NGHIEN dm KHOA HQC I
DANH GIA KET QUA BAN DAU DO NHAN AP BANG NHAN AP KE DIATON
SO VOI NHAN AP KE PERKINS 6 TRE EM
Trdn Thf Phuang Thu*, Phan Thi Anh Thu*
TOM TAT
Md dau: nhdn dp ki dipt tir m&i Diaton do nhan dp qua mi iniit. khong tiep xuc true tiep v&i gidc mgc.
Nhdn dp ki Perkins Id phiin han cdm tay ciia nhdn dp ke Goldmann thich h<.rp sir dung a tre em vd binh nhdn khdng ngdi dirac.
Muc tieu: so .sdnh kit qud cua nhdn dp ki do qua mi Diaton (DT) vd nhan dp ke Perkins (PT) a tre em PhiroTig phap: nghien cuu md td cdt ngang thirc hii'n trin 50 mdl clion ngdn nhiin tir cdc binh nhi den khdm tgi Benh vii-n Min TP. Hd Chi Mmh Mdi mdt dupc do v&i DT vd PTlheo thir tu ngdu nhiin trong vdng 5 phiit
Ket qua: gid tri nhdn dp trung binh Id 10.52 ± 5.96 mmHg khi do v&i DTvd 11.72 ± 5.54 mmHg v&i PT Do chinh lech trung binh (DT- PTi la-1.20 ± 1.96 mmHg (p< 0.05) trin cd mau vd -0.37 ± 1.86 mmHg (p > 0.05) khi do trin mdl tre trin 4 iiidi DTcd mdi luang quan rdt cao vdi GAT(r = 0.94; p < 0.001). Khi so sdnh v&i GAT thi cd 84.0% gid tn DTsai lixh irong khodng ± 3 mmHg.
Kit luan: nhdn dp ke Diaton cd thi dung de thdm khdm vd theo doi iren mdl benh nhi ddc biet ddi v&i tri trin 4 tudi hodc mdl khdng thi do dirac hdng nhdn dp ke Hep xik
I. DAT VAN DE
Benh gidcdm d Ire em rat hiem gap nhung khdng dieu tri thich hgp se dua den hau qua mii Ida sudt cudc ddi. Phat hien va chan doan sdm gdp phan quan trgng vao su thanh cdng ciia qua trinh dieu Iri benh gldcom. Cac trieu chirng ggi y benh gidcom d tre nhu so anh sang, co thfit mi, eha\
nudc mat, giac mac to, vet ran mang Descemet.
I5ra gai do anh hudng ciia tfing nhan ap Chan doan benh gidcdm trong cac trudng hgp khdng cd trieu chiing rd rang gap nhieu khd khan, khi do phai nhd vao do nhan ap. dac biet Irong theo ddi lang nhan ap.
Thii phat a mat Ire cd benh ly ndi khoa nhu viem mang bd dao hoac sau phau thual due ihe
* Benh viin Mat TP Hd Chi Minh
Ihiiy tinh. chan Ihuong... Cac phuong phap do nhan ap tiep xiic true tiep vdi giac mac cd nhieu sai sd va khd Ihyc hien Iren mat cd benh ly giac mac, phil giac mac, bal Ihirdng dp day, dp cong giac mac hoac mdi phau thual giac mac Do nhan ap d Ire ihudng gap nhieu khd khan. Nhan ap ke Dialon do qua mi khong Iicp \iic true tiep vdi giac mac, CO Ihe do o lu the ngdi hoac nfim, thdi gian do nhanh. thich hop de lam soal Iren so krgng ldn [5]. Nhan ap ke na\ chua dugc sir dung d Viel Nam vi va\ can cd nghien ciru danh gia trudc khi ap dung rdng rai
Muc lieu nghien ciru: so sanh gia Iri trung binh vfi danh gia mirc do luong quan giira hai nhan ap ke Diaton va Perkins.
Nhan khoa Viet Nam (So 28 - 2012)
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n. D 6 I TU(:rNG VA pmrtfNG PH APNGHIKN (I'lU 1. Phutmg phAp nghien ciru: md tfi cflt ngang cd phan tich.
2. DSn so nghien ciru
2.L Doi tirOmg: cae Ire cm den khfim mfil Ipi B?nh vi?n Mfit TP Ho Chi Minh.
