超广角视网膜激光扫描成像系统在DR筛查中的应用评价

Evaluation of the clinical application of ultra-widefield scanning laser ophthalmoscopy for screening diabeticretinopathy

目的评价超广角视网膜激光扫描成像(UWFSLO)在糖尿病视网膜病变(DR)筛查中的应用价值。方法采用横断面研究,选取2016年10—12月在河北省唐山市开滦康复医院行DR筛查的2型糖尿病患者1288例2304眼,收集患者一般信息,完成UWFSLO和45°水平两视野数字彩色眼底照相检查,比较DR的检出及分级水平。不同眼底检查对DR分级的一致性采用Cohen Kappa检验。结果去除成像不清晰及缺失的图像,最终1857眼纳入分析。彩色眼底照相、UWFSLO复合彩色图像及绿通道图像对DR的检出率分别为31.3%(581/1857)、44.5%(826/1857)和43.4%(807/1857),差异有统计学意义(χ2=85.547,P<0.001),其中UWFSLO复合彩色图像、绿通道图像对DR的检出率均高于彩色眼底照相,差异均有统计学意义(均P<0.001)。45°水平两视野数字彩色眼底照相与UWFSLO复合彩色图像在DR检出分级之间的一致性一般,Kappa值为0.375(P<0.001),完全一致性为64.08%。UWFSLO绿通道图像与复合彩色图像对DR分级的一致性极好,Kappa值为0.953(P=0.008),完全一致性为98.17%。UWFSLO复合彩色图像对微动脉瘤(MA)、视网膜内微血管异常(IRMA)、视网膜新生血管(NV)病变的检出水平均低于绿通道图像,差异均有统计学意义(Z=-16.489、-4.198、-2.111,均P<0.05)。结论UWFSLO较45°水平两视野数字彩色眼底照相对DR的检出及分级评估水平更高,其中绿通道图像在MA、IRMA和小的NV病变检出上更为出色。在大规模人群DR的筛查及诊断中,UWFSLO具有较好的应用价值。

Objective To evaluate the value of ultra-widefield scanning laser ophthalmoscopy(UWFSLO)for screening diabetic retinopathy(DR).Methods A cross-sectional study was conducted.A total of 1288 patients(2304 eyes)with type 2 diabetes who underwent the screening of DR were selected in Kailuan Rehabilitation Hospital in Tangshan City,Hebei Province from October 2016 to December 2016.The general information and medical records were collected.Patients completed fundus inspection by both UWFSLO and two-field 45°horizontal digital color fundus photography.The effective retinal images of the two methods were analyzed and the detection and grading of DR were compared between the two methods.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Kailuan(Group)Co.,Ltd.Hospital(No.2006-5).Written informed consent was obtained from each subject.Results After excluding the unclear and missing images,1857 eyes were finally included in this study.The detection rates of DR by color fundus photo,UWFSLO pseudocolor image and green channel image were 31.3%(581/1857),44.5%(826/1857),and 43.4%(807/1857),respectively,with a statistically significant difference(χ2=85.547,P<0.001).The detection rates of DR by UWFSLO pseudocolor image and green channel image were higher than that by color fundus photo,and the differences were statistically significant(both at P<0.001).The agreement between UWFSLO and two-field 45°horizontal digital color fundus photography for grading DR severity was moderate with a Kappa value of 0.375(P<0.001)and a complete agreement of 64.08%.The UWFSLO green channel image and pseudocolor images had excellent consistency for grading DR severity with a Kappa value of 0.953(P=0.008)and complete agreement of 98.17%.The detection rates of microaneurysm(MA),intraretinal microvascular abnormalitie(IRMA)and neovascularization(NV)by UWFSLO pseudocolor images were lower than that by green channel images,showing statistically significant differences(Z=-16.489,-4.198,-2.111;all at P<0.05).Conclusions UWFSLO has better detection and grading of DR than two-field 45°horizontal digital color fundus photography,and green channel images are better at detecting MA,IRMA,and small NV lesions.UWFSLO has good application value in the screening and diagnosis of DR in large populations.