眼科广域数字成像系统（RetCam3）临床应用研究

发布时间：2018-07-31 11:44

【摘要】：目的：探讨眼科广域数字成像系统（RetCam3）的临床应用价值。方法：1.使用眼科广域数字成像系统（RetCam3）对621例婴幼儿进行眼部检查并拍照，对其中50例婴幼儿（包括46例早产儿,4例足月儿），以及3例儿童进行前房角检查并拍照； 2.对200例(400眼)早产儿应用双目间接眼底镜及RetCam3进行眼底检查，以双目间接眼底镜检查的结果作为“金标准”，比较两种检查方法对眼底病变的检出情况； 3.使用RetCam3及前房角镜对原发性闭角型青光眼及原发性浅前房患者30例（52眼）、正常人15例（26眼）行房角检查，采用Scheie方法对房角进行分级，以前房角镜检查结果为参照，比较两种方法在房角分级检查中的优劣。结果：1.621例婴幼儿中发现有眼部病变者132例（21.3%），其中，在就诊目的为筛查ROP的579例早产儿和足月低出生体重儿中，早产儿视网膜病变（ROP）65例，ROP以外的眼底病变35例，如视网膜孤立黄白色小点、单纯视网膜出血等；80例足月婴幼儿中，眼底有病变者26例，包括视神经发育不良、陈旧性视网膜炎、陈旧性视网膜脱离、视网膜血管性病变、视网膜母细胞瘤等，眼前部病变者6例，如先天性虹膜异常等。婴幼儿房角检查发现其特点为：小梁网半透明无色素，巩膜嵴较清晰，虹膜根部基质层“嵴”样附着于小梁网上，随着年龄增长，房角结构暴露范围增加，最终虹膜止点完全附着睫状体带，小梁网色素附着。 2.200例（400眼）早产儿中，双目间接眼底镜检查出各期ROP53眼，RetCam3检查出ROP49眼，RetCam3与间接眼底镜检查结果经R×R列表的配对卡方检验，，差异有统计学意义（χ2=6.0，P=0.05），Pearson相关系数=0.85（P0.01），Kappa值=0.94（P0.01），二者检查结果一致率高，RetCam3检查ROP I期灵敏度89.7%，特异度99.4%； ROP II期灵敏度80.0%，特异度100%；ROP III期灵敏度、特异度100%。二者对眼底出血诊断的一致率为87.5％；二者对眼底白点诊断的一致率为33.3％。 3.前房角镜与RetCam3对78眼前房角检查结果的比较采用R×R列表的配对卡方检验，差异有统计学意义（X2=72，P0.01）；RetCam3对宽角及I级房角诊断的灵敏度为100%，特异度为48.3%，对II级房角诊断的灵敏度为33.3%，特异度为97.2%，对可关闭房角诊断的灵敏度为43.5%，特异度为100%。结论：在婴幼儿眼部疾病的筛查中，眼科广域数字成像系统(RetCam3)是一种有效、准确的检查方法；RetCam3判定的房角分级较房角镜对房角分级的判定偏低；在虹膜明显膨隆时，难以判定房角分级，其在房角分级检查中的作用有待进一步研究、探讨。
[Abstract]:Objective: to evaluate the clinical value of wide area digital imaging system (RetCam3) in ophthalmology. Method 1: 1. The ophthalmic wide-area digital imaging system (RetCam3) was used to examine and photograph the eyes of 621 infants, 50 infants (including 46 preterm infants and 4 term infants) and 3 children with anterior chamber angle. 2. Two hundred cases (400 eyes) of premature infants were examined with binocular indirect fundus microscopy and RetCam3. The results of binocular indirect fundus examination were taken as the "gold standard" to compare the detection of fundus lesions between the two methods. 3. Thirty patients (52 eyes) with primary angle-closure glaucoma and primary shallow anterior chamber and 15 normal subjects (26 eyes) with angle were examined by RetCam3 and anterior chamber angle endoscopy. The angle of the chamber was graded by Scheie method. To compare the advantages and disadvantages of the two methods in angle grading inspection. Results among 1. 621 infants, 132 (21. 3%) were found to have ocular lesions. Among the 579 premature infants and full-term low birth weight infants whose objective was to screen for ROP, there were 35 cases of retinopathy other than (ROP) in premature infants. Among 80 term infants with retinal isolated yellowish white dots, simple retinal hemorrhage and so on, 26 cases had fundus lesions, including optic nerve dysplasia, old retinitis, old retinal detachment, retinal vascular disease, etc. Retinoblastoma and other 6 cases of anterior lesions, such as congenital iris abnormalities. The results showed that the trabecular meshwork was translucent and colorless, the scleral ridge was clear, the "cristae" of the iris root stroma attached to the trabecular meshwork, and the exposed range of the angle structure increased with age. Finally, the iris stop was completely attached to the ciliary band, and trabecular reticulum pigment was attached. 2.200 cases (400 eyes) of premature infants, Binocular indirect fundus examination showed that the results of ROP49 eye retCam3 and indirect fundus examination were matched chi-square test of R 脳 R list. The correlation coefficient of Pearson was 0.85 (P0.01) and 0.94 (P0.01). The rate of agreement between the two methods was higher than that of RetCam3 in detecting ROP stage I sensitivity (89.7g), specificity (99.4), ROP II (80.0), specificity (100ROP III) and specificity (100mg / kg). The consistent rate of diagnosis of fundus hemorrhage was 87.5%, and that of white spot was 33.33.3%. The comparison between anterior chamber angle and RetCam3 for 78 anterior atrial angle was compared by using the matched chi-square test of R 脳 R list. The difference was statistically significant (X2O72P0.01). The sensitivity of RetCam3 for the diagnosis of wide angle and grade I atrial angle was 100, the specificity was 48.3, the sensitivity for grade II angle was 33.33.3, the specificity was 97.2and the sensitivity for the diagnosis of closed angle was 43.5 and the specificity was 100. Conclusion: the wide area digital imaging system (RetCam3) of ophthalmology is an effective and accurate method in the screening of infant eye diseases. It is difficult to judge the classification of angle, and its role in the examination of angle grade needs further study and discussion.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R770.4

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