Suresight视力筛查仪在儿童屈光筛查中的准确性及早产儿视网膜病变及光凝术对视网膜影响的研究
发布时间：2018-08-08 11:55
【摘要】：目的:Welchallyn Suresight视力筛查仪等手持式的验光设备因其方便携带,不需要儿童的主观合作等特点,目前越来越多的应用于儿童视力筛查中。本研究对一组屈光不正患者分别用Welchallyn Suresight一代(SS1)和二代(SS2)以及Topcon电脑验光仪和视网膜检影法测量其屈光不正度数,并对数据进行了分析比较,探讨SS1和SS2所测量数据的可重复性与一致性,评价SS1和SS2的临床应用价值。方法:研究所选51例102只眼,均为在广州市妇女儿童医疗中心眼科经检查确诊的屈光不正患者。患者年龄2~16岁(平均年龄10.26岁),排除有其他眼部疾病,眼部手术史以及全身系统性疾病的患者。受检患者先在自然瞳孔状态下分别用SS1和SS2视力筛查仪,Topcon电脑验光仪进行检查,记录屈光结果。之后用0.5%托吡卡胺滴眼液散瞳30-45分钟,再进行视网膜检影验光,记录屈光结果。屈光数据的可重复性研究采用个体分别测量,三次结果的组内相关系数(intraclass correlation coefficient,ICC)以及重复系数作为重复测量精确性的分析指标。SS1,SS2和Topcon电脑验光仪三组数据,和视网膜检影比较的95%一致性界限,作为一致性的分析指标。结果:1.在柱镜度数测量方面,SS1,SS2和Topcon电脑验光仪三组与散瞳后检影结果的差值比较无显著性差异(P0.05),在球镜(-5D至+5D),球镜(-10D至+5D)度数和柱镜轴向测量方面,SS1,SS2和Topcon电脑验光仪三组与散瞳后检影结果的差值有统计学意义(P0.05)。2.可重复性:SS1,SS2及Topcon电脑验光仪三者在球镜度数测量方面ICC均大于0.75,有很好的可重复性;柱镜度数测量方面SS1 ICC为0.66,SS2和Topcon电脑验光仪ICC分别为0.88和0.99,SS2可重复性较SS1好;柱镜轴向方面SS1和SS2 ICC分别为0.71和0.72,在除去柱镜度数小于0.5D的数据后SS1和SS2的测量可重复性有提高,分别为0.83和0.73。3.95%一致性界限:SS1与视网膜检影法比较的95%一致性界限在球镜(-5D至+5D)度数测量方面为(-3.09,1.94)D,柱镜度数测量方面为(-1.76,1.75)D,柱镜轴向(本组全部数据)测量方面为(-41.66,53.02)°,柱镜轴向(柱镜度数≥0.5D)测量方面为(-33.55,32.31)°;SS2与视网膜检影法比较的95%一致性界限在球镜(-5D至+5D)度数测量方面为(-3.15,1.83)D,球镜(-10D至+5D)度数测量方面为(-2.96,2.23)D,柱镜度数测量方面为(-1.26,1.27)D,柱镜轴向(本组全部数据)测量方面为(-44.69,68.35)°,柱镜轴向(柱镜度数≥0.5D)测量方面为(-38.86,45.50)°;Topcon电脑验光仪与视网膜检影法比较的95%一致性界限在球镜(-5D至+5D)度数测量方面为(-2.57,0.94)D,球镜(-10D至+5D)度数测量方面为(-3.10,1.25)D,柱镜度数测量方面为(-0.61,0.54)D,柱镜轴向(本组全部数据)测量方面为(-31.92,36.35)°,柱镜轴向(柱镜度数≥0.5D)测量方面为(-22.97,19.75)°。SS1和SS2的95%一致性界限均较Topcon电脑验光仪宽。结论:1.SS1,SS2在自然瞳孔状态下球镜度数测量方面,与Topcon电脑验光仪比较,一致性与可重复性均较好。2.相对于SS1,SS2所拓宽的负性屈光度数测量范围,测量结果与Topcon电脑验光仪比较,一致性与可重复性均较好。在远视测量方面,SS2跟SS1比较无明显差异;3.在柱镜测量方面,SS1和SS2也有较好的一致性与可重复性。虽然其对柱镜轴向测量的表现略差于Topcon电脑验光仪,但这不影响它在群体性筛查中的应用。4.本研究表明在自然瞳孔状态下,Welch Allyn Suresight视力筛查仪的屈光检查结果对于初步了解儿童屈光状态,发现可能导致弱视的严重屈光不正并指导下一步的临床处理有很大的意义。目的:本研究对一组经视网膜激光光凝术治疗后的ROP患者和一组无ROP的早产儿以及一组足月儿应用光学相干断层扫描仪(OCT)测量了黄斑区视网膜厚度和容积,并对数据进行了分析比较,探讨ROP以及低出生胎龄对儿童视网膜发育的影响。方法:研究所选39例72只眼,均为在广州市妇女儿童医疗中心就诊的儿童,分为三组(第一组为有激光光凝手术史的ROP患者,第二组为无ROP的正常早产儿,第三组为其年龄相匹配的足月儿)。其中,激光光凝术后的ROP患者16例26只眼(激光光凝组)。所有纳入研究的均为高危阈值前期1型和阈值期ROP,经激光光凝术治疗后视网膜血管的发育趋于正常,临床症状消失的患者。无高度屈光不正及其他眼底病变的正常早产儿7例14只眼(正常早产儿组)。与患者年龄性别匹配的足月儿16例32只眼(足月儿组)。应用Topcon 3D OCT-1000对受检者黄斑区及周围6.0×6.0mm区域行放射状扫描,测量黄斑区视网膜厚度与容积,记录结果。结果:1.黄斑区视网膜厚度的比较:激光光凝组与正常早产儿组比较,在所分成的九区中,激光光凝组视网膜厚度均较正常早产儿组增厚,差异均有统计学意义(P0.05)。激光光凝组与足月儿组比较,在黄斑中心凹区(Fovea)和黄斑中心凹内环下方区(I?),激光光凝组视网膜厚度较足月儿组增厚(P0.05),差异有统计学意义。在其余各区,激光光凝组与足月儿组视网膜厚度无显著性差异(P0.05)。正常早产儿组与足月儿组比较,在黄斑中心凹区(Fovea),两组视网膜厚度无显著性差异(P0.05)。在其余各区,正常早产儿组视网膜厚度较足月儿组薄(P0.05),差异均有统计学意义。2.黄斑区视网膜容积的比较:激光光凝组与正常早产儿组比较,激光光凝组黄斑区视网膜总容积较正常早产儿组大,差异有统计学意义(P0.05)。在所分成的九区中,激光光凝组视网膜容积均较正常早产儿组大(P0.05),差异均有统计学意义。激光光凝组与足月儿组比较,黄斑区视网膜总容积无明显差异(P0.05)。在黄斑中心凹区(Fovea)和黄斑中心凹内环下方区(I?),激光光凝组视网膜容积较足月儿组大(P0.05),差异有统计学意义。在其余各区,激光光凝组与足月儿组视网膜容积无显著性差异(P0.05)。正常早产儿组与足月儿组比较,正常早产儿组黄斑区视网膜总容积较足月儿组小,差异有统计学意义(P0.05)。在黄斑中心凹区(Fovea),正常早产儿组视网膜容积与足月儿组比较差异无统计学意义(P0.05)。在其余各区,正常早产儿视网膜容积均较足月儿组小(P0.05),差异均有统计学意义。结论:1.正常早产儿组和足月儿组比较,正常早产儿组的黄斑中心凹区视网膜厚度较足月儿组厚,中心凹周边部视网膜厚度较足月儿组薄;正常早产儿组的黄斑区视网膜总容积较足月儿组小,黄斑中心凹区视网膜容积较足月儿组大,中心凹周边部视网膜容积较足月儿组小。2.激光光凝组和正常早产儿组比较,激光光凝组的黄斑中心凹区以及中心凹周边部视网膜厚度均较正常早产儿组厚;激光光凝组的黄斑区视网膜总容积,黄斑中心凹区视网膜容积以及中心凹周边部视网膜容积均较正常早产儿组大。
[Abstract]:Objective: Welchallyn Suresight eyesight screening instrument, such as hand-held optometry, is used in children's vision screening because of its convenience and no need for children's subjective cooperation. In this study, a group of patients with ametropia use Welchallyn Suresight (SS1) and two generation (SS2) and Topcon optometry, respectively. The refractive error of the retina was measured and the data were analyzed and compared. The repeatability and consistency of the data measured by SS1 and SS2 and the clinical application value of SS1 and SS2 were evaluated. Methods: 51 cases of 102 eyes selected from the research institute were diagnosed as ametropia in the ophthalmology of Guangzhou women