数码彩色眼底照相对糖尿病视网膜病变早期诊断模式的研究

目的采用直接眼底镜检查、数码彩色眼底照相、荧光素眼底血管造影及光学相干断层扫描等4种方法,对糖尿病视网膜病变患者进行检查和评估,探讨早期糖尿病视网膜病变筛查方法。方法对2009年1月~2010年1月就诊我院眼科门诊的糖尿病患者,进行直接眼底镜检查、数码彩色眼底照相、荧光素眼底血管造影及光学相干断层扫描检查。以荧光素眼底血管造影诊断为标准,分析各种检查结果的敏感性、特异性及与眼底荧光血管造影诊断的一致性。结果以糖尿病视网膜病变1期为筛查阈值时,眼底彩色照相的敏感性、特异性均明显高于直接眼底镜检查,Kappa检验有高度一致性;以糖尿病视网膜病变2期为筛查阈值时,直接眼底镜检查与眼底彩色照相的特异性基本一致,但眼底彩色照相的敏感性明显高于直接眼底镜检查,Kappa检验有高度一致性。同正常组相比,糖尿病视网膜病变1期视网膜各方位厚度并无明显增加,糖尿病视网膜病变2期各方位神经上皮层厚度比相应方位的正常组增加。结论数码彩色眼底照相可作为糖尿病视网膜病变2期以上患者的主要筛查诊断方法。     

眼底照相及眼底荧光血管造影在糖尿病性视网膜病变的临床分析

目的评价眼底照相及眼底血管荧光造影（FFA）在糖尿病视网膜病变（DRP）的诊断及治疗的临床价值。方法采用APS～B型眼底血管造影仪对1400例（2784只眼）糖尿病患者行眼底摄片或造影。结果根据国际分期法对糖尿病视网膜病变进行分期,并给予指导治疗。结论眼底照相可作为糖尿病视网膜病变早期筛查的金标准,而FFA可作为眼底激光治疗及其疗效评估的指标。     

彩色数码眼底照相在健康体检中的应用

目的探讨彩色数码眼底照相在健康体检中对眼底病的筛查及指导诊治的重要性。方法对50245例（100490只眼）健康受检者用Topcon TRCNW 100彩色数码眼底照相机进行照相后进行筛查分析。结果总检查人数50245例,其中正常者45373例,占90．3％,一般性描述者359例,占0．7％,阳性发现4513例,占9．0％。各年龄组男女之间阳性比较,差异均无统计学意义（P〉0．05）。阳性发现中视网膜动脉硬化的检出率7．4％、糖尿病型视网膜病变0．1％、黄斑病变0．1％、视网膜病变0．6％、视神经萎缩0．1％、视乳头C／D大于0．7％。对筛查出有阳性发现的受检者给予及时准确的诊断和合理的治疗建议。结论彩色数码底照相具有客观性、重复性及非创伤性特点,影像数据便于存储和交流,且视网膜微血管病变对心脑血管事件具有较好的预测作用,因此在健康体检领域具有重要的应用价值。     

浅析眼底荧光血管造影对诊治糖尿病患者视网膜病变的重要性

目的探讨眼底荧光血管造影（FFA）对诊治糖尿病患者视网膜病变的重要性。方法回顾分析2007年8月至2008年8月糖尿病患者405例810只眼（患病时间从5-20年不等，从未进行过眼底检查），患者进行眼底彩色照相及FFA的检查。结果405例患者810只眼中，FFA显示眼底正常者90只眼，占11.1％，糖尿病视网膜病变I期者335只眼，占41.4％，糖尿病视网膜病变Ⅱ期者110只眼，占13.6％，糖尿病视网膜病变Ⅲ期者235只眼，占29.1％，糖尿病视网膜病变Ⅳ期者30只眼，占3.7％，糖尿病视网膜病变V期者s10s只眼，占1.1％。结论绝大多数（本研究中占88.9％）糖尿病患者（患病时间5-10年）视网膜有不同程度的损害，应早期行FFA检查。     

糖尿病视网膜病变与硬性渗出位置相关因素的探讨

硬性渗出是糖尿病视网膜病变(diabetic retinopathy，DR)较早出现的临床表现，黄斑区的硬性渗出是严重影响视力的原因之一。我们应用彩色眼底照相和眼底荧光血管造影(fundus fluorecein angiography，FFA)检查对我院眼科386例非增生期及增生早期糖尿病视网膜病变息者699只患眼硬性渗出定位，并对其与糖尿病病程、视力情况、DR程度及黄斑水肿的关系进行了探讨。     

