标准方位眼底摄像技术在早产儿视网膜病变远程筛查中的应用

目的观察标准方位眼底摄像技术在早产儿视网膜病变(retinopathy of prematurity,ROP)远程筛查中的应用价值。方法将2016年11月至2018年2月通过我院ROP远程筛查阅片系统筛查的早产儿1402例2804眼纳入研究,男711例1422眼,女691例1382眼。所有早产儿均使用双目间接眼底镜检查和广角数码视网膜成像系统完成眼底标准方位摄像,并将图像上传至远程阅片系统进行远程阅片。统计远程阅片系统检出ROP发病的阳性率、假阴性率、灵敏度、特异度以及ROP总发病率,评价标准方位眼底摄像技术在ROP远程筛查中的价值。结果1402例2804眼经远程筛查系统阅片,84例168眼发病,阳性率为6.0%;因图像模糊或方位不佳导致阅片困难,可疑病变,而双目间接眼底镜检查确诊的ROP患者5例10眼,假阴性率为0.3%,灵敏度为94.4%;所有患儿总发病率为6.3%,需要激光或抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗的重症ROP患儿28例56眼,占2.0%,其中急进型后极部ROP患儿5例10眼、阈值期患儿14例28眼、阈值前1型患儿9例18眼。重症ROP患儿中,26例52眼经一次激光或抗VEGF治疗后病情得到控制,2例4眼急进型后极部ROP患儿经抗VEGF治疗后4周病情复发,再次给予激光光凝治疗后病情稳定。所有患儿无一例漏诊、误诊、贻误最佳治疗时机者。结论标准方位眼底摄像技术是ROP远程筛查的有力保障;ROP远程筛查阅片系统对ROP病变检出灵敏度高,可以有效解决目前ROP专业防治人员相对缺乏的困境。

Application of standard azimuth fundus camera technique in remote screening of retinopathy of prematurity

Objective　To evaluate the application of standard azimuth fundus camera technique in remote screening of retinopathy of prematurity (ROP).Methods　A total of 1402 preterm infants (2804 eyes) were included in the study from a remote screening system for ROP in Shenzhen Eye Hospital from November 2016 to February 2018,including 711 males(1422 eyes) and 691 females(1382 eyes).All infants underwent examinations using binocular indirect ophthalmoscopy and standard azimuth fundus camera of wide-angle digital retinal imaging system.All fundus images were uploaded for remote reading.The positive rate,false negative rate,sensitivity,specificity and total incidence of ROP were analyzed automatically by the remote screening system.Results　Among 1402 patients (2804 eyes),the positive rate was 6%(168 eyes of 84 patients).There were 5 patients (10 eyes) diagnosed to be other diseases due to blurry fundus images or poor orientation while confirmed to be ROP by binocular indirect ophthalmoscopy,making the false negative rate to be 0.3%,and sensitivity to be 94.4%.Total incidence of ROP was 6.3% in all patients.There were 28 severe patients (56 eyes),who needed to be treated with laser or anti-VEGF,with aggressive posterior retinopathy of prematurity (AP-ROP) in 5 patients (10 eyes),threshold-stage disease of ROP in 14 patients (28 eyes),prethreshold type 1 of ROP in 9 patients (18 eyes).Among severe patients,lesions were effectively controlled after treatments of laser or anti-VEGF in 26 patients (52 eyes),and 2 patients (4 eyes) relapsed after treatment of anti-VEGF for 4 weeks but controlled by laser treatment later.None of the patients were missed diagnosed,misdiagnosed and delayed for treatment.Conclusion　The standard azimuth fundus camera technique is a powerful guarantee for ROP telemedicine.The application of ROP remote screening system shows high sensitivity in diagnosing ROP diseases and can effectively solve the problems of ROP clinicians shortage.