散瞳对糖尿病患者眼底照片质量影响的研究  

Effect of mydriasis on quality of fundus image in diabetic patients

作　　者：李月桃 陈冬翠 孟洁 黄文勇 韩笑 Li Yuetao;Chen Dongcui;Meng Jie;Huang Wenyong;Han Xiao(Department of Preventive Ophthalmology,Sun Yat-sen Ophthalmic Center,Sun Yat-sen University,Guangzhou 510060,China;Seventh Hospital,Sun Yat-sen University,Shenzhen 518107,China)

机构地区：[1]中山大学中山眼科中心防盲治盲办公室,广州510060 [2]中山大学附属第七医院,深圳518107

出　　处：《国际医药卫生导报》2020年第24期3782-3785,共4页International Medicine and Health Guidance News

摘　　要：目的对募集的糖尿病患者进行全面的眼科检查,用免散瞳眼底照相机拍摄患者散瞳前后眼底照片,分析研究影响照片质量的原因。方法选取2017年1月至3月间对韶关市某医院登记在档及糖尿病门诊就诊的糖尿病患者进行筛查,使用免散瞳眼底相机,散瞳前后分别采集双眼45°单视野的后极部眼底电子照片眼底阅片师在单盲情况下分别对两组电子眼底照片进行分级并纂写标准报告。结果共收集289例(共578眼)研究对象的小瞳和散瞳眼底照相,散瞳后眼底照片可分级为95.5%(552/578),显著高于散瞳前55.4%(320/578),差异有统计学意义(P<0.001);利用多自变量logistic回归分析得出,影响眼底照片不可分级的因素主要为瞳孔直径和晶体混浊程度;瞳孔直径<3.0 mm时,眼底照片不可分级比例是瞳孔直径>3.5 mm时的12.68倍(OR=12.68,P<0.001,95%CI:2.95~60.70);晶体皮质、核混浊程度越高,眼底照片越不易分级(OR=1.802,P=0.032,95%CI:1.053~3.084;OR=2.549,P<0.001,95%CI:1.540~4.218);年龄、性别、糖尿病病程与视力对眼底照片等因素对眼底照片清晰度无明显影响。结论小瞳孔(<3.0 mm)或晶状体浊程度是影响用免散瞳眼底相机筛查DR质量的主要原因;在排除相关危险因素的情况下,散瞳可以明显提高眼底照片可分级率。Objective To detect the factors that influence quality of fundus photographs for grading diabetic retinopathy in diabetic patients by taking a comprehensive ophthalmic examination and fundus photos before and after pupil dilation(PD)with a dilation-free fundus camera.Methods From January to March,2017,the outpatients and registered patients at a hospital in Shaoguan were screened.Electronic photographs of the posterior polar fundus of both eyes with a single field of vision of 45°were taken by dilation-free fundus camera before and after PD.And all the photographs were graded and reported in a single blind condition.Results The fundus photographs of the 289 diabetic patients(578 eyes)were taken through small and dilated pupils.The grading ratio of fundus photos after PD was significantly higher compared with that before PD[95.5%(552/578)vs.55.4%(320/578);(P<0.001)].Multivariate logistic regression analysis showed that the major influence factors of gradability of fundus photos were pupil diameter and lens opacity.When the pupil diameter was less than 3.0 mm,the proportion of fundus photos that could not be graded was 12.68 times that when the pupil diameter was greater than 3.5 mm(OR=12.68,95%CI 2.95-60.70,P<0.001).The higher the degree of lens cortex and nucleus opacity,the higher the proportion of photographs that could not be graded was(for cortex opacity:OR=1.802,95%CI 1.053-3.084,P=0.032;for nucleus opacity:OR=2.549,95%CI 1.540-4.218,P<0.001).Age,gender,duration of diabetes,and visual acuity showed no significant effect on the clarity of fundus photos.Conclusion Small pupils(<3.0 mm)and lens opacity are major influence factors of the quality of fundus photographs by a dilation-free fundus camera for DR screening.With the exclusion of relevant factors,pupil dilation can significantly improve the gradability ratio of fundus photographs.

关 键 词：糖尿病视网膜病变 散瞳 眼底照片分级 

分 类 号：R587.2[医药卫生—内分泌] R774.1[医药卫生—内科学]