2.2. Tieu cltu^n ch{>n h^nh nhdn - Tieu chudn nhgn vdo.
Tre em dudi 15 luoi den kham mfit Uu Bpnh vien Mfit TP.Ho Chi Minh tir Ihang 3/2011 den hei Ihang 6/2011.
- Tieu chudn hgt trir:
+ Logn thj eao: nhihig mfil mfi khi do bfing nhan ap ke Perkins cho thay viing tiep xiie eo hinh oval, can thj eao > -6D, vicn thi > +3D.
+ Bat thudng giac mpc nhu: s?o, logn dudng, trdc bi^u md, tan mgch. giac mac chdp, dp day giac mac trung lam bat thudng.
+ Mdi trfii qua phau thugl npi nhfin, hofic trudc day ed phlu thuat tren gifie mac, gdm ea phau thual laser giac mac.
+ Mfit nhd hoac mfit trau (ldi mfit trau), co that mi, rung giat nhan eau, dang cd tinh trang viem nhiem d mat, cd benh ly mi mfil (chfip. leo. u budu.
phil mi, seo mi).
+ Tien sii dj ung Ihudc te nhd mfit.
3. Co mau nghien ciru: 50 mat
4. Cac birde lien hanh do nhan ap: Iheo irinh l\r ngau nhien.
4.1. Do nhdn dp hang nhdn dp ke Perkins:
gay te mfit bfing dung dich
Dicainc 1%, nhu^m gtfic m^c b&ng dung djch fluorcsccine 1%, mSi m^t dugc do 2 l4n lien nhau, niu kk qufi do trong hai lin chSnh l?ch khdng qui 2 mmHg sO dugc chip nh§n vai kit qua lay Imng binh cong ciia hai lan do, N^u ket qui chenh nhau irfin 2 mmHg ihi mfil dd sS bj logi ra khdi miu nghien cim. Sau khi do nia sgch mfit bfing dung dich Chloramphenicol 0,4%.
4.2. Do nhdn dp bing nhdn dp ke Diatom Do qua mi infil d vi Iri mfil nhin xuong tgo I' mh mpt gdc khoang 45". khi do bd mi ngang
\oi VI iri ria gific ciing mgc. Th^rc hi^n do nhfin^
lien phan syn mi ngay giua luong ung phan ciing mgc phia dudi. Ma> Uf dpng tinh ra gia trj Uung binh ciia 6 hin do lien tiep. Ghi nhgn gia Irj nhfin ap trung binh nay khi khdng ed bao ldi kem theo uj so nhfin fip (L may khdng dfit thfing Uvc, H: cd sai s6 trong qua trinh di chu\cn eiia Idi trye).
5. Phan tich thong ke: so li?u duoc nhap bing phan mem Epidata 3 1 wi xu I> Ihdng ke bang chucmg trinh Stata 10,0 \a phan mem R. Mue >' nghTa p •- 0.05
HI. K F T O l A
Nghien cim 50 mfil ciia 39 b^nh nhfiji Uxingdo ed 32 mat nam (64.0%) va 18 mfil nft (36.0%), do tudi Irung binh la 73,86 i 47.78 Ihang, nhd nhat la 10 Ihang tuoi \.i Idn nhat la 15 tudi. Gom 23 mat phai (4(..(ro) va 27 mfil trai (54.0%)
Su sanh giii (ri trung binh ciia hai nhan ap ke Diaton va Perkins:
Biinf,
M ± S D M m - Max
Trung VI Q 1 - Q 3
1. Ddc diem mdu nghien Dialon
iru (n =
10.52 ± 5,96 2 , 0 - 14,0
9,0 6 . 0 - 15,0
SO)
Perkins 11,72 ± 5 , 5 4
3 , 0 - 3 8 , 0 10,0 8 , 0 - 1 5 , 0 ' M±.SD [rung binh ± dp lech chua.. (mmHg)
*Q! -Q3 khoang lit phdn v( 25% vd 75% (mmHg) ' Mm - Max gid tn nho nhdt - idn nhdt (mmHg)
22 I Nhan khoa Viet Nam (So' 28 - 2012)
Gifi tri nhan ap trung binh la 10,52 ± 5,96 11,72 ± 5.54 mmHg (phgm vi tir 3,0 den 38.0 mmHg (phgm vi tir 2,0 den 34,0 mmHg, trung mmHg. trung vj 10.0 mmHg) khi do vdi nhfin ap vj 9,0 mmHg) khi do vdi nhan ap ke Diaton, ke Perkins.