and children's medical treatment center. Patients aged 2~16 (10.26 years of age) were excluded from other ocular diseases, eye surgery, and systemic systemic diseases. The patients were examined first in the natural pupil, with the SS1 and SS2 eyesight screening apparatus, the Topcon optometry, and the refraction results. Then the 0.5% Tropicamide Eye Drops pupil was used for 30-45 minutes. Retinometry and refraction were performed. The reproducibility of the refractive data was measured by individual measurements, the intra group correlation coefficient (intraclass correlation coefficient, ICC) and the repetition coefficient were used as an indicator of the accuracy of repeated measurements,.SS1, SS2 and the Topcon computer optometry data, and the retina, and the retina, and the retina. The 95% consistency limit of the contrast, as an indicator of consistency. Results: 1. there was no significant difference in the difference between the three groups of SS1, SS2 and Topcon optometry and the results of pupil examination (P0.05), in the sphere (-5D to +5D), the degree of -10D to +5D, and the axial measurement of the cylindrical mirror, SS1, SS2, and Topcon computers. The difference between the three groups of the optometre and the results of the pupil after the pupil was statistically significant (P0.05).2. repeatability: SS1, SS2 and Topcon computer optometry were more than 0.75 in the sphere mirror degree measurement, with a good repeatability; the SS1 ICC of the column mirror degree measurement was 0.66, and the SS2 and Topcon optometry was 0.88 and 0.99 respectively. SS2 could be repeated, respectively. The sex is better than SS1; the axial aspect of the column mirror SS1 and SS2 ICC are 0.71 and 0.72, respectively, and the repeatability of SS1 and SS2 is improved after removing the column mirror degree less than 0.5D, and the 0.83 and 0.73.3.95% conformance boundaries are respectively: the 95% conformance boundary of the SS1 and retinoscopy is in the sphere (-5D to +5D) degree measurement. Mirror degree measurement is (-1.76,1.75) D, the axial (all data of this group) is measured (-41.66,53.02), and the axial (columnar degree or 0.5D) measurement is (-33.55,32.31) degrees; the 95% consistency limit of SS2 and retinoscopy is (-3.15,1.83) D, and the degree of spherical mirror (-10D to +5D) degrees in the sphere (-5D to +5D) degree measurement. The measurement is (-2.96,2.23) D, the degree measurement of columnar mirror degree is (-1.26,1.27) D, the axial (all data of this group) is measured (-44.69,68.35), the axis of the columnoscope (the degree of columnar degree > 0.5D) is (-38.86,45.50); the 95% consistency limit of the Topcon computer optometry is compared with the retina detection method in the sphere (-5D to +5D) degree measurement In terms of (-2.57,0.94) D, the degree measurement of the sphere mirror (-10D to +5D) is (-3.10,1.25) D, the degree measurement of the columnoscope is (-0.61,0.54) D, the axial (all data) of the columnoscope (-31.92,36.35) degree is (-31.92,36.35), and the axis of the columnoscope (columnoscope degree > 0.5D) is the (-22.97,19.75) degree of the 95% conformance between the.SS1 and the gland. Conclusion: 1.SS1, SS2 in the sphere mirror degree measurement of natural pupil, compared with Topcon computer optometry, the consistency and repeatability are better than that of SS1 and SS2, the measurement result is better than that of the Topcon computer optometry. The consistency and repeatability are better. In the hyperopia measurement side, the measurement result is better. There is no obvious difference between SS2 and SS1; 3. in cylindrical mirror measurement, SS1 and SS2 also have better consistency and repeatability. Although the axial measurement of the column mirror is slightly worse than the Topcon computer optometry, it does not affect the application of