基于眼底照相机外眼像的远程眼表疾病筛查的特异性与敏感性分析

The clinical specificity and sensitivity of tele-ophthalmology screening for ocular surface disease based on fundus photography

目的研究基于眼底照相机外眼像在远程眼表疾病筛查中诊断的特异性、敏感性。设计诊断技术评价。研究对象9种眼表疾病中随机选择30例患者,每种疾病选出10例正常人外眼像作为对照组。方法对9种眼表疾病(结膜下出血、结膜炎、睑裂斑、翼状胬肉、角膜带状变性、角膜炎、角膜营养不良、角膜瘢痕、眼睑肿物)的远程筛查图像诊断标准进行测试。金标准选择门诊使用的裂隙灯照相机获得的外眼像。每种眼表病的40例受检者的两种照片分别由2位角膜病专科医师进行双盲诊断,采用Fisher精确概率法检验远程筛查图像诊断的特异性及敏感性。主要指标特异性及敏感性。结果结膜下出血、角膜带状变性、眼睑肿物眼底照相机外眼像诊断的敏感性及特异性均达100%(95%CI:92%-100%);翼状胬肉、角膜瘢痕、角膜炎的诊断敏感性分别为:93%、83%和83%,特异性均为100%。而睑裂斑、结膜炎、角膜营养不良的诊断敏感性分别为70%、60%和63%,特异性分别为100%、80%和100%。除陈旧性角膜炎敏感性100%(95%CI:92%-100%)外,其余角膜炎的远程诊断敏感性均低于80%。结论结膜下出血、角膜带状变性、眼睑肿物可通过眼底照相机外眼像为基础的远程筛查模式进行诊断;而睑裂斑、结膜炎、角膜营养不良、角膜炎的判定敏感性较差。

Objective To evaluate the clinical speeificity and sensitivity of tele-ophthahnology screening criteria for ocular surface disease （OSD）based on fundus photography. Design Evaluation of diagnosis technique. Participants 30 cases of every kind of OSD were the test group, and the 10 normal person ocular surface photos were the control grnup. Methods The telephthalmology screening criteria for OSD （conjuuctival hemorrhage, conjunctivitis, pingueculae, pterygium, band-shaped corneal dystrophy, keratitis, corneal dystrophy, corneal sear, and eyelid tumor） were evaluated with goht standard, ocular surface images obtained hy slit lamp camera. Two kinds of photos were asked for the senior corneal ophthalmologists （LQF and DSJ） for a double-blind diagnosis. The clinical specificity and sensitivity of tele-ophthahnology screening criteria was analyzed with Fisher exact probability method of SPSS software. Main Outcome Measures Specificity and sensitivity of tele-ophthahnology screening criteria for OSD. Result The sensitivity and specificity of the diagnosis of conjunctival hemorrhage, the zonal degeneration of cornea, and the imaging diagnosis of eyelid tmnors were all up to 100% （confidence interval 92%-100%）. The diagnostic sensitivity and specificity of pterygium, corneal scar and keratitis were more than 80%, the sensitivity was 93%, 83% and 83%, respectively; specificity were all 100%. While the diagnostic sensitivity of pingueculae, conjunctivitis, corneal dystrophy were less than 80%, respectively 70%, 60% and 63%, and the diagnostic specificity were higher （100%, 80% and 100%）. Meanwhile, the comparative study tbund that the sensitivity of the chronic： keratitis 100% （92%-100%）, diagnostic sensitivity of remaining keratitis was lower than 80%. Conclusion Conjunetival hemorrhage, corneal degeneration, and eyelid tumors can be accurately diagnosed by tele-ophthalmology screening hased on the fundus camera, and the diagnostic： sensitivity of the pingueeulae, conjunctivitis and corneal dystrophy was low. Ocular surface images obtained by tundus camera were less sensitive to differentiate the lype of keratitls.