小儿视网膜数字照相系统与间接眼底镜在早产儿眼底疾病筛查中的作用比较

Comparison of effect of RetCam pedo-retino-digital photography and indirect ophthalmoscope on screening of retinal disease of prematurity

目的:评估小儿视网膜数字照相系统(RetCam)在早产儿眼底疾病筛查中的作用。方法:对200例(400眼)早产儿应用双目间接眼底镜及RetCam进行眼底检查,以双目间接眼底镜检查的结果作为"金标准",比较两种检查方法对眼底病变的检出情况。结果:双目间接眼底镜检查出各期早产儿视网膜病变(ROP)共53眼,RetCam检查出ROP 49眼,RetCam与间接眼底镜检查结果经R×R列表的配对χ2检验,差异有统计学意义(P<0.05),二者检查结果一致率高。RetCam检查ROP I期灵敏度89.7%,特异度99.4%;ROP II期灵敏度80.0%,特异度100.0%;ROP III期灵敏度、特异度100.0%。二者对眼底出血诊断的一致率为87.5%,二者对眼底白点诊断的一致率为33.3%。结论:在早产儿眼底疾病筛查中RetCam是一种有效、准确的检查方法。

Objective： To evaluate the role of RetCam pedo - retino - digital photography in screening of retinal disease of prematurity. Methods： The fundus of 200 cases （400 eyes） of premature infants who were visited hospital from February to May in 2012 were examinated by binocular indirect ophthalmoscope and RetCam. The examination results of binocular indirect ophthalmoscope was as ＂ gold standard＂ and two examination methods were compared in detection of fundus pathological changes. Results： 53 eyes of all stages of retinopathy of prematurity （ROP） were detected by binocular indirect ophthalmoscope, while 49 eyes by RetCam. The examination resuhs between the two examination methods were analyzed by R × RX^2 test of paired comparison of enumeration data, there was statistical significant difference （X^2 = 6. 0, P = 0. 05 ） . Pearson coefficient correlation was 0. 85 （ P = 0. 00 ）, Kappa value was 0. 94 （ P = 0. 00） . The concordance rate for ROP between binocular indirect ophthalmoscope and RetCam was high. The sensitivity of diagnose for ROP I stage was 90. 2% , while the specificity was 99.4% , the sensitivity of ROP Ⅱ stage was 80. 0%, while the specificity was 100% , the sensitivity and the specificity of ROP Ⅲ stage were 100%. The concordance rate for fundus hemorrhage between two examination methods was 87.5% , while the concordance rate for fundus isolated tiny flakes between two examination methods was 33.3%. Conclusion： RetCam is an utility and precise examination method in screening of retinal disease of prematurity, and can be used for screening and whole population survey in fundus pathological changes of premature infant and newborn infant.