Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Telemed J E Health. 2013 Aug;19(8):627-31. doi: 10.1089/tmj.2012.0233. Epub 2013 Jun 11.
Screening for cytomegalovirus retinitis (CMVR) is important in patients with acquired immune deficiency syndrome and low CD4(+) counts. However, many human immunodeficiency virus (HIV) patients lack access to specialist ophthalmological care. Telemedicine screening is a cost-effective method for screening these patients. We aimed to report the use of composite nine-field digital fundus photography (DFP) images for CMVR screening. We report its sensitivity and specificity in detecting CMVR and the level of agreement with gold-standard binocular indirect ophthalmoscopy.
An audit was performed on our national CMVR screening program that screened all HIV patients referred to the Ophthalmology Department at Tan Tock Seng Hospital, Singapore. All patients underwent retinal screening with DFP. Images were categorized as CMVR-positive, CMVR-negative, suspicious, or unreadable by blinded retinal specialists. Patients subsequently underwent dilated gold-standard indirect ophthalmoscopy by a different retinal specialist. Diagnoses were categorized as CMVR-positive, CMVR-negative, or unreadable. Sensitivity and specificity of retinal findings on DFP and kappa values for level of agreement between the two screening methods were calculated.
Three hundred seventy screenings on 188 patients were performed. Twenty-three eyes diagnosed with CMVR on indirect ophthalmoscopy were also identified on DFP (100% sensitivity). A 99.9% specificity was achieved. The fundus photograph of one eye without CMVR was read as CMVR-positive because of an artifact, accounting for a false-positive. Kappa values ranged from 0.739 to 0.987.
DFP is a sensitive and specific method of screening HIV patients for CMVR and has a high level of agreement with indirect ophthalmoscopy.
在获得性免疫缺陷综合征和低 CD4(+)计数的患者中，筛查巨细胞病毒视网膜炎 (CMVR) 非常重要。然而，许多人类免疫缺陷病毒 (HIV) 患者无法获得专业眼科护理。远程医疗筛查是筛查这些患者的一种具有成本效益的方法。我们旨在报告使用复合九视场数字眼底摄影 (DFP) 图像进行 CMVR 筛查。我们报告其在检测 CMVR 中的敏感性和特异性，以及与金标准双目间接检眼镜的一致性水平。
我们对新加坡 Tan Tock Seng 医院眼科转诊的所有 HIV 患者进行了全国性 CMVR 筛查计划的审计。所有患者均接受 DFP 视网膜筛查。图像分为 CMVR 阳性、CMVR 阴性、可疑或无法读取由盲法视网膜专家。随后，患者由另一位视网膜专家进行了散瞳金标准间接检眼镜检查。诊断分为 CMVR 阳性、CMVR 阴性或无法读取。计算 DFP 视网膜检查的敏感性和特异性以及两种筛查方法之间一致性的kappa 值。
对 188 名患者的 370 次筛查进行了分析。在间接检眼镜下诊断为 CMVR 的 23 只眼中，也在 DFP 上发现（100%的敏感性）。达到了 99.9%的特异性。一只无 CMVR 的眼睛的眼底照片因伪影而被读为 CMVR 阳性，导致假阳性。kappa 值范围为 0.739 至 0.987。
DFP 是一种敏感且特异性的方法，可用于筛查 HIV 患者的 CMVR，与间接检眼镜具有高度一致性。