Bdng 2. Dp chenh Ifch Irung hinh giira 2 nhdn dp ke Irong cdc nhdm luoi D$c diem
C a m a u
Thdng tudi:
- 2 4 24 din < 48
> 4 8 n
50 13 10 27
J ± S D -1,20 ± 1,96 - l , 7 7 ± 1,59 -2,70 ± 1,63 -0,37 ± 1,86
Test Paired t-lcst(p- 0,0001)
Wilcoxon(p = 0,0054) Wilcoxon (p - 0,0049) Wilcoxon (p = 0,3283)
• Dp chenh Ifch d = kit qud DT- kei qua PT(minHg)
Gifi trj trung binh ciia dp chenh l^ch d gii^a tninHg). Cd sy khac biel cd y nghTa thdng ke gia trj hai nhan fip ke trong ca mau la -1,20 ± 1,96 mmHg do ciia 2 nhfin ap ke tren cfi mau (p = 0,0001) vfi d (phgm vi tir 1,0 den 3,0 mniHg. trung vi la 1,0 dp tuoi dudi 4 tuoi (48 Ihang) (p < 0,05).
Bdng 3. Muc do chenh lech giira hai nhdn dp ke
w
m m H g
< 2
< 3
< 5
>5
N=SO Tan so
36 42 49 1
72,0
%
84,0 98.0 2,0
Tt Ie gia trj do dupe cua nhan ap ke vdi nhan ap ke Perkins trong ca mau nghien Diaton sai lech trong khoang ± 3 mmHg so ciiu la 84,0%
Bdng 4. Dp chenh lech Irung binh giua cua hai nhdn dp ke trong cdc nhdm Dac diem
Gidi;
Mit:
Nil Nam Phai Trai
n IS 32 23 27
d ± S D -1.61 ± 1,82 -0,97 ± 2,04 -1,09*2,02 -1,30 1 1,96
Test Wilcoxon p - 0 , 1 9 6 8 Wilcoxon p« 0,8979 Khdng cd su khac biet ve gifi tri do ciia hai nhom mai phai va trai (p > 0,05).
nhan ap ke giira cae nhdm gidi tinh nam va nii, Su luong quan va phuong Irinh hoi Bdng 5. Su luang quan giiia hai nhdn dp ki
X gid In do t/irpr bang nhdn dp ke Perkins
y gid tn lien dodn cua nhdn dp kc Dial on
Gia tri do bfing nhan ap ke Dialon cd mdi tuong quan Ihuan rat cao vdi nhan dp ke Perkins, r = 0,94 ( p < 0,001)
SirtuoTg quan r P Phuong trinh hoi quy
Dialon & Perkins 0,94
< 0,001 Y = 2,49 + 0,88X
Nhan khoa Viet Nam (So 28 - 2012) 123
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Biiu do I. Tuang qiitm giua DT vd PT Y - 2 . 4 9 + 0.88X
\ gia trj do dupe bfing nhfin ap kc Perkins Y gia iri lien doan ciia nhfin ap kc Diaton.
Bieu do 2. Phau ho gid tri do cua hai nhan dp ke theo duirng hdng nhau Gia Iri ciia nhan ap ke Dialon va Perkins phan bo tap trung dpc Iheo dudng bang nhau chiing td su phil hap cao ciia hai nlian ap kc, Bicu dd Bland- Allman cho Ihay 95% giii Iri dp chenh lech d se nfim trong khoang d ± 1,96 x SD (lir -5.04 dCn 2,64 mmHg)
IV. BAN LIA.N
1. Su sanh gia trj trung binh ciia hai nhiin ap ke Chiing ldi su dung phep kiem 1 bal cap de so sanh gia In do trung binh ciia hai nhan ap kg tren ciing mpi mau (n ^ 50). Ket qua cho ihdy gia trj
Bieu dd 3. Bieu dd Bland-Altman
trung binh ciia nhan ap ke Dialon \a Perkins khac nhau ed \ nghTa thdng kc, Tuy nhien kel luan nay khdng ed >' nghia trong ihuc Ic \i mau nghien cuu
\di nhieu Ire cd dp mdi khac nhau, do dd dp mem eua Cling mac. ciia da mi khac nhau nen kel qua nay khdng dai dien cho bat ky dan sd dieh nao.
