超广角激光扫描检眼镜与间接检眼镜对近视患者眼底病变筛查的比较

陈珊; 周跃华; 郑燕; 张晶

doi:10.3760/cma.j.cn115989-20200512-00333

高级检索

IP登录

登录IP

切换

退出

中华实验眼科杂志

• 临床研究 •

ENGLISH ABSTRACT

超广角激光扫描检眼镜与间接检眼镜对近视患者眼底病变筛查的比较

作者及单位信息

出版日期： 2020 -06 -10 ·

DOI： 10.3760/cma.j.cn115989-20200512-00333

Comparison of ultra-wide field laser ophthalmoscopy and indirect ophthalmoscopy for fundus examination of myopia

Authors Info & Affiliations

Chen Shan

Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730, China(Chen Shan is working at Air Force Medical Center, Beijing 100142, China)

Zhou Yuehua

Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730, China(Zhou Yuehua is working at Beijing Ming Vision and Ophthalmology Hospital, Beijing 100062, China; The Academy of Ophthalmology, Chengdu University of TCM, Chengdu 610032, China)

Zheng Yan

Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730, China

Zhang Jing

Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730, China

Published： 2020 -06 -10 ·

DOI： 10.3760/cma.j.cn115989-20200512-00333

620

153

APP内阅读

摘要

目的评价超广角激光扫描检眼镜与间接检眼镜检查在角膜屈光手术前眼底病变筛查中的可靠性。

方法采用诊断试验研究方法，对2017年3—5月于北京同仁医院拟行角膜屈光手术的近视患者1 052例2 104眼先行超广角激光扫描检眼镜检查；充分扩瞳后，再使用间接检眼镜进行检查，观察眼底病变的情况。分别对2种检查方法检查出的视网膜病变数量、病变眼数、病变部位、漏诊情况等进行对比分析，并采用Kappa检验分析2种检测方法的一致性。

结果超广角激光扫描检眼镜和间接检眼镜眼底检查共筛查出眼底病变137例186眼，2种方法均检测出的眼底病变89眼121个病灶。其中超广角激光扫描检眼镜发现眼底病变110眼150个病灶，漏诊27眼36个病灶；经扩瞳间接检眼镜眼底检查发现眼底病变116眼157个病灶，漏诊21眼29个病灶。2种检查方法眼底病变检出一致性较好(kappa＝0.776， P<0.001)；超广角激光扫描检眼镜与间接检眼镜不同种类视网膜病灶数比较，差异有统计学意义( χ ²＝15.527， P＝0.004)。相对于间接检眼镜，超广角激光扫描检眼镜对视网膜格子样变性、视网膜裂孔和局限性视网膜浅脱离的检出率较高。2种检查方法对眼底病变检出率、不同年龄眼底病变检出数、不同象限眼底病变检出数以及不同屈光度眼底病变检出率比较，差异均无统计学意义(均 P>0.05)。

结论超广角激光扫描检眼镜检查是角膜屈光手术前近视患者眼底病变筛查的可靠方法，与常规扩瞳间接检眼镜眼底病变检出率相近。

关键词：近视;眼底病变;超广角激光扫描检眼镜;间接检眼镜

ABSTRACT

ObjectiveTo evaluate the clinical reliability of ultra-wide field laser scanning ophthalmoscopy and indirect ophthalmoscopy for the fundus examination of myopia.

MethodsA diagnostic test was performed.A total of 2 104 eyes of 1 052 myopic patients scheduled for corneal refractive surgery were enrolled from March to May in 2017 in Beijing Tongren Hospital, the subjects were firstly examined with ultra-wide field laser scanning ophthalmoscopy, then followed indirect ophthalmoscopy in full dilated pupil for the detection of fundus lesions.The total number of lesions, the number of lesion eyes, the lesions location and the missed diagnosis were analyzed and compared between the two examination methods.The consistency of the two methods was analyzed by Kappa test.This study followed the Declaration of Helsinki.and the written consent was obtained from the patients and their families.

