2159例患者非散瞳视网膜摄影与检眼镜检查的比较：移动视网膜相机研究
Comparison of non-mydriatic retinal photography with ophthalmoscopy in 2159 patients: mobile retinal camera study.
作者信息
Taylor R, Lovelock L, Tunbridge W M, Alberti K G, Brackenridge R G, Stephenson P, Young E
机构信息
Royal Victoria Infirmary, Newcastle upon Tyne.
出版信息
BMJ. 1990 Dec 1;301(6763):1243-7. doi: 10.1136/bmj.301.6763.1243.
OBJECTIVE
To determine whether non-mydriatic Polaroid retinal photography was comparable to ophthalmoscopy with mydriasis in routine clinic screening for early, treatable diabetic retinopathy.
DESIGN
Prospective study of ophthalmoscopic findings according to retinal camera screening and ophthalmoscopy and outcome of referral to ophthalmologist.
SETTING
Outpatient diabetic clinics of three teaching hospitals and three district general hospitals.
PATIENTS
2159 Adults selected randomly from the diabetic clinics, excluding only those registered as blind or those in wheelchairs and unable to enter the screening vehicle.
MAIN OUTCOME MEASURES
Numbers of patients and eyes correctly identified by each technique as requiring referral with potentially treatable retinopathy (new vessel formation and maculopathy) and congruence in numbers of microaneurysms, haemorrhages, and exudates reported.
RESULTS
Camera screening missed two cases of new vessel formation and did not identify a further 12 but indicated a need for referral. Ophthalmoscopy missed five cases of new vessel formation and indicated a need for referral in another four for other reasons. Maculopathy was reported in 147 eyes with camera screening alone and 95 eyes by ophthalmoscopy only (chi 2 = 11.2; p less than 0.001), in 66 and 29 of which respectively maculopathy was subsequently confirmed. Overall, 38 eyes received laser treatment for maculopathy after detection by camera screening compared with 17 after ophthalmoscopic detection (chi 2 = 8.0; p less than 0.01). Camera screening underestimated numbers of microaneurysms (chi 2 = 12.9; p less than 0.001) and haemorrhages (chi 2 = 7.4; p less than 0.01) and ophthalmoscopy underestimated hard exudates (chi 2 = 48.2; p less than 0.001).
CONCLUSIONS
Non-mydriatic Polaroid retinal photography is at least as good as ophthalmoscopy with mydriasis in routine diabetic clinics in identifying new vessel formation and absence of retinopathy and is significantly better in detecting exudative maculopathy.
目的
确定在常规门诊筛查早期可治疗的糖尿病视网膜病变时，非散瞳宝丽来视网膜摄影与散瞳检眼镜检查是否具有可比性。
设计
根据视网膜相机筛查和检眼镜检查结果以及转诊至眼科医生的结果进行前瞻性研究。
地点
三家教学医院和三家地区综合医院的门诊糖尿病诊所。
患者
从糖尿病诊所随机选取2159名成年人，仅排除那些登记为盲人或坐在轮椅上无法进入筛查车辆的人。
主要观察指标
每种技术正确识别出需要转诊至患有潜在可治疗视网膜病变（新生血管形成和黄斑病变）的患者和眼睛数量，以及报告的微动脉瘤、出血和渗出物数量的一致性。
结果
相机筛查漏诊了2例新生血管形成病例，另外12例未识别出，但提示需要转诊。检眼镜检查漏诊了5例新生血管形成病例，另有4例因其他原因提示需要转诊。仅通过相机筛查报告有黄斑病变的眼睛有147只，仅通过检眼镜检查报告有黄斑病变的眼睛有95只（χ² = 11.2；P < 0.001），其中分别有66只和29只随后被确诊为黄斑病变。总体而言，相机筛查发现后有38只眼睛因黄斑病变接受了激光治疗，检眼镜检查发现后有17只眼睛接受了激光治疗（χ² = 8.0；P < 0.01）。相机筛查低估了微动脉瘤数量（χ² = 12.9；P < 0.001）和出血数量（χ² = 7.4；P < 0.01），检眼镜检查低估了硬性渗出物数量（χ² = 48.2；P < 0.001）。
结论
在常规糖尿病诊所中，非散瞳宝丽来视网膜摄影在识别新生血管形成和无视网膜病变方面至少与散瞳检眼镜检查一样好，在检测渗出性黄斑病变方面明显更好。
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