Wallace David K, Quinn Graham E, Freedman Sharon F, Chiang Michael F
Department of Ophthalmology, Duke University, Durham, North Carolina, USA.
J AAPOS. 2008 Aug;12(4):352-6. doi: 10.1016/j.jaapos.2007.11.022. Epub 2008 Mar 10.
Plus disease has become the major criterion for laser treatment in infants with retinopathy of prematurity (ROP), but its assessment is subjective. Our purpose was to compare quadrant-level and eye-level assessment of plus disease and pre-plus disease among 3 experienced ROP examiners and to report their rate of agreement.
One hundred eighty-one high-quality RetCam images from premature infants were graded by 3 of the authors. Dilation and tortuosity were judged separately using a scale of normal or sufficiently abnormal to meet criteria for pre-plus or plus disease.
There was disagreement on the presence of plus disease for 18 images (10%), on tortuosity sufficient for plus disease (plus tortuosity) for 26 images (14%), and on dilation sufficient for plus disease (plus dilation) for 26 images (14%). Of 67 images judged to have pre-plus disease or worse, there was disagreement on the presence of plus disease for 18 images (27%), on plus tortuosity for 25 images (37%), and on plus dilation for 21 images (31%). For distinguishing plus or pre-plus disease from normal, there was disagreement on pre-plus tortuosity for 38 of 181 images (21%) and on pre-plus dilation for 58 of 181 images (32%).
Three experienced ROP examiners disagreed frequently on the diagnosis of plus or pre-plus disease when evaluating cropped clinical photographs of infants, many of which had borderline plus disease. Further study is required to determine the implications of these observations on clinical decision making.
附加病变已成为早产儿视网膜病变（ROP）婴儿激光治疗的主要标准，但其评估具有主观性。我们的目的是比较3名经验丰富的ROP检查者对附加病变和附加病变前期在象限水平和眼水平的评估，并报告他们的一致性率。
3位作者对181张来自早产儿的高质量RetCam图像进行分级。分别使用正常或异常程度足以符合附加病变前期或附加病变标准的量表来判断血管迂曲和扩张情况。
对于18张图像（10%）附加病变的存在、26张图像（14%）足以诊断附加病变的血管迂曲（附加迂曲）以及26张图像（14%）足以诊断附加病变的血管扩张（附加扩张）存在分歧。在67张被判定为有附加病变前期或更严重病变的图像中，对于18张图像（27%）附加病变的存在、25张图像（37%）附加迂曲以及21张图像（31%）附加扩张存在分歧。对于区分附加病变或附加病变前期与正常情况，在181张图像中有38张（21%）在附加病变前期迂曲方面存在分歧，58张（32%）在附加病变前期扩张方面存在分歧。
3名经验丰富的ROP检查者在评估婴儿裁剪后的临床照片时，对于附加病变或附加病变前期的诊断经常存在分歧，其中许多照片处于附加病变的临界状态。需要进一步研究以确定这些观察结果对临床决策的影响。