Khi so sanh DT va PT trong tirng dp tuoi cu the Ihi chimg tdi ghi nhan gia tri do dupe cua hai nhan ap ke ihap hon gia tn do duoc ciia nhan ap ke Perkins cd \ nghia thdng ke khi do d mat tre nho hon 4 tudi (48 thang). doi vdi ire Iren 4 tudi thi gia trj do dupe ciia 2 nhan ap kc khac nhau khdng coy
24 I Nhan khoa Viet Nam (Sd 28 - 2012)
nghTa thong ke. Dieu nay ed the dupe gifii thich do mi mat cd ve hogt dpng nhu mpt vgt dem khac nhau d cac dp tudi khac nhau. Ngoai ra dp dan hoi ciing mac theo tudi, dp mem eiia mfit cung cd the anh hudng den kel qua do dupc ciia nhan ap ke Diaton.
Khao sat tren ca mfiu cd 84,0% gia trj do dirpc cua nhan ap ke Diaton sai l^ch trong khoang ± 3 mmHg so vdi nhfin fip ke Perkins. Chi cd 2% gifi Iri dp chenh lech nam ngoai khoang ± 5 mmHg do do cd the diing nhan ap ke Dialon de theo doi dieu Irj benh nhi ed tang nhan ap.
Phep kiem Wilcoxon rank-sum (Mann-Whit- ney) cdn eho ihay gidi tinh va mfit phai hay irai khdng anh hudng den dp chenh lech giira DT va PT(p>0.05).
2. Su tirong quan va phirong tnnh hoi quy Gia In do bang DT cd mdi tuong quan thuan rfit cao va cd \ nghTa thdng ke vdi PT, he sd Urong quan Pearson r = 0,94 (p < 0,001). Gifi trj H = 0,88 cho thay 88% su bien ddi ciia DT cd the quy cho mdi quan he tuyen tinh vdi PT. Thuc hien phan tich dp phil hgp giiia DT vfi PT dua Iren bieu dd Bland- Allman: gia Iri cua DT va PT phan bd tap Irung dpc Iheo dudng bang nhau chimg td sir phii hgp cao ciia hai nhan ap ke.
Vi dp chenh lech cd phan phdi binh Ihudng nen 95% gifi In dp chenh leeh d nam trong gidi han tir -5,04 den 2,64 mmHg, gidi ban nay nhd hon so vdi dp chenh lech cd the chap nhan ± 5,0 mmHg.
Do dd nhan ap ke Dialon cd the dung de lam soal va theo ddi benh nhi cd tang nhan ap.
Cac nguyen nhan co the gdp phan dan den sai so trong hoat ddng cua nhan ap ke do qua mi bao gdm:
I. Su dan truyen luc tir be mat mi den lien phdng khdng giong nhau do su Ihay ddi ve md dan hdi, hinh thai va thanh phan cau tao ciia mat,
2 Hudng nhin cua benh nhan, vi tri khdng thfing diing ciia nhan ap ke, v| tri dat dau do Iren mi thay ddi
3. Gifii phau vfi cau tgo cua mi mfit khac nhau.
4. Dp dan hoi ciia ciing mac khac nhau phy thu^c vao ban chat cua nd va vj Iri so vdi ria giac mac
5. Dp day trung tam giac mgc. Toker vfi edng s\r [4] cho th^y cd s\r anh hudng nhat djnh ciia dp da\ Irung tam giac mgc Ien gia trj do bfing nhan ap ke Diaton
Hi?n Igi cd rai it nghien cuu ve nhfin fip ke Dialon. Tuy nhien cae nghien cuu dugc thye hien tren inal ngudi irudng Ihfinh deu cho thay ed nhung trien vong kha quan ve nhfin ap ke do qua mi ii;i>', Shaun Maria Dacosta vfi CS [3] thue hien so sanh nhan ap ke Diaton va nhan ap ke khdng tiep xiie Iren 100 mat ngudi An Dp binh thudng, kel qua cho Ihay nhfin ap ke Diaton cd dp phii hpp rat cao vdi nhan fip ke khdng liep xiic. Do dd Shaun Maria Dacosta kel lufin nhan ap ke Diaton CO the cd ich trong tham kham benh nhan thudng quy nhat la cac Irudng hpp mdi phau thuat khiic xg hoac cd benh ly giac mgc. Nghien ciiu ciia Mustafa 1 Iker Toker va cdng su [4] thuc hien danh gia anh hudng ciia dp day trung tam giac mac Ien gia tri do bang nhan ap ke Dialon cho Ihay nhan ap ke Diaton cd mdi tuong quan trung binh vdi nhfin ap ke Goldmann vfi cd ve sd do ciia nhan ap ke Dialon bi anh htrdng bdi giac mac mdng Yuehua Li va CS [2] so