摘要
目的通过免散瞳眼底数码照相方法诊断白内障并筛出白内障需手术者,探讨用该方法筛查白内障的可行性。设计前瞻性病例系列。研究对象2009年2月至8月同仁医院白内障中心就诊的白内障患者92例165眼。方法所有病例均检查裸眼视力及矫正视力,经裂隙灯显微镜检查并进行白内障分类分级。使用免散瞳眼底数码照相机进行小瞳孔眼底数码照相检查,根据眼底照片的模糊程度作出分级诊断。比较免散瞳眼底照相的诊断结果与裂隙灯检查结果的一致性,两种手术诊断标准所得筛查结果进行Kappa检验。主要指标灵敏度、特异度、约登(Youden)指数、阳性预测值、阴性预测值。结果免散瞳眼底照相与裂隙灯检查结果呈高度一致性。以裂隙灯显微镜检查为金标准,各级白内障中2级以上者免散瞳眼底照相诊断的灵敏度均在89%以上。免散瞳眼底照相筛查白内障需手术者的Kappa值均达0.70以上。皮质性、核性和囊下性的阳性预测值分别为100%、84.2%和76.2%,阴性预测值分别为82.4%、93.3%和91.9%。结论用免散瞳眼底照相方法筛查明显影响视力的中、重度白内障是可行的。可以用免散瞳眼底照相方法替代裂隙灯显微镜检查法筛查白内障需手术者。
Objective To evaluate the value of screening for cataract needed surgery with digital nonmydriatie fundus camera. Design Prospective observational case series. Participants 92 patients with cataract （165 eyes） at Cataract Center for Beijing Tongren Hospital in 2009. Methods Photos were taken with digital nonmydriatie fundus camera and slit-lamp microscopic examination of the anterior segment of all subjects was performed in the same darkened examination room after visual acuity examination. Diagnosis and grading of cataract were made based on fundus photography and WHO Simplified Cataract Grading System. Main Outcome Measures Sensitivity, specificity, Kappa value and correlative coefficient. Results There was significant correlation between the degree of cataract detected by digital nonmydriatic fundus photos and that seen in slit-lamp microscopic examination. The sensitivity of photography compared with slit-lamp microscopic examination in Grade 3 or more was above 89%. The Kappa value in cataract needed surgery screening with digital nonmydriatic fundus camera was above 0.70. The positive predictive value in cortical, nuclear and subcapsular cataract was 100%, 84.2% and 76.2%, and the negative predictive value was 82.4%, 93.3% and 91.9%, respectively. Conclusion It is a valid screening method for diagnosing middle or severe cataract with nonmydriatic fundus photography. It may be an alternative method to screen for cataract needed surgery.
出处
《眼科》
CAS
2010年第1期46-49,共4页
Ophthalmology in China
关键词
免散瞳眼底照相
白内障
筛查
方法评估
digital fundus photography
cataract
screening
method assessment