the.4. in the group screening. The Welch Allyn Suresight visual sieves are shown in the natural pupil state. The results of the refraction of the instrument are of great significance for a preliminary understanding of the diopter of children, the detection of severe ametropia that may lead to amblyopia and the guidance of the next step of clinical treatment. Objective: This study used a group of ROP patients after the optic retinal laser photocoagulation treatment and a group of preterm infants without ROP and a group of foot months. A dry fault scanner (OCT) was used to measure the retinal thickness and volume of the macular region. The effects of ROP and low birth gestational age on the development of retina in children were analyzed and compared. Methods: 39 cases of 72 eyes selected in the study were divided into three groups (the first group was treated with laser photocoagulation. " The second group of ROP patients with a history of operation were normal preterm infants without ROP, and the third group was the matched foot of the age. Among them, 16 cases of 26 eyes (laser photocoagulation group) after laser photocoagulation (laser photocoagulation group). All the subjects included in the study were the prethreshold 1 type and the threshold period ROP, and the retinal vascular development tended to be normal after the photocoagulation therapy. Patients with disappearance of clinical symptoms. 7 normal preterm infants without high diopter and other fundus lesions (normal preterm infants). 16 cases of 32 eyes (foot Moon Group) matched with age and sex of the patient, 32 eyes (foot month group). Topcon 3D OCT-1000 was used to scan the macular area and the surrounding 6 x 6.0mm region, and the macular area was measured. The thickness and volume of the membrane were recorded. Results: 1. comparison of retinal thickness in the macula area: the laser photocoagulation group was compared with the normal preterm infant group. In the nine areas, the retinal thickness of the laser photocoagulation group was thicker than the normal preterm group (P0.05). The laser photocoagulation group was compared with the foot Moon Group, in the macular fovea region (F The retinal thickness of the laser photocoagulation group was more thicker than that of the foot Moon Group (P0.05). There was no significant difference in retinal thickness between the laser photocoagulation group and the foot Moon Group (P0.05) in the rest of the areas (P0.05). The two groups of retina were in the two groups of retina in the normal preterm group and the foot Moon Group (Fovea). There was no significant difference in thickness (P0.05). In the rest of the areas, the retinal thickness of the normal preterm infants was thinner than that of the full moon group (P0.05). The difference was statistically significant in the retinal volume of.2. macula region: compared with the normal prematurity group, the total volume of the retina in the laser photocoagulation group was larger than that in the normal preterm group, and the difference was statistically significant. Significance (P0.05). In the divided nine regions, the retinal volume of the laser photocoagulation group was larger than that of the normal preterm group (P0.05). There was no significant difference between the laser photocoagulation group and the foot moon group. There was no significant difference in the total volume of retina in the macular region (P0.05). In the macular fovea (Fovea) and the underneath of the macular fovea (I?), laser photocoagulation The retinal volume of the group was larger than that of the full moon group (P0.05). There was no significant difference in the retinal volume between the laser photocoagulation group and the foot Moon Group (P0.05). In the normal preterm infants, the total retinal volume of the macular area in normal preterm infants was smaller