Banaee Touka, Ansari-Astaneh Mohammad-Reza, Pourreza Hamidreza, Faal Hosseini Fatemeh, Vatanparast Maryam, Shoeibi Nasser, Jami Vajihe
a Retina Research Center, Khatam-al-Anbia Eye Hospital , Mashhad University of Medical Science , Mashhad , Iran.
b Department of Ophthalmology, School of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran.
Ophthalmic Epidemiol. 2017 Aug;24(4):217-221. doi: 10.1080/09286586.2016.1274039. Epub 2017 Jun 28.
To compare the quality of fundus photographs taken before and after instillation of one drop of tropicamide.
The 45º fundus photographs were taken with a non-mydriatic fundus camera in three conditions of the pupil; pre-mydriatic, 10 minutes after one drop of tropicamide, and fully dilated. Two photographs were taken in each condition; one centered on the macula and the other on the optic disc. Two vitreoretinal specialists graded the images.
A total of 1768 fundus photographs of 149 diabetic patients with dark irides were included. There were more ungradable images (38.1% and 50.3%, graders 1 and 2, respectively) in the non-mydriatic state than partially- (4.6% and 11.5%) or fully-dilated (15.4% and 10.0%) conditions (p < 0.001, both graders). Partially and fully dilated states had similar rates of ungradable images (p = 0.56 and p = 0.54, graders 1 and 2, respectively). Test-retest reliability (repeatability) was 92.5% and 74.3% for the two graders, respectively. Inter-grader agreement was moderate (Kappa = 0.50).
Non-mydriatic fundus photographs have a high rate of ungradable images in patients with dark irides. Instillation of only one drop of tropicamide improves the quality of fundus photographs, which is not furthered by adding more drops. This strategy can be used in tele-ophthalmology programs.
比较滴入一滴托吡卡胺前后所拍摄的眼底照片质量。
使用免散瞳眼底相机在三种瞳孔状态下拍摄45°眼底照片，即散瞳前、滴入一滴托吡卡胺10分钟后以及充分散瞳状态。每种状态下拍摄两张照片，一张以黄斑为中心，另一张以视盘为中心。两名玻璃体视网膜专科医生对图像进行分级。
共纳入149例虹膜颜色较深的糖尿病患者的1768张眼底照片。与部分散瞳（分别为4.6%和11.5%）或充分散瞳（分别为15.4%和10.0%）状态相比，免散瞳状态下不可分级的图像更多（分别为38.1%和50.3%，分级医生1和分级医生2）（两位分级医生的p值均<0.001）。部分散瞳和充分散瞳状态下不可分级图像的比例相似（分级医生1的p = 0.56，分级医生2的p = 0.54）。两位分级医生的重测信度（重复性）分别为92.5%和74.3%。分级医生间的一致性为中等（Kappa = 0.50）。
虹膜颜色较深的患者，免散瞳眼底照片不可分级的比例较高。仅滴入一滴托吡卡胺可提高眼底照片质量，增加滴数并不能进一步改善。该策略可用于远程眼科项目。
