【摘要】：目的：探討眼科廣域數(shù)字成像系統(tǒng)（RetCam3）的臨床應(yīng)用價值。方法：1.使用眼科廣域數(shù)字成像系統(tǒng)（RetCam3）對621例嬰幼兒進行眼部檢查并拍照，對其中50例嬰幼兒（包括46例早產(chǎn)兒,4例足月兒），以及3例兒童進行前房角檢查并拍照； 2.對200例(400眼)早產(chǎn)兒應(yīng)用雙目間接眼底鏡及RetCam3進行眼底檢查，以雙目間接眼底鏡檢查的結(jié)果作為“金標(biāo)準(zhǔn)”，比較兩種檢查方法對眼底病變的檢出情況； 3.使用RetCam3及前房角鏡對原發(fā)性閉角型青光眼及原發(fā)性淺前房患者30例（52眼）、正常人15例（26眼）行房角檢查，采用Scheie方法對房角進行分級，以前房角鏡檢查結(jié)果為參照，比較兩種方法在房角分級檢查中的優(yōu)劣。結(jié)果：1.621例嬰幼兒中發(fā)現(xiàn)有眼部病變者132例（21.3%），其中，在就診目的為篩查ROP的579例早產(chǎn)兒和足月低出生體重兒中，早產(chǎn)兒視網(wǎng)膜病變（ROP）65例，ROP以外的眼底病變35例，如視網(wǎng)膜孤立黃白色小點、單純視網(wǎng)膜出血等；80例足月嬰幼兒中，眼底有病變者26例，包括視神經(jīng)發(fā)育不良、陳舊性視網(wǎng)膜炎、陳舊性視網(wǎng)膜脫離、視網(wǎng)膜血管性病變、視網(wǎng)膜母細(xì)胞瘤等，眼前部病變者6例，如先天性虹膜異常等。 嬰幼兒房角檢查發(fā)現(xiàn)其特點為：小梁網(wǎng)半透明無色素，鞏膜嵴較清晰，虹膜根部基質(zhì)層“嵴”樣附著于小梁網(wǎng)上，隨著年齡增長，房角結(jié)構(gòu)暴露范圍增加，最終虹膜止點完全附著睫狀體帶，小梁網(wǎng)色素附著。 2.200例（400眼）早產(chǎn)兒中，雙目間接眼底鏡檢查出各期ROP53眼，RetCam3檢查出ROP49眼，RetCam3與間接眼底鏡檢查結(jié)果經(jīng)R×R列表的配對卡方檢驗，，差異有統(tǒng)計學(xué)意義（χ2=6.0，P=0.05），Pearson相關(guān)系數(shù)=0.85（P0.01），Kappa值=0.94（P0.01），二者檢查結(jié)果一致率高，RetCam3檢查ROP I期靈敏度89.7%，特異度99.4%； ROP II期靈敏度80.0%，特異度100%；ROP III期靈敏度、特異度100%。二者對眼底出血診斷的一致率為87.5％；二者對眼底白點診斷的一致率為33.3％。 3.前房角鏡與RetCam3對78眼前房角檢查結(jié)果的比較采用R×R列表的配對卡方檢驗，差異有統(tǒng)計學(xué)意義（X2=72，P0.01）；RetCam3對寬角及I級房角診斷的靈敏度為100%，特異度為48.3%，對II級房角診斷的靈敏度為33.3%，特異度為97.2%，對可關(guān)閉房角診斷的靈敏度為43.5%，特異度為100%。 結(jié)論：在嬰幼兒眼部疾病的篩查中，眼科廣域數(shù)字成像系統(tǒng)(RetCam3)是一種有效、準(zhǔn)確的檢查方法；RetCam3判定的房角分級較房角鏡對房角分級的判定偏低；在虹膜明顯膨隆時，難以判定房角分級，其在房角分級檢查中的作用有待進一步研究、探討。
[Abstract]:Objective: to evaluate the clinical value of wide area digital imaging system (RetCam3) in ophthalmology. Method 1: 1. The ophthalmic wide-area digital imaging system (RetCam3) was used to examine and photograph the eyes of 621 infants, 50 infants (including 46 preterm infants and 4 term infants) and 3 children with anterior chamber angle. 2. Two hundred cases (400 eyes) of premature infants were examined with binocular indirect fundus microscopy and RetCam3. The results of binocular indirect fundus examination were taken as the "gold standard" to compare the detection of fundus lesions between the two methods. 3. Thirty patients (52 eyes) with primary angle-closure glaucoma and primary shallow anterior chamber and 15 normal subjects (26 eyes) with angle were examined by RetCam3 and anterior chamber angle endoscopy. The angle of the chamber was graded by Scheie method. To compare the advantages and disadvantages of the two methods in angle grading inspection. Results among 1. 621 infants, 132 (21. 3%) were found to have ocular lesions. Among the 579 premature infants and full-term low birth weight infants whose objective was to screen for ROP, there were 35 cases of retinopathy other than (ROP) in premature infants. Among 80 term infants with retinal isolated yellowish white dots, simple retinal hemorrhage and so on, 26 cases had fundus lesions, including optic nerve dysplasia, old retinitis, old retinal detachment, retinal vascular disease, etc. Retinoblastoma and other 6 cases of anterior lesions, such as congenital iris abnormalities. The results showed that the trabecular meshwork was translucent and colorless, the scleral ridge was clear, the "cristae" of the iris root stroma attached to the trabecular meshwork, and the exposed range of the angle structure increased with age. Finally, the iris stop was completely attached to the ciliary band, and trabecular reticulum pigment was attached. 2.200 cases (400 eyes) of premature infants, Binocular indirect fundus examination showed that the results of ROP49 eye retCam3 and indirect fundus examination were matched chi-square test of R 脳 R list. The correlation coefficient of Pearson was 0.85 (P0.01) and 0.94 (P0.01). The rate of agreement between the two methods was higher than that of RetCam3 in detecting ROP stage I sensitivity (89.7g), specificity (99.4), ROP II (80.0), specificity (100ROP III) and specificity (100mg / kg). The consistent rate of diagnosis of fundus hemorrhage was 87.5%, and that of white spot was 33.33.3%. The comparison between anterior chamber angle and RetCam3 for 78 anterior atrial angle was compared by using the matched chi-square test of R 脳 R list. The difference was statistically significant (X2O72P0.01). The sensitivity of RetCam3 for the diagnosis of wide angle and grade I atrial angle was 100, the specificity was 48.3, the sensitivity for grade II angle was 33.33.3, the specificity was 97.2and the sensitivity for the diagnosis of closed angle was 43.5 and the specificity was 100. Conclusion: the wide area digital imaging system (RetCam3) of ophthalmology is an effective and accurate method in the screening of infant eye diseases. It is difficult to judge the classification of angle, and its role in the examination of angle grade needs further study and discussion.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R770.4

