间接检眼镜、眼B超、OCT及全视网膜镜对视网膜裂孔的早期诊断

目的 探究视网膜裂孔早期诊断的最佳检查方法。方法 纳入2019年6月至2020年6月期间经A/B超、验光检查诊断为玻璃体混浊伴后脱离（posterior vitreous detachment ,PVD）及高度近视的974例患者,分别采用间接检眼镜、眼B超,光学相干断层扫描技术（optical coherence tomography, OCT）及全视网膜镜（125°或165°）行眼底检查,对比各种方法对早期视网膜裂孔的检出率及不同检查方法对于早期检出视网膜裂孔的灵敏性和特异性。结果 974例（1 008眼）玻璃体混浊或PVD患者视网膜裂孔检出眼分别为：眼B超160眼、OCT42眼、间接检眼镜71眼、全视网膜镜65眼,检出率分别为15.9%、4.2%、7.0%及6.4%。统计学分析显示间接检眼镜与全视网膜镜早期视网膜裂的检出率大致相同（P>0.05）;检测灵敏度,间接检眼镜高于眼B超（P<0.001）和OCT（P<0.001）,眼B超高于OCT（P<0.001）。特异度OCT高于眼B超（P<0.001）和间接检眼镜（P>0.05）,间接检眼镜高于眼B超（P>0.05）。结论 在检出视网膜裂孔方面,间接检眼镜具有最高的灵敏度,OCT具有最高的特异度;眼B超的误诊率最高,特异性较低。全视网膜镜（或间接检眼镜）是早期查找视网膜裂孔的有力工具,应得到广大医生的重视及广泛应用。

Comparative study on early diagnosis of retinal holes by indirect ophthalmoscope,B ultrasound,OCT and retinoscopy

Objective To explore the best method for early diagnosis of retinal holes. Methods A total of 974 patients diagnosed with vitreous posterior vitreous detachment （PVD） and high myopia by A/B ultrasound and optometry from June 2019 to June 2020 were enrolled. Indirect ophthalmoscope, B ultrasound, optical coherence tomography（OCT） and retinoscopy （125° or 165°） were used for fundus examination. The detection rate of retinal holes by different methods and the accuracy and specificity of different examination methods for diagnosis of retinal holes were compared. Results 974 cases （1 008 eyes） with vitreous opacity or PVD patients with retinal tears were detected in 160 eyes by B ultrasound, 42 eyes by OCT, 71 eyes by indirect ophthalmoscope, and 65 eyes by retinoscopy, with the detection rates of 15.9%, 4.2%, 7.0% and 6.4%, respectively. Statistical analysis showed that the detection rate of early retinal holes by indirect ophthalmoscopy and retinoscopy was about the same （P>0.05）. The detection sensitivity of indirect ophthalmoscope was higher than that of ocular B ultrasound （P<0.001） and OCT （P<0.001）, and ocular B ultrasound was higher than OCT （P<0.001）. The specificity of OCT was higher than that of ocular B ultrasound （P<0.001） and indirect ophthalmoscopy （P>0.05）, and the indirect ophthalmoscope was higher than that of ocular B ultrasound （P>0.05）. Conclusion In the detection of retinal tears, indirect ophthalmoscope has the highest sensitivity and OCT has the highest specificity; ocular B ultrasound has the highest misdiagnosis rate and low specificity. Retinoscopy （or indirect ophthalmoscope） is a useful tool for early detection of retinal tears; it should be paid attention to and widely used by doctors.