免散瞳眼底照相仪在糖尿病视网膜病变社区防治中临床疗效评价

目的:探索免散瞳眼底照相仪在糖尿病视网膜病变社区防治中临床疗效。方法:本次研究对象为100例疑似糖尿病视网膜病变患者,均进行免散瞳眼底照相仪检查,随访分析此项检查在视网膜病变分期中正确率以及图像质量。结果:免散瞳眼底照相仪图像质量可以评估的有78.05%,对视网膜病变Ⅰ期诊断正确率为96.00%,对Ⅱ期诊断正确率为95.83%,对Ⅲ期诊断正确率为94.74%,对Ⅳ期诊断正确率为94.44%。同时对糖尿病视网膜病变敏感度为95.35%,特异度为92.86%,漏诊率为4.65%,误诊率为7.14%。结论:在评估糖尿病视网膜病变患者时,运用免散瞳眼底照相仪检查,可及时发现眼底病变,为后期随访提供详细参考信息。     

眼底血管造影在糖尿病视网膜病变中的应用

目的 探讨眼底血管造影（FFA）在糖尿病视网膜病变（DR）中的应用价值.方法 选取2011年1月-2012年12月于本院进行诊治的168例（320眼）患者为研究对象,采用荧光素眼底血管造影（FFA）检查.结果 眼底血管造影对DR病变分期及检查结果准确率均显著高于眼底镜的检查.结论 眼底血管造影在糖尿病视网膜病变中的应用价值较高,能更早的显示DR的眼底改变,对于了解疾病分期及进展有积极的作用,在判断预后及指导治疗上都有重要的价值     

某院2007～2011年糖尿病视网膜病变患者的生存质量调查

目的 探讨糖尿病视网膜病变的发病率、危险因素及视网膜激光光凝和手术治疗的有效率.方法 回顾性分析了2007年3月～2011年11月在某院诊治的糖尿病视网膜病人,进行了体格检查,实验室检查,裂隙灯眼底检查,眼底照相,眼底FFA造影检查,有适应症的患者进行了视网膜激光光凝或行玻璃体切割手术治疗.统计了DR的患病率及相关危险因素,治疗的有效率.结果 糖尿病视网膜病变的患病率约为40.1％,其中以轻、中度较多见;BMI、病程、血糖、血脂、血压均是其发生的危险因素,适时的采取治疗措施能取得良好的治疗效果.结论 糖尿病视网膜病变发病率较高,定期进行眼底检查能做到早发现,早诊断,早治疗,及时挽救患者的有用视力,提高生存质量.     

数字化眼底彩照及荧光血管造影诊断糖尿病视网膜病变临床分析

目的观察数字化眼底彩照及荧光血管造影对糖尿病视网膜病变的诊断价值.方法?对糖尿病视网膜病变患者60例进行数字化眼底彩照及荧光血管造影检查,对比诊断准确率.结果?数字眼底彩照诊断左眼准确90.20%,右眼92.31%,组间比较,P>0.05.结论?数字化眼底彩照及荧光血管造影诊断糖尿病视网膜病变均有较高的应用价值.     

早发型重度子痫前期病情与眼底检查的临床分析

目的:探讨早发型重度子痫前期患者视网膜病变与病情严重程度及治疗的关系。方法:动态观察158例早发型重度子痫前期患者眼底情况并进行分析。结果:158例患者中眼底改变率100.0%;视网膜病变分期与早发型重度子痫前期病情的严重程度成正比。结论:根据眼底病变程度指导治疗,有利于孕产妇的预后。     