【參考文獻】

相關(guān)期刊論文 前6條

1 李春波,何燕玲,張明園;一致性檢驗方法的合理應(yīng)用[J];上海精神醫(yī)學(xué);2000年04期

2 劉少凌;陳運彬;;眼底鏡檢查及散瞳藥應(yīng)用對早產(chǎn)兒的影響[J];中國婦幼健康研究;2006年05期

3 楊軍;尹曉娟;李愛華;安育林;羅分平;封志純;;RetCam數(shù)字視網(wǎng)膜照像機檢測早產(chǎn)兒視網(wǎng)膜病[J];實用兒科臨床雜志;2007年10期

4 楊紅;崔錚;趙燕;寒溪;;840例早產(chǎn)兒視網(wǎng)膜病的門診篩查結(jié)果分析[J];中國婦幼保健;2011年26期

5 單海冬,趙培泉;RetCam數(shù)字視網(wǎng)膜照相機在早產(chǎn)兒視網(wǎng)膜病變篩查中的應(yīng)用[J];中華眼底病雜志;2005年05期

6 王寧利,葉天才,賴銘瑩,歐陽潔,曾明兵,楊成武;應(yīng)用超聲生物顯微鏡與房角鏡檢查眼前房角結(jié)果的比較[J];中華眼科雜志;1999年03期

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