免散瞳真彩超广角眼底成像联合光学相干断层扫描在DR临床筛查中的应用评价

Evaluation of No-Dilatation True-Color Ultra-Wide-Field Fundus Imaging Combined with Optical Coherence Tomography in Clinical Screening of DR

摘要: 目的：评价免散瞳真彩超广角眼底成像系统(UWFSLO)联合光学相干断层扫描(OCT)在糖尿病视网膜病变(DR)筛查中的临床应用价值。方法：选取参加惠州爱尔眼科医院糖尿病视网膜病变关爱日来院筛查的糖尿病人55例(99眼)纳入研究。患者年龄32~81岁，平均年龄(57.3 ± 11.2)岁。分别应用蔡司CLARUS 500免散瞳真彩UWF四方位自动模式拍摄联合海德堡Spectralis OCT经过黄斑区线性扫描与散瞳下日本Topcon眼底照相机行眼底荧光血管造影(FFA)检查。采用Kappa一致性检验将两种检查方法进行比较。以临床诊断结果为标准，比较两种检查方法对DR疾病诊断效能。结果：(1) 对UWF + OCT与FFA两种检查方法在DR中视网膜微血管瘤(MA)、视网膜新生血管(RNV)、视网膜内微血管异常(IRAM)、视网膜无灌注区(NPAS)、糖尿病性黄斑水肿(DME)结果进行一致性检验，结果显示MA结果具有一定的一致性，一致性程度一般，具有统计学意义，p < 0.05；RNV结果一致性程度很强，具有统计学意义，p < 0.05；IRMA结果一致性程度较强，具有统计学意义，p < 0.05，NPAS结果一致性程度一般，具有统计学意义，p < 0.05。两种方法对DME结果一致性程度很强，具有统计学意义，p < 0.05。(2) 54例DME中OCT形态分四种：海绵样弥漫型视网膜增厚(SDRT) 19例(35.19%)；黄斑囊样水肿(CME) 13例(24.07%)；浆液性视网膜脱离(SRD) 9例(16.67%)；综合型FULL 13例(24.07%)。(3) UWF + OCT与FFA分别对本病的分类：UWF + OCT法与FFA法对本病的分类具有很强的一致性(Kappa值 = 1.000，p < 0.001)，具有统计学意义，具体分类为轻度NPDR 52例(52.53%)，中度NPDR 17例(17.17%)，重度NPDR 19例(19.19%)，PDR 11例(11.11%)，使用2种检查方法结果分类一致。结论：免散瞳真彩超广角眼底照相联合OCT可以显著提高DR检出水平，与荧光眼底造影具有较高一致性。同时检查方便、快捷，并为进一步诊疗与病患规范化管理提供有效指导。

Abstract: Objective: To evaluate the clinical value of the no-dilatation true color ultra-wide-field (UWF) fundus imaging system combined with optical coherence tomography (0CT) in screening diabetic retinopathy (DR). Methods: Fifty-five diabetic patients (99 eyes) who participated in the screening of diabetic retinopathy in the Huizhou Aier Eye Hospital were included in the study. Patients ranged in age from 32 to 81 years, with an average age of (57.3 ± 11.2) years. Fluorescence fundus imaging (FFA) was performed by using Zeiss CLARUS 500 no-dilatation true color UWF quadrilateral automatic mode photography combined with Heidelberg Spectralis OCT through macular linear scanning and Japanese Topcon fundus camera under dilated eyes. The Kappa consistency test was used to compare the two methods. Based on the clinical diagnosis results, the diagnostic efficacy of the two methods for DR Disease was compared. Result: (1) Consistency test was performed on the results of retinal microangioma (MA), retinal neovascularization (RNV), intraretinal microvascular abnormality (IRAM), retinal non-perfusion area (NPAS) and diabetic macular edema (DME) in DR By UWF + OCT and FFA, and the results showed that MA results were consistent to a certain extent. The degree of consistency was general, with statistical significance (p < 0.05); The consistency of RNV results was significant (p < 0.05). The consistency of IRMA results was strong and statistically significant (p < 0.05), while the consistency of NPAS results was general and statistically significant (p < 0.05). There was a strong consistency between the two methods in DME results, with statistical significance (p < 0.05). (2) There were four types of OCT in 54 cases of DME: spongy diffuse retinal thickening (SDRT) in 19 cases (35.19%); There were 13 cases (24.07%) of macular cystoid edema (CME). Serous retinal detachment (SRD) occurred in 9 cases (16.67%). Comprehensive FULL 13 cases (24.07%). (3) Classification of the disease by UWF + OCT and FFA, respectively: UWF + OCT method and FFA method showed a strong consistency in the classification of the disease (Kappa value =1.000, p < 0.001), which was statistically significant. The specific classification was mild NPDR 52 cases (52.53%), moderate NPDR 17 cases (17.17%), and severe NPDR 19 cases (19.19%). There were 11 cases of PDR (11.11%), and the results of the two methods were consistent. Conclusion: The detection level of DR can be significantly improved by non-dilated true-color ultra-wide-field fundus photography combined with OCT, which has a high consistency with fluorescence fundus angiography. At the same time, the examination is convenient and fast, and provides effective guidance for further diagnosis and treatment and standardized management of patients.