共焦激光扫描炫彩眼底成像与彩色眼底照相对糖尿病视网膜病变的检出比较

Comparison of confocal laser scanning colorful fundus imaging and color fundus photography for detection of diabetic retinopathy

目的对比观察炫彩激光扫描眼底成像（MSLI）和传统彩色眼底照相（CFP）对糖尿病视网膜病变（DR）患眼常见各类病变的成像特点和检出情况。方法前瞻性病例系列观察研究。临床检查确诊的DR患者38例72只眼纳入研究。其中，男性21例，女性17例；平均年龄（62.6±11.2）岁；平均糖尿病病程（14.3±7.5）年。均行CFP、MSLI、频域光相干断层扫描（SD-OCT）、荧光素血管造影（FFA）检查。采用德国Heidelberg公司Spectralis HRA＋OCT行MSLI检查，一次扫描同时获得基于488 nm蓝光反射（BR）、515 nm绿光反射（GR）、820 nm红外光反射（IR）成像，合成炫彩图像（MC）成像。对比观察传统CFP和MC对微动脉瘤（MA）、硬性渗出（HEX）、棉绒斑（CWS）、视网膜内出血（IRH）、视网膜内微血管异常（IRMA）、静脉串珠（VB）、静脉环（VL）、黄斑水肿（DME）、黄斑前膜（MEM）、激光光凝斑（LB）等检出情况。以FFA检查结果作为病变诊断标准，SD-OCT用于判断病变位置和深度及DME和MEM的诊断参考。结果MC图像对MA（χ^2=10.460）、DME（（χ^2=4.006）、MEM（χ^2=4.444）的检出眼数均显著高于传统CFP，差异有统计学意义（P＜0.05）；IRH（χ^2=0.103）、CWS（χ^2=1.515）、HEX（χ^2=0.227.）、IRMA（χ^2=0.051）、VB（χ^2=0.001）、VL（χ^2=0.149）、VH（χ^2=0.693）、LB（χ^2=0.720）的检出眼数比较，差异无统计学意义（P＞0.05）。MSLI各模式成像质量明显好于传统CFP。其中，GR成像对MA、CWS、HEX、MEM等视网膜浅中层结构改变显示最佳；IR成像对LB等视网膜深层显示清晰。DME在MC像上以绿色呈现，IR成像上可见弱反射暗区；与SD-OCT检查显示的DME范围一致。结论与传统CFP比较，MSLI可更清晰显示DR各类常见病变，MC图像对MA、DME、MEM检出高。

ObjectiveTo compare the imaging characteristics and detection of various types of lesions in diabetic retinopathy （DR） with colorful laser scanning fundus imaging （MSLI） and traditional color fundus photography （CFP）.MethodsProspective case series observational study. A total of 38 eyes of 38 patients with DR diagnosed by clinical examination were included in the study. Among them, 21 were male and 17 were female; the mean age was 62.6±11.2 years; the average duration of diabetes was 14.3±7.5 years. All the patients were performed CFP, MSLI, frequency domain optical coherence tomography （SD-OCT）, fluorescein angiography （FFA） examination. Using the Helielberg Spectralis HRA＋OCT MSLI inspection, one scan simultaneously obtained 488 nm blue reflection （BR）, 515 nm green light reflection （GR）, 820 nm infrared light reflection （IR）, and multicolor image （MC）. The detection of traditional CFP and MC on microaneurysm （MA）, hard exudation （HEX）, cotton plaque （CWS）, intraretinal hemorrhage （IRH）, intraretinal microvascular abnormality （IRMA）, venous bead （VB）, venous ring （VL）, macular edema （DME）, macular anterior membrane （MEM） and laser photocoagulation （LB） were comparatively observed. The results of FFA examination were used as the diagnostic criteria for lesions. SD-OCT was used to determine the location and depth of lesions and the diagnostic reference for DME and MEM.ResultsThe numbers of eyes with MA （χ^2=10.460）, DME （χ^2=4.006）, MEM （χ^2=4.444） was significantly higher in MC than that of traditional CFP. But the number of eyes with IRH （χ^2=0.103）, CWS （χ^2=1.515）, HEX （χ^2=0.227）, IRMA （χ^2=0.051）, VB （χ^2=0.001）, VL （χ^2=0.149）, VH （χ^2=0.693） and LB （χ^2=0.720） were not statistically significant between two methods （P〉0.05）. The imaging quality of MSLI mode is obviously better than that of traditional CFP. Among them, GR imaging shows the best structural changes of superficial retina in MA, CWS, HEX, MEM, etc. IR imaging shows clear depth in deep retina such as LB. DME was green on MC and the weak low-reflection dark area was visible on the IR image, which were consistent with the DME range indicated by the SD-OCT examination.ConclusionsCompared with the traditional CFP, the MSLI can clearly show the DR lesion. The number of checkouts is high on MA, DME and MEM by MC image.