评估有和没有眼科专业培训的兽医检测与系统性高血压相关的猫眼底异常的可靠性。
Reliability of detecting fundus abnormalities associated with systemic hypertension in cats assessed by veterinarians with and without ophthalmology specialty training.
机构信息
Division of Cardiology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland.
Division of Ophthalmology Section, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland.
出版信息
J Feline Med Surg. 2021 Oct;23(10):921-927. doi: 10.1177/1098612X20983265. Epub 2021 Jan 13.
OBJECTIVES
Systemic hypertension (SHT) causes severe target organ damage (TOD) and blood pressure (BP) measurement should be routine in at-risk populations. Fundoscopy is a tool to corroborate acute clinical relevance of high BP results and to decide on immediate therapy. Not every cat with a high BP result can be examined by an ophthalmologist. The study objective was to determine the reliability of fundoscopy in cats with SHT performed by a veterinarian without ophthalmology specialty training.
METHODS
Cats with suspicion of hypertensive TOD or belonging to an at-risk population for SHT with a first measurement of elevated BP >160 mmHg were enrolled. Indirect ophthalmoscopy was performed by a recent graduate veterinarian followed by a veterinary ophthalmologist. Confirmation of SHT was based on two additional sets of systolic BP measurements >160 mmHg by Doppler sphygmomanometry.
RESULTS
Thirty-three cats were included. SHT was confirmed in 27 cats. SHT was detected on routine examinations in 12/27 cats; fundoscopic lesions were observed in 9/12 by the non-trained veterinarian and in 11/12 by an ophthalmologist. Nine of 27 cats were neurological patients; fundoscopic lesions were detected in 4/9 by the non-trained veterinarian and in 7/9 by an ophthalmologist. Six of 27 cats were presented for acute blindness; fundus lesions were detected in all six cats by the non-trained veterinarian and ophthalmologist. SHT was not confirmed and fundoscopic lesions were not detected by either examiner in 6/33 cats. Compared with a veterinary ophthalmologist, reliability of detecting fundus abnormalities by the non-trained veterinarian was 72% (13/18) for cats with, and 100% (6/6) for cats without, vision.
CONCLUSIONS AND RELEVANCE
Fundus examination by a non-specialty trained veterinarian has reasonably high reliability for the detection of ocular TOD. Private practice veterinarians are encouraged to perform an initial fundic examination in suspected hypertensive cats.
目的
全身性高血压（SHT）可导致严重的靶器官损伤（TOD），应在高危人群中常规测量血压（BP）。眼底检查是一种工具，可以证实高血压结果的急性临床相关性，并决定是否立即进行治疗。并非每只血压升高的猫都可以由眼科医生进行检查。本研究的目的是确定未经眼科专业培训的兽医在患有 SHT 的猫中进行眼底检查的可靠性。
方法
纳入怀疑患有高血压 TOD 或属于高血压高危人群且首次测量血压升高>160mmHg 的猫。间接眼底镜检查由最近毕业的兽医进行，然后由兽医眼科医生进行。根据多普勒血压计测量的另外两组收缩压>160mmHg，确认存在 SHT。
结果
共纳入 33 只猫。27 只猫确诊为 SHT。27 只猫中，有 12 只在常规检查中发现 SHT；未经培训的兽医在 9/12 只猫中观察到眼底病变，而眼科医生在 11/12 只猫中观察到眼底病变。27 只猫中有 9 只为神经科患者；未经培训的兽医在 4/9 只猫中检测到眼底病变，而眼科医生在 7/9 只猫中检测到眼底病变。27 只猫中有 6 只为急性失明；未经培训的兽医和眼科医生均在所有 6 只猫中发现眼底病变。在 33 只猫中，有 6 只既未确诊 SHT，也未发现眼底病变，无论是兽医还是眼科医生均未发现眼底病变。与兽医眼科医生相比，非专业兽医检测眼底异常的可靠性对于有视力的猫为 72%（13/18），对于无视力的猫为 100%（6/6）。
结论和相关性
未经专业培训的兽医进行眼底检查对于检测眼部 TOD 具有相当高的可靠性。鼓励私人执业兽医在疑似高血压猫中进行初步眼底检查。
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