sanh nhan ap ke Diaton va Goldmann khi co hieu chinh va khong hieu chinh theo dd day trung lam giac mac tren 212 mat va dua ra kel luan khdng khuven cao sir dung nhan ap ke Diaton Ihay Ihe nhan ap ke Goldmann Irong chan doan vfi theo ddi cac Irudng hop nhan ap bat Ihudng, luy nhien. nhfin ap ke nay cd ich trong viec lam soal nhat Ifi cho ngudi Irong dp tudi tir 20 den 50 va cho ngirdi binh Ihudng, C) Viet Nam, Tran Thi Phuong Thu va cdng su [I] so sanh ket qua do ciia nhan ap ke Dialon va Goldmann Iren 315 mat ngudi trudng Ihanh cho thay vdi ngudng chan doan la 21 mmHg, nhan ap ke Dialon cd dd
Nhan khoa Viet Nam (So 28 - 2012) I 25
nhay va dp chuyen kha cao: dp nhgy la 91.7% vfi dp chuyen Ifi 89,3%, trong dd 72,1% gi^ trj do dupe cd sai sp nfim Irong khoang ± 3 mmHg so vdi nhfin fip ke Goldmann. Do dd lac gifi dfi kien nghi nhan ap ke Diaton la mpt cdng cy t4m soal tot nhfin fip.
V. KfeT LU^N
Nhfin fip k4 Diaton cd the diing d^ ihfim kham vfi Ihco ddi IrSn mfil b«nh nhi d$c bift doi v(H ire tren 4 tu6i ho$e mfll khdng the do dupe bfing nhin fip ke liep xiic
TAI L1$U THAM KHAO
1. TRAN THI PHUONG THU. PHAN TH!
ANH THU* (201 l)."So sanh nhfin fip ke do qua mi Diaton vfi nhfin ap ke Goldmann". \hQc Thdnh pho Ho Chi Minh IS (I), pp.I2-l 8.
2. Ll Y. SHI J,. DUAN X.. FAN F. (2010).
"Transpalpebral measurement of intraocular pressure using the Dialon tonometer versus standard Goldmann applanation tonometry".
Graefe's Archive for Clinical and Experimental Ophthalmology 248, pp. 1765-1770
3.SHAUNM.D„BAHUR.,JANAK1RAMAN P. (2008). "Comparison of Diaton Tonometry
and Non Contact Tonomcir\ in Indian Subjects".
AIOC 2008 Proceedings Glaucoma Session II.
pp.260-263.
4. TOKF,R M.I„ LT AL. (2008). "CenUal corneal thickness and Diaton transpalpebral tonometry". Graefes Archive for Clinical and Experimental Ophthalmology. 246 (6). pp.881-889.
5. WEBB J.A. (2009). "Transpalpebral technique: Pen-like lonometer designed tn be patient-friendly". Ophthalmology Times. 34 (20), pp.42-44.
SUMMARY
Background: the new digital Diaton tonometer measures intraocular pres-^ure through the eyelid without corneal conlacl. Perkins is a hand-held version of the original. Goldmann tonometer useful in children and patients unable to sit.
Purpose: to compare intraocularpre.s.siire (lOP) measurements obtained with the Dialon transpalpebrd tonometer (DT). and Perkins applanatum tonometer (PT) in children
Method: ihis cross seclional study on 50 eves .selei led randomly from the children who attended Eye Hospital Hochiminh City The intraocular pressure of eat h eve » as measured with DT and PT wilhin 5 minutes in random order
Results: the average lOP reading was 10 52 ±5 96 mmHg for DT. and 11 '^2 ±5 54 mmHg for PT.
The mean differences between DT and PT was -I 20 ± I 96 mmHg (p < 0.05. X - 50) for the overall group and was -0.37 ± 1.86 mmHg (p > 0 05) in chidren older than 4 vears old There were very high correlation between IDP readings obtained using DT and PT (r = 0 94. p < 0 001) Compared with PT 84.0% of the lOP readings measured by DTwere in an interval of ± 3 mmHg
Conclusions: the eyelid tonometer DTmay he used in routine eye exams and in following up in children especially with children older than 4 years old and when applanation tonometry is not applicable.
26 I Nhan khoa Viet Nam (Sd 28 - 2012)