Screening for Diabetic Retinopathy in Rural Areas: The Potential of Telemedicine

Diabetic retinopathy is a common cause of blindness, and screening can identify the disease at an earlier, more treatable stage. However, rural individuals with diabetes may have limited access to needed eye care. The objective of this project was to demonstrate the feasibility of a diabetic retinopathy screening program using a state-of-the-art nonmydriatic digital fundus imaging system. The study involved a series of patients screened in primary care and public health locations throughout seven predominantly rural counties in eastern North Carolina. Images of each fundus were obtained and sent to a retinal specialist. The retinal specialist reviewed each image, recorded image quality, diagnosed eye disease and made recommendations for subsequent care. Of 193 volunteers with a history of diabetes mellitus, 96.3 percent reported that they were very comfortable or comfortable with the camera. Eighty-five percent of images were rated as good or fair by the retinal specialist. The retinal specialist also reported being very certain or certain of the diagnosis in 84 percent of cases. Image quality correlated highly with the certainty of diagnosis (Spearman's rank order correlation coefficient = 0.79; P < 0.001). The average time since the previous examination by an eye care specialist for diabetic subjects was two years. Approximately 62 percent of diabetic patients had diagnosable eye conditions, the most common of which was diabetic retinopathy (40.9 percent). In this convenience sample, African Americans, despite similar age and disease duration, were more likely to have retinopathy. Digital imaging is a feasible screening modality in rural areas, may improve access to eye care, and may improve compliance with care guidelines for individuals with diabetes mellitus.     

The potential of digital monochrome images versus colour slides in telescreening for diabetic retinopathy

We explored the potential of digital monochrome images as an alternative to colour slides in screening for diabetic retinopathy. Twenty-eight patients with diabetes were recruited for the study and 20 actually participated. Using a fundus camera (Nikon 505AF) one set of three digital images and one set of three colour slides were taken per eye. Two independent ophthalmologists graded the colour slides and the digital images for diabetic retinopathy. The ophthalmologists spent about two minutes grading each set of images, suggesting that specialists could potentially screen a large number of patients. The agreement between the two screening methods was 0.95 and 0.89, with respect to disease or no disease. The agreement (kappa) between the two ophthalmologists for grade of retinopathy was 0.47 when colour slides were employed and 0.61 when digital monochrome images were employed. The results indicate that digital red-free monochrome images represent a superior screening tool for diabetic retinopathy. Tele-screening may be beneficial when patients have to travel substantial distances to visit an ophthalmologist.     

Diagnostic Accuracy of Detecting Diabetic Retinopathy by Using Digital Fundus Photographs in the Peripheral Health Facilities of Bangladesh: Validation Study

BackgroundDiabetic retinopathy can cause blindness even in the absence of symptoms. Although routine eye screening remains the mainstay of diabetic retinopathy treatment and it can prevent 95% of blindness, this screening is not available in many low- and middle-income countries even though these countries contribute to 75% of the global diabetic retinopathy burden.ObjectiveThe aim of this study was to assess the diagnostic accuracy of diabetic retinopathy screening done by non-ophthalmologists using 2 different digital fundus cameras and to assess the risk factors for the occurrence of diabetic retinopathy.MethodsThis validation study was conducted in 6 peripheral health facilities in Bangladesh from July 2017 to June 2018. A double-blinded diagnostic approach was used to test the accuracy of the diabetic retinopathy screening done by non-ophthalmologists against the gold standard diagnosis by ophthalmology-trained eye consultants. Retinal images were taken by using either a desk-based camera or a hand-held camera following pupil dilatation. Test accuracy was assessed using measures of sensitivity, specificity, and positive and negative predictive values. Overall agreement with the gold standard test was reported using the Cohen kappa statistic (κ) and area under the receiver operating curve (AUROC). Risk factors for diabetic retinopathy occurrence were assessed using binary logistic regression.ResultsIn 1455 patients with diabetes, the overall sensitivity to detect any form of diabetic retinopathy by non-ophthalmologists was 86.6% (483/558, 95% CI 83.5%-89.3%) and the specificity was 78.6% (705/897, 95% CI 75.8%-81.2%). The accuracy of the correct classification was excellent with a desk-based camera (AUROC 0.901, 95% CI 0.88-0.92) and fair with a hand-held camera (AUROC 0.710, 95% CI 0.67-0.74). Out of the 3 non-ophthalmologist categories, registered nurses and paramedics had strong agreement with kappa values of 0.70 and 0.85 in the diabetic retinopathy assessment, respectively, whereas the nonclinical trained staff had weak agreement (κ=0.35). The odds of having retinopathy increased with the duration of diabetes measured in 5-year intervals (P<.001); the odds of having retinopathy in patients with diabetes for 5-10 years (odds ratio [OR] 1.81, 95% CI 1.37-2.41) and more than 10 years (OR 3.88, 95% CI 2.91-5.15) were greater than that in patients with diabetes for less than 5 years. Obesity was found to have a negative association (P=.04) with diabetic retinopathy.ConclusionsDigital fundus photography is an effective screening tool with acceptable diagnostic accuracy. Our findings suggest that diabetic retinopathy screening can be accurately performed by health care personnel other than eye consultants. People with more than 5 years of diabetes should receive priority in any community-level retinopathy screening program. In a country like Bangladesh where no diabetic retinopathy screening services exist, the use of hand-held cameras can be considered as a cost-effective option for potential system-wide implementation.     