than that in the full moon group (P0.05). The difference was statistically significant. There was no significant difference in retinal volume of normal preterm infants (Fovea) in the normal preterm infants (P0.05). In the other areas, the retinal volume of normal preterm infants was smaller than that of the full moon group (P0.05). The difference was statistically significant. Conclusion: 1. normal preterm infants were compared with the foot Moon Group, and the macular fovea in the normal preterm infants group. The thickness of the retina was thicker than that of the full moon group, and the retinal thickness around the central fovea was thinner than that of the foot moon group; the total retinal volume of the macular area in the normal preterm group was smaller than that in the foot Moon Group, and the retinal volume in the macular fovea was larger than that in the full moon group. The volume of the retina in the periphery of the central fovea was more than that of the small.2. laser photocoagulation group and the normal preterm group. In the laser photocoagulation group, the retinal thickness of the macular center and the periphery of the central fovea were all thicker than that of the normal preterm infants. The total volume of the retina in the macular region, the volume of the retina in the macular fovea and the volume of the peripheral retina around the central fovea were greater in the laser photocoagulation group than in the normal prematurity group.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R774.1
[Abstract]:Objective: Welchallyn Suresight eyesight screening instrument, such as hand-held optometry, is used in children's vision screening because of its convenience and no need for children's subjective cooperation. In this study, a group of patients with ametropia use Welchallyn Suresight (SS1) and two generation (SS2) and Topcon optometry, respectively. The refractive error of the retina was measured and the data were analyzed and compared. The repeatability and consistency of the data measured by SS1 and SS2 and the clinical application value of SS1 and SS2 were evaluated. Methods: 51 cases of 102 eyes selected from the research institute were diagnosed as ametropia in the ophthalmology of Guangzhou women and children's medical treatment center. Patients aged 2~16 (10.26 years of age) were excluded from other ocular diseases, eye surgery, and systemic systemic diseases. The patients were examined first in the natural pupil, with the SS1 and SS2 eyesight screening apparatus, the Topcon optometry, and the refraction results. Then the 0.5% Tropicamide Eye Drops pupil was used for 30-45 minutes. Retinometry and refraction were performed. The reproducibility of the refractive data was measured by individual measurements, the intra group correlation coefficient (intraclass correlation coefficient, ICC) and the repetition coefficient were used as an indicator of the accuracy of repeated measurements,.SS1, SS2 and the Topcon computer optometry data, and the retina, and the retina, and the retina. The 95% consistency limit of the contrast, as an indicator of consistency. Results: 1. there was no significant difference in the difference between the three groups of SS1, SS2 and Topcon optometry and the results of pupil examination (P0.05), in the sphere (-5D to +5D), the degree of -10D to +5D, and the axial measurement of the cylindrical mirror, SS1, SS2, and Topcon computers. The difference between the three groups of the optometre and the results of the pupil after the pupil was statistically significant (P0.05).2. repeatability: SS1, SS2 and Topcon computer optometry were more than 0.75 in the sphere mirror degree measurement, with a good repeatability; the SS1 ICC of the column mirror degree measurement was 0.66, and the SS2 and Topcon optometry was 0.88 and 0.99 respectively. SS2 