Yen K G, Hess D, Burke B, Johnson R A, Feuer W J, Flynn J T
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA.
Trans Am Ophthalmol Soc. 2000;98:145-50; discussion 150-1.
Labor-intensive screening of infants in the neonatal intensive care units is the only way to detect retinopathy of prematurity (ROP). Our purpose is to determine if RetCam 120 photos, acquired by a neonatal nurse, can be used to screen for ROP by performing 2 screening examinations, at 32 to 34 weeks (exam 1) and at 38 to 40 weeks (exam 2) post-conceptional age.
RetCam examinations are performed by a nurse on infants at exam 1 and exam 2 intervals. At the same time, an examination is performed by an experienced ophthalmologist. Masked readers evaluate the photos for ROP and determine if each eye will progress to prethreshold or threshold disease. The data are compared to the clinical course of the eyes.
Forty-six eyes were photographed at exam 1 and 50 eyes at exam 2 from July 1, 1999, to December 15, 1999. Sensitivity and specificity of detecting ROP were 76% and 100% for exam 2 and 46% and 100% for exam 1. Sensitivity and specificity of predicting prethreshold disease were 64% and 97% for exam 2 and 33% and 100% for exam 1. Sensitivity and specificity of predicting threshold were both 100% at exam 2 and 0% (one photo in category) and 95% at exam 1.
A potential reason for low sensitivity is technical limitations of the Retcam, such as the difficulty in capturing peripheral retina in small eyes and the need for a better lid speculum.
在新生儿重症监护病房对婴儿进行劳动密集型筛查是检测早产儿视网膜病变（ROP）的唯一方法。我们的目的是确定由新生儿护士获取的RetCam 120照片是否可用于通过在孕龄32至34周（检查1）和38至40周（检查2）进行两次筛查检查来筛查ROP。
护士在检查1和检查2的间隔期对婴儿进行RetCam检查。同时，由经验丰富的眼科医生进行检查。蒙面阅片者评估照片是否存在ROP，并确定每只眼睛是否会发展为阈值前或阈值疾病。将数据与眼睛的临床病程进行比较。
从1999年7月1日至1999年12月15日，检查1时有46只眼睛被拍照，检查2时有50只眼睛被拍照。检查2检测ROP的敏感性和特异性分别为76%和100%，检查1分别为46%和100%。检查2预测阈值前疾病的敏感性和特异性分别为64%和97%，检查1分别为33%和100%。检查2预测阈值的敏感性和特异性均为100%，检查1时分别为0%（一张照片属于该类别）和95%。
敏感性低的一个潜在原因是Retcam的技术限制，例如在小眼睛中难以捕捉周边视网膜以及需要更好的眼睑撑开器。
