Lorenz B, Bock M, Müller H M, Massie N A
Department of Pediatric Ophthalmology, Strabismology and Ophthalmogenetics, University of Regensburg, Germany.
Stud Health Technol Inform. 1999;64:155-63.
Retinopathy of Prematurity (ROP) is a major risk for permanent visual loss in extreme prematures. In stage 3+ (zone I and II), defined as threshold disease, the risk for retinal detachment with subsequent blindness is about 50% without treatment, compared to only a few percent with laser photoablation. Visualisation and interpretation of the critical retinal changes requires a high degree of expertise. Therefore, screening by general ophthalmologists will not identify all cases at threshold necessary to prevent blindness in as many infants as possible. The development of a new digital wide-field camera system (RetCam 120) allows documentation of nearly the entire retina within minutes. Recently, sensitivity, specificity, positive predictive power and negative predictive power have been evaluated to be high. Data collection is also possible by trained staff of the neonatal care units. Data can be transferred electronically, even though it could be transferred through physical transport. Analyzing the data in a central reading center specialized in the treatment of ROP will allow optimal timing of treatment and thus salvage vision in more infants. In addition, unnecessary referrals that are not only expensive but put also stress on the very vulnerable prematures can be avoided. At present, efforts are made to realize a pilot project in Eastern Bavaria that will test the potentials of telemedicine based screening for ROP. In addition, the potential of the system will be evaluated in other neuroophthalmological diseases.
早产儿视网膜病变（ROP）是极早早产儿永久性视力丧失的主要风险因素。在3+期（I区和II区），即阈值疾病，未经治疗时视网膜脱离及随后失明的风险约为50%，而激光光凝治疗后的风险仅为百分之几。关键视网膜变化的可视化和解读需要高度专业知识。因此，普通眼科医生进行筛查无法识别所有处于阈值阶段的病例，而这些病例对于尽可能多的婴儿预防失明是必要的。新型数字广角相机系统（RetCam 120）的开发使得在几分钟内就能记录几乎整个视网膜。最近，经评估该系统的敏感性、特异性、阳性预测值和阴性预测值都很高。新生儿重症监护病房的经过培训的工作人员也能够收集数据。数据可以通过电子方式传输，尽管也可以通过物理运输方式传输。在专门治疗ROP的中央阅片中心分析数据将有助于实现最佳治疗时机，从而挽救更多婴儿的视力。此外，还可以避免不必要的转诊，这些转诊不仅费用高昂，还会给极其脆弱的早产儿带来压力。目前，正在努力在巴伐利亚东部开展一个试点项目，以测试基于远程医疗的ROP筛查的潜力。此外，该系统在其他神经眼科疾病中的潜力也将得到评估。