could be repeated, respectively. The sex is better than SS1; the axial aspect of the column mirror SS1 and SS2 ICC are 0.71 and 0.72, respectively, and the repeatability of SS1 and SS2 is improved after removing the column mirror degree less than 0.5D, and the 0.83 and 0.73.3.95% conformance boundaries are respectively: the 95% conformance boundary of the SS1 and retinoscopy is in the sphere (-5D to +5D) degree measurement. Mirror degree measurement is (-1.76,1.75) D, the axial (all data of this group) is measured (-41.66,53.02), and the axial (columnar degree or 0.5D) measurement is (-33.55,32.31) degrees; the 95% consistency limit of SS2 and retinoscopy is (-3.15,1.83) D, and the degree of spherical mirror (-10D to +5D) degrees in the sphere (-5D to +5D) degree measurement. The measurement is (-2.96,2.23) D, the degree measurement of columnar mirror degree is (-1.26,1.27) D, the axial (all data of this group) is measured (-44.69,68.35), the axis of the columnoscope (the degree of columnar degree > 0.5D) is (-38.86,45.50); the 95% consistency limit of the Topcon computer optometry is compared with the retina detection method in the sphere (-5D to +5D) degree measurement In terms of (-2.57,0.94) D, the degree measurement of the sphere mirror (-10D to +5D) is (-3.10,1.25) D, the degree measurement of the columnoscope is (-0.61,0.54) D, the axial (all data) of the columnoscope (-31.92,36.35) degree is (-31.92,36.35), and the axis of the columnoscope (columnoscope degree > 0.5D) is the (-22.97,19.75) degree of the 95% conformance between the.SS1 and the gland. Conclusion: 1.SS1, SS2 in the sphere mirror degree measurement of natural pupil, compared with Topcon computer optometry, the consistency and repeatability are better than that of SS1 and SS2, the measurement result is better than that of the Topcon computer optometry. The consistency and repeatability are better. In the hyperopia measurement side, the measurement result is better. There is no obvious difference between SS2 and SS1; 3. in cylindrical mirror measurement, SS1 and SS2 also have better consistency and repeatability. Although the axial measurement of the column mirror is slightly worse than the Topcon computer optometry, it does not affect the application of the.4. in the group screening. The Welch Allyn Suresight visual sieves are shown in the natural pupil state. The results of the refraction of the instrument are of great significance for a preliminary understanding of the diopter of children, the detection of severe ametropia that may lead to amblyopia and the guidance of the next step of clinical treatment. Objective: This study used a group of ROP patients after the optic retinal laser photocoagulation treatment and a group of preterm infants without ROP and a group of foot months. A dry fault scanner (OCT) was used to measure the retinal thickness and volume of the macular region. The effects of ROP and low birth gestational age on the development of retina in children were analyzed and compared. Methods: 39 cases of 72 eyes selected in the study were divided into three groups (the first group was treated with laser photocoagulation. " The second group of ROP patients with a history of operation were normal preterm infants without ROP, and the third group was the matched foot of the age. Among them, 16 cases of 26 eyes (laser photocoagulation group) after laser photocoagulation (laser photocoagulation group). All the subjects included in the study were the prethreshold 1 type and the threshold period ROP, and the retinal vascular development tended to be normal after the photocoagulation therapy. Patients with disappearance of clinical symptoms. 7 normal preterm infants without high diopter and other fundus lesions (normal preterm infants). 