ResultsA total of 186 fundus lesions in 137 eyes were screened out, of which 121 fundus lesions in 89 eyes were detected by both the two methods.For ultra-widefield laser ophthalmoscopy, 150 fundus lesions in 110 eyes were found and 36 fundus lesions in 27 eyes were missed; For indirect ophthalmoscopy, 157 of fundus lesions in 116 eyes were found and 29 fundus lesions in 21 eyes were missed.There was a good consistent of the detection rate of fundus leision between the two examination methods (kappa=0.776, P<0.001). There was a significant difference in the number for different kinds of retinal lesions between the two methods ( χ ²=15.527, P=0.004). Compared with the indirect ophthalmoscopy, the ultra-wide field laser scanning ophthalmoscopy had a higher detection rate for lattice-like degeneration, retinal holes, and retinal detachment.There were no statistically significant differences between the two methods in the detection rate of fundus lesions, the number of fundus lesions among different ages, the number of fundus lesions among different quadrants, and the detection rate of fundus lesions among different diopters.

ConclusionsUltra-wide field laser scanning ophthalmoscopy is a reliable method for screening the fundus lesions of myopia in prerefractive surgery.The detection rate is similar to conventional dilated pupil indirect ophthalmoscopy.

KEYWORDS： Myopia;Fundus lesion;Ultra-wide field laser scanning ophthalmoscope;Indirect ophthalmoscope

Corresponding author: Zhou Yuehua, Email: mocdef.oabohay0220hy

COPYRIGHTS:

No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.

All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.

引用本文

陈珊,周跃华,郑燕,等. 超广角激光扫描检眼镜与间接检眼镜对近视患者眼底病变筛查的比较[J]. 中华实验眼科杂志,2020,38(06)：504-509.

DOI:10.3760/cma.j.cn115989-20200512-00333

PERMISSIONS

Request permissions for this article from CCC.

评价本文

*以上评分为匿名评价

版权归中华医学会所有。

未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

近视是一种常见的眼科疾病，尤其是病理性近视可能导致脉络膜新生血管、视网膜脱离和青光眼等各种并发症 ^{[
1
,

2
,

3
]}。近几十年，各国的近视患病率均有所升高 ^{[
3
,

4
]}。调查研究显示，欧洲和东亚等地区视力下降的主要原因是病理性近视 ^{[
3
,

5
]}。《国民视觉健康报告》中指出，中国高中生和大学生的近视发病率超过了70%，并且呈逐年升高的趋势 ^{[
6
]}。角膜屈光手术是矫正屈光不正常用的方法。高度近视是视网膜脱离的高危因素，角膜屈光手术后出现视网膜脱离的病例时有报道 ^{[
7
,

8
]}。为了使角膜屈光手术更安全、有效，术前进行详细的眼底检查十分重要，通过眼底检查可以及早发现影响视功能的眼底病变，防止术后视网膜脱离等并发症。目前常用的间接检眼镜受检查者经验等因素的影响，不利于动态、客观地记录眼底变化等情况，而超广角激光扫描检眼镜具有免扩瞳、超广角眼底激光扫描的特点，克服了间接检眼镜的不足，为临床眼底病变检查提供了客观手段，但是该技术在角膜屈光手术前检查中尚未得到广泛应用。本研究采用间接检眼镜和超广角激光扫描检眼镜2种检查方法对激光角膜屈光手术前的眼底病变进行筛查，评价超广角激光扫描检眼镜在角膜屈光手术前眼底病变筛查中的可靠性。

试读结束，您可以通过登录机构账户或个人账户后获取全文阅读权限。

已是订阅账户? 登录

摘要
参考文献

参考文献

[1]

Ceklic L , Munk MR , Wolf-Schnurrbusch U ，et al. Visual acuity outcomes of ranibizumab treatment in pathologic myopic eyes with macular retinoschisis and choroidal neovascularization[J]．Retina， 2017，37(4)∶687-693. DOI： 10.1097/IAE.0000000000001236 .