眼底彩色照像与荧光素眼底血管造影对判断糖尿病视网膜病变临床分期的一致性研究

目的 探讨眼底彩色照像与荧光素眼底血管造影(FFA)对判断糖尿病视网膜病变(DR)临床分期的一致性.方法 为系列病例研究.选择行FFA检测的99例(188只眼)糖尿病患者,均经眼底镜检查除外轻度非增生性糖尿病视网膜病变(NPDR)和严重增生性视网膜病变(PDR).所有患者在行FFA检测之前,拍摄眼底彩色照片,每只眼获得5张非立体、50°角视野的眼底彩色照片.根据DR国际临床分类法,对从眼底彩色照片和FFA图像获得的DR临床分期结果进行一致性比较.结果 眼底彩色照像诊断中度NPDR 59只眼(31.4%),重度NPDR 76只眼(40.4%);PDR53只眼(28.2%);FFA检测诊断中度NPDR 50只眼(26.6%),重度NPDR 72只眼(38.3%);PDR66只眼(35.1%).眼底彩色照像与FFA检测在判断DR临床分期方面具有相对的一致性(κ=0.601),在判断是否需要进行全视网膜光凝即达到重度NPDR和PDR方面,两者的一致性相对较高(κ=0.652).结论 眼底彩色照像(5张50°角视野)可以为DR患者全视网膜光凝治疗提供有力依据,FFA检测能够更早、更准确地判断DR病程.

Comparison of fundus photography and fluorescein angiography in grading diabetic retinopathy

OBJECTIVE: To study the consistency of the color fundus photography and fluorescein angiography for grading the diabetic retinopathy. METHODS: It was a retrospective case series. The agreement study was conducted in a series of diabetic patients, who were excluded from the mild non-proliferative diabetic retinopathy (NPDR) and the severe proliferative diabetic retinopathy (PDR). Ninety-nine cases (188 eyes) met the selected criteria Five 50 degrees non-stereoscopic photography for each eye were taken in all cases before FFA was performed. The diabetic retinopathy was graded from the fundus photography and FFA images according to international diabetic retinopathy disease severity scale. The kappa value was calculated according to the grading outcomes from the fundus photography and FFA images to estimate the agreement of the grading outcomes. RESULTS: The fundus photography showed 59 moderate NPDR (31.4%), 76 severe NPDR (40.4%) and 53 PDR eyes (28.2%) respectively, FFA showed 50 moderate NPDR (26.6%), 72 severe NPDR (38.3%) and 66 PDR (35.1%) respectively. The agreement for the grading of DR by the fundus photography and FFA was substantial (K = 0.601). In the evaluation whether it was necessary to implement PRP (more serious than NPDR and PDR), there was higher agreement between them (K = 0.652). CONCLUSIONS: Five 50 degrees photography can provides the support of the application of PRP for diabetic patients, FFA may be earlier and restively accuracy in the diagnose of diabetic retinopathy.