria.The sample size,average age,sample characteristics and follow-up time were extracted.The value of intraocular pressure measured by NCT and GAT were analyzed.The overall effect size was analyzed using Review Manager 5.3 (from The Cochrane Collaboration) as weighted mean difference (WMD).There existed heterology in this study.Radom effect mode was used to evaluate and compare the difference between NCT and GAT value.Results Twenty four articles were retrieved.Six comparison studies incorporated with 478 eyes were included for Meta analysis.After random effects model was performed for correction.Intraocular pressure measured by NCT was 0.02 mmHg larger than that by GAT (1 mmHg =0.133 kPa).There was no significant difference in the measurement value of IOP between the two instruments (WMD =0.02,95％ CI:-0.59 to 0.63,P =0.95).Funnel chart method showed that literature publication bias existed in this study.Conclusions Normal persons' IOP obtained from NCT and GAT showed a good reproducibility.More comparison studies are needed to support this result.