Prakalapakorn S Grace, Freedman Sharon F, Hutchinson Amy K, Saehout Piyada, Cetinkaya-Rundel Mine, Wallace David K, Kulvichit Kittisak
J Pediatr Ophthalmol Strabismus. 2018 Jul 1;55(4):245-253. doi: 10.3928/01913913-20180327-04. Epub 2018 May 29.
To evaluate an alternative retinopathy of prematurity (ROP) screening system that identifies infants meriting examination by an ophthalmologist in a middle-income country.
The authors hypothesized that grading posterior pole images for the presence of pre-plus or plus disease has high sensitivity to identify infants with type 1 ROP that requires treatment. Part 1 of the study evaluated the feasibility of having a non-ophthalmologist health care worker obtain retinal images of prematurely born infants using a non-contact retinal camera (Pictor; Volk Optical, Inc., Mentor, OH) that were of sufficient quality to grade for pre-plus or plus disease. Part 2 investigated the accuracy of grading these images to identify infants with type 1 ROP. The authors prospectively recruited infants at Chulalongkorn University Hospital (Bangkok, Thailand). On days infants underwent routine ROP screening, a trained health care worker imaged their retinas with Pictor. Two ROP experts graded these serial images from a remote location for image gradability and posterior pole disease.
Fifty-six infants were included. Overall, 69.4% of infant imaging sessions were gradable. Among gradable images, the sensitivity of both graders for identifying an infant with type 1 ROP by grading for the presence of pre-plus or plus disease was 1.0 (95% confidence interval [CI]: 0.31 to 1.0) for grader 1 and 1.0 (95% CI: 0.40 to 1.0) for grader 2. The specificity was 0.93 (95% CI: 0.76 to 0.99) for grader 1 and 0.74 (95% CI: 0.53 to 0.88) for grader 2.
It was feasible for a trained non-ophthalmologist health care worker to obtain retinal images of infants using the Pictor that were of sufficient quality to identify infants with type 1 ROP. [J Pediatr Ophthalmol Strabismus. 2018;55(4):245-253.].
评估一种用于筛查早产儿视网膜病变（ROP）的替代系统，该系统能够识别出在中等收入国家需要眼科医生检查的婴儿。
作者假设对后极部图像进行预加或加病变分级，对于识别需要治疗的1型ROP婴儿具有较高的敏感性。研究的第1部分评估了非眼科医护人员使用非接触式视网膜相机（Pictor；Volk Optical, Inc., Mentor, OH）获取早产儿视网膜图像的可行性，这些图像的质量足以进行预加或加病变分级。第2部分研究了对这些图像进行分级以识别1型ROP婴儿的准确性。作者在朱拉隆功大学医院（泰国曼谷）前瞻性招募婴儿。在婴儿接受常规ROP筛查的当天，一名经过培训的医护人员使用Pictor对他们的视网膜进行成像。两名ROP专家从远程位置对这些系列图像进行分级，以评估图像的可分级性和后极部病变情况。
共纳入56名婴儿。总体而言，69.4%的婴儿成像检查可进行分级。在可分级的图像中，分级者1通过对预加或加病变进行分级来识别1型ROP婴儿的敏感性为1.0（95%置信区间[CI]：0.31至1.0），分级者2的敏感性为1.0（95%CI：0.40至1.0）。分级者1的特异性为0.93（95%CI：0.76至0.99），分级者2的特异性为0.74（95%CI：0.53至0.88）。
经过培训的非眼科医护人员使用Pictor获取婴儿视网膜图像是可行的，这些图像的质量足以识别1型ROP婴儿。[《小儿眼科与斜视杂志》。2018；55(4)：245 - 253。]