16 cases of 32 eyes (foot Moon Group) matched with age and sex of the patient, 32 eyes (foot month group). Topcon 3D OCT-1000 was used to scan the macular area and the surrounding 6 x 6.0mm region, and the macular area was measured. The thickness and volume of the membrane were recorded. Results: 1. comparison of retinal thickness in the macula area: the laser photocoagulation group was compared with the normal preterm infant group. In the nine areas, the retinal thickness of the laser photocoagulation group was thicker than the normal preterm group (P0.05). The laser photocoagulation group was compared with the foot Moon Group, in the macular fovea region (F The retinal thickness of the laser photocoagulation group was more thicker than that of the foot Moon Group (P0.05). There was no significant difference in retinal thickness between the laser photocoagulation group and the foot Moon Group (P0.05) in the rest of the areas (P0.05). The two groups of retina were in the two groups of retina in the normal preterm group and the foot Moon Group (Fovea). There was no significant difference in thickness (P0.05). In the rest of the areas, the retinal thickness of the normal preterm infants was thinner than that of the full moon group (P0.05). The difference was statistically significant in the retinal volume of.2. macula region: compared with the normal prematurity group, the total volume of the retina in the laser photocoagulation group was larger than that in the normal preterm group, and the difference was statistically significant. Significance (P0.05). In the divided nine regions, the retinal volume of the laser photocoagulation group was larger than that of the normal preterm group (P0.05). There was no significant difference between the laser photocoagulation group and the foot moon group. There was no significant difference in the total volume of retina in the macular region (P0.05). In the macular fovea (Fovea) and the underneath of the macular fovea (I?), laser photocoagulation The retinal volume of the group was larger than that of the full moon group (P0.05). There was no significant difference in the retinal volume between the laser photocoagulation group and the foot Moon Group (P0.05). In the normal preterm infants, the total retinal volume of the macular area in normal preterm infants was smaller than that in the full moon group (P0.05). The difference was statistically significant. There was no significant difference in retinal volume of normal preterm infants (Fovea) in the normal preterm infants (P0.05). In the other areas, the retinal volume of normal preterm infants was smaller than that of the full moon group (P0.05). The difference was statistically significant. Conclusion: 1. normal preterm infants were compared with the foot Moon Group, and the macular fovea in the normal preterm infants group. The thickness of the retina was thicker than that of the full moon group, and the retinal thickness around the central fovea was thinner than that of the foot moon group; the total retinal volume of the macular area in the normal preterm group was smaller than that in the foot Moon Group, and the retinal volume in the macular fovea was larger than that in the full moon group. The volume of the retina in the periphery of the central fovea was more than that of the small.2. laser photocoagulation group and the normal preterm group. In the laser photocoagulation group, the retinal thickness of the macular center and the periphery of the central fovea were all thicker than that of the normal preterm infants. The total volume of the retina in the macular region, the volume of the retina in the macular fovea and the volume of the peripheral retina around the central fovea were greater in the laser photocoagulation group than in the normal prematurity group.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R774.1
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