多光谱眼底分层成像仪获取白内障眼眼底图像的可行性研究

Feasibility of fundus imaging in cataractous eyes by Retinal Health Assessment System

目的:探讨多光谱眼底分层成像仪(RHA)在白内障眼中获取可用于观察分析的眼底图像的可行性。方法:采用横断面研究设计,纳入2016年12月至2017年1月于上海交通大学附属第一人民医院接受手术的白内障患者41例45眼。扩瞳后行晶状体混浊程度分级以及RHA眼底成像检查。按晶状体混浊程度分为4个组:皮质混浊组18眼,核性混浊组21眼,后囊下混浊组2眼和混合型组4眼。采用RHA2020全层扫描模式获取眼底图像,对眼底图像清晰程度进行评价,并比较皮质混浊组及核性混浊组眼底图像清晰度评分。结果:45眼中晶状体混浊度最轻的1眼分级为C0N2P0,最重的2眼分级分别为C2N5P2和C4N2P4。晶状体核混浊4级、皮质混浊3级或后囊下混浊3级明显降低RHA眼底图片的清晰度,尤其是红绿光组合图(620 nm+550 nm)的清晰度降低最明显。在光谱580 nm和590 nm处可观察到皮质混浊组视盘及视网膜血管,清晰程度评分分别为2.0(1.0,3.0)和2.0(2.0,3.0);在光谱810 nm处可观察到视网膜血管、脉络膜血管以及色素分布,清晰程度评分为2.0(2.0,3.0),显著低于红绿光组合图的3.0(2.0,3.0),差异有统计学意义(P<0.05)。核性混浊组中,核混浊3级时RHA眼底图像仍清晰;核混浊4级时RHA眼底图像清晰度明显下降,在光谱580 nm和590 nm处偶可见视网膜血管,其清晰程度评分分别为1.0(1.0,3.0)和2.0(1.0,3.0);在光谱810 nm和850 nm处可观察视网膜血管、脉络膜血管以及色素分布,其清晰程度评分为2.0(1.0,3.0),显著低于红绿光组合图的3.0(1.5,3.0),差异有统计学意义(P<0.05)。在后囊下混浊组中,光谱580 nm处可观察视网膜血管,光谱810 nm和850 nm处可观察视网膜血管、脉络膜血管以及色素分布。混合型白内障组中850 nm处可观察到视网膜血管走行,血管反光不可见,脉络膜血管区域性可见。结论:除重度白内障外,RHA中580、590、810和850 nm光谱成像可获取白内障患者的眼底图像,有助于及时发现白内障术前眼底疾病以及评估预后。

Objective To study the ability of the Retinal Health Assessment(RHA)system to obtain fundus images in patients with different types and degrees of cataracts.Methods A cross-sectional study was performed.Forty-five eyes of 41 patients with cataract were enrolled in First People's Hospital,Shanghai Jiaotong University from December 2016 to January 2017.Lens opacity grading and RHA fundus imaging were performed after pupil dilation.Forty-five eyes were divided into 4 groups according to the degree of lens opacity:cortical cataract group 18 eyes,nucleus cataract group 21 eyes,posterior subcapsular cataract group 2 eyes,hybrid cataract group 4 eyes.Fundus images were obtained by FullSpectrum mode of RHA2020,and the clearness of fundus images was evaluated.Scores of fundus images clarity were compared between the cortical cataract group and nucleus cataract group.This study was approved by the Ethics Committee of First People's Hospital,Shanghai Jiaotong University.Written informed consent was obtained from each patient prior to any medical examination.Results In all 45 eyes,the phacoscotasmus classification ranged from mildest(C0N2P0,1 eye)to very serious(C2N5P2 and C4N2P4,2 eyes).The gradeⅣnuclear opacity,gradeⅢcortical opacity,and gradeⅢposterior subcapsular opacity reduced the quality of RHA images significantly,especially for images with red and green light.In cortical cataract group,images showed peripapillary vessels and retinal vessels at 580 nm and 590 nm,while retinal and choroidal vessels,as well as choroidal pigmentation,were visible at 810 nm.The clarity scores at 580,590 and 810 nm were 2.0(1.0,3.0),2.0(2.0,3.0)and 2.0(2.0,3.0),which were lower than that with red and green light(620 nm+550 nm)(3.0[2.0,3.0]),with statistically significant differences(all at P<0.05).In nucleus cataract group,the quality of fundus images from the eyes with gradeⅢnucleus cataracts was good,the image quality decreased when the nucleus opacity was gradeⅣ,retinal vessels were occasionally observed at 580 nm and 590 nm.Additionally,retinal and choroidal vessels and choroidal pigment were visible at 810 nm and 850 nm.The clarity scores at 580,590,810 and 850 nm were 1.0(1.0,3.0),2.0(1.0,3.0)and 2.0(1.0,3.0),which were lower than that with red and green light(620 nm+550 nm)(3.0[1.5,3.0]),with statistically significant differences(all at P<0.05).In posterior subcapsular cataract group,the retinal vessels were visible at 580 nm,meanwhile retinal and choroidal vessels and choroidal pigment could be observed at 810 nm and 850 nm.In hybrid cataract group,running lines of retinal vessels could be seen at 850 nm,while the central reflection was absent.Focal choroidal vessels were observed.Conclusions Except for severe cases,RHA system can produce good quality fundus images in cataract eyes at 580,590,810 and 850 nm,facilitating the evaluation of fundus disease before surgery and prediction of visual outcomes after surgery.