黑龙江省双城市农村50岁以上人群糖尿病视网膜病变的流行病学调查

目的 了解黑龙江省双城市农村50岁以上人群中糖尿病视网膜病变(DR)的患病和防治情况.方法 采用整群随机抽样法,有5053名调查对象进行检测和问卷调查.采用SPSS13.0软件进行X2和Fisher确切概率法检验.结果 5053名调查对象接受检查,受检率为91.8%.诊断DR有56例(112眼),患病率为1.108%(95%CI:0.819%～1.397%).其中非增生性49例(87.50%),增生性7例(12.50%);玻璃体积血7眼(6.25%),黄斑水肿9眼(8.04%).DR患病率的性别差异无统计学意义(P＞0.05),按每10岁分组,以60～69岁年龄组患病率显著增高(P=0.045).56例DR的112眼中,低视力34眼(30.4%),盲6眼(5.4%).空腹血糖＞11.1 mmol/L和增生性DR患者其低视力和盲的比例高于空腹血糖＜11.1 mmol/L和非增生性DR患者(P=0.000);空腹血糖＞11.1 mmol/L和病程＞5年的患者,患增生性DR的比例高于空腹血糖＜11.1 mmol/L和短病程者(P=0.015,0.006).56例有38例(67.9%)未经任何治疗,在药物治疗者中应用胰岛素或坚持规律用药者仅8例(14.3%),而针对DR的治疗者仅1例(1.8%).调查问卷表明,DR患者对该病防治知识了解状况较差.结论 病程长、高血糖是影响DR患者视力及眼底病变程度的重要危险因素,农村人群对DR防治知识匮乏.     

Telemedicine Screening for Diabetic Retinopathy

Diabetic eye disease is the most common cause of new cases of blindness in the Western world. If the disease is detected early then proper treatment can be provided to prevent loss of vision. Regular screening can reduce the incidence and prevalence of blindness due to diabetic retinopathy. Health personnel, optometrists and primary care providers can perform the screening using digital nonmydriatic fundus cameras. Digital data can be archived, stored, manipulated and sent via telecommunication networks, e.g. the Internet, to ophthalmologists for diagnosis and second opinions.Easy-to-operate, low cost and portable digital fundus cameras and intuitive software are necessary to perform cost-effective screening of rural, remote and underserved communities using trained lay personnel. Several feasibility studies of telemedicine screening for diabetic retinopathy have been reported. These studies demonstrate the enormous usefulness of this technology for communities living in rural and remote areas. Further studies are needed to prove the cost benefit of telemedicine technology for diabetic retinopathy screening.     

构建区域内糖尿病视网膜病变智慧健康管理模式

组建糖尿病视网膜病变健康管理团队,根据河南省地域特点建立区域糖尿病视网膜病变诊疗联盟,依托人工智能技术形成高效筛查方法;结合信息技术构建健康信息平台,对糖尿病患者进行风险评估、健康教育、延续护理等健康管理;形成省级医院、县级医院、家庭三级联动的同质化诊疗方案。智能化筛查提高了筛查效率及覆盖率,信息化管理提高了筛查执行率及患者生活质量,区域化糖尿病视网膜病变健康管理有助于发挥各级医疗机构优势,降低糖尿病患者的致盲风险     

倍频Nd：YAG（532）激光治疗糖尿病性视网膜病变83例的护理报告

目的总结应用倍频Nd：YAG（532）激光治疗糖尿病性视网膜病变83例的护理体验。方法根据眼底血管荧光造影,应用倍频Nd：YAG（532）激光治疗83例（137眼）糖尿病性视网膜病变患者,配合医生做好诊断时的眼底血管荧光造影检查、术前的心理护理和术前准备、以及术后的宣教回访等护理工作。结果83例（137眼）糖尿病性视网膜病变患者的光凝有效率达89．7％。结论对糖尿病性视网膜病变患者及时进行激光光凝术,配合全面、细致、周到的护理,可使绝大部分患者避免失明,提高其生活质量。