van den Born B J, Schlingemann R O, Hoekstra J B, van Montfrans G A
Afd. Inwendige Geneeskunde, Academisch Medisch Centrum/Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam.
Ned Tijdschr Geneeskd. 2004 Mar 6;148(10):464-8.
Funduscopic examination according to the classification of Keith, Wagener and Barker has been used since 1939 to assess retinal damage in patients with hypertension. Improved treatment possibilities and the screening of patients with hypertension seem to have led to a decrease in the incidence and severity of the retinal abnormalities found. The following findings have been published during the past ten years. The assessment of retinopathy is subject to a large interobserver-variability, especially with respect to venous-crossings and arteriolar narrowing of retinal vessels. The positive and negative predictive value of retinopathy for high blood pressure is low. The association of retinopathy with other predictive indicators for organ damage is inconsistent and its association with cardiovascular complications is weak. These findings indicate that the usefulness of funduscopic examination as an instrument for assessing organ damage in patients with hypertension is limited. Therefore it should not be used as a routine diagnostic tool unless a hypertensive crisis is indicated.
自1939年以来，一直采用根据Keith、Wagener和Barker分类法进行的眼底检查来评估高血压患者的视网膜损伤情况。治疗可能性的改善以及对高血压患者的筛查似乎已导致所发现的视网膜异常的发生率和严重程度有所下降。在过去十年间已发表了以下研究结果。视网膜病变的评估存在较大的观察者间差异，尤其是在视网膜血管的静脉交叉处和小动脉狭窄方面。视网膜病变对高血压的阳性和阴性预测价值较低。视网膜病变与其他器官损伤预测指标之间的关联并不一致，且其与心血管并发症之间的关联较弱。这些研究结果表明，眼底检查作为评估高血压患者器官损伤的一种手段，其效用有限。因此，除非有高血压危象指征，否则不应将其用作常规诊断工具。
