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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2019, Vol. 09 ›› Issue (04) : 233 -239. doi: 10.3877/cma.j.issn.2095-2007.2019.04.007

论著

广角激光扫描检眼镜筛查近视眼术前眼底病变的临床研究
付彩云1, 王刚1, 郑燕1, 张晶1, 黄厚斌2, 张丽1, 王玥1, 张秋露1, 翟长斌1,†()   
  1. 1. 100730　首都医科大学附属北京同仁医院　北京同仁眼科中心　北京市眼科学与视觉科学重点实验室
    2. 572013　三亚，解放军总医院海南医院眼科
  • 收稿日期:2019-07-28 出版日期:2019-08-28
  • 通信作者: 翟长斌
  • 基金资助:
    北京市医院管理局临床技术创新项目(XMLX201614); 首都临床特色应用研究基金项目(Z161100000516115)

Application of wide-field laser ophthalmoscope in the fundus examination of myopia before refractive surgery

Caiyun Fu1, Gang Wang1, Yan Zheng1, Jing Zhang1, Houbin Huang2, Li Zhang1, Yue Wang1, Qiulu Zhang1, Changbin Zhai1,†()   

  1. 1. Beijing Tongren Eye Cener, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab., Beijing 100730, China
    2. Department of Ophthalmology, Hainan Hospital of People′s Liberation Army of China General Hospital, Sanya 572013, China
  • Received:2019-07-28 Published:2019-08-28
  • Corresponding author: Changbin Zhai
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引用本文：

付彩云, 王刚, 郑燕, 张晶, 黄厚斌, 张丽, 王玥, 张秋露, 翟长斌. 广角激光扫描检眼镜筛查近视眼术前眼底病变的临床研究[J]. 中华眼科医学杂志(电子版), 2019, 09(04): 233-239.

Caiyun Fu, Gang Wang, Yan Zheng, Jing Zhang, Houbin Huang, Li Zhang, Yue Wang, Qiulu Zhang, Changbin Zhai. Application of wide-field laser ophthalmoscope in the fundus examination of myopia before refractive surgery[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2019, 09(04): 233-239.

目的

对比广角激光扫描检眼镜与目前常用眼底检查方法在筛查近视眼眼底相关病变中的区别。

方法

收集2019年3月至2019年4月在北京同仁医院就诊的52例患者(104只眼)于正常照明瞳孔状态下行广角激光扫描检眼镜眼底图像，并与散瞳后双目间接检眼镜及前置镜眼底检查结果对比。同时，利用调查问卷了解患者对三种检查方法的主观感受。

结果

经配对χ2检验统计分析发现，广角激光扫描检眼镜与间接检眼镜、前置镜，及间接检眼镜与前置镜，在后极部视盘旁脉络膜萎缩弧、后巩膜葡萄肿及豹纹状眼底病眼检出数的比较，差异均无统计学意义(χ2＝0.00，0.00，0.00；P>0.05)、(χ2＝0.00，0.00，0.00；P>0.05)、(χ2＝2.25，2.25，0.00；P>0.05)；在周边部非压迫样变白、霜样变性及脱色素、Fuchs斑及色素、干性视网膜裂孔及视网膜脱离及视网膜增殖膜或血管膜的病眼检出数的比较，差异均无统计学意义(χ2＝0.00，0.08，0.00；P>0.05)、(χ2＝1.50，3.20，0.00；P>0.05)、(χ2＝0.57，0.00，0.10；P>0.05)、(χ2＝0.50，0.00，0.00；P>0.05)、(χ2＝0.25，0.25，0.50；P>0.05)。间接检眼镜与前置镜对于周边部的视网膜突起及格子样变性的病眼检出数的比较，差异有统计学意义(χ2＝4.17；P<0.05)。而余广角激光扫描检眼镜与间接检眼镜、广角激光扫描检眼镜与前置镜的两两比较，差异均无统计学意义(χ2＝0.00，2.29；P>0.05)，且广角激光扫描检眼镜对以上病变病眼检出率达71.15%。广角激光扫描检眼镜与间接检眼镜、广角激光扫描检眼镜与前置镜及间接检眼镜与前置镜对于低度近视、中度近视及高度近视患者的病眼检出数的比较，差异均无统计学意义(χ2＝1.33，0.17，0.00；P>0.05)、(χ2＝0.00，0.00，0.00；P>0.05)、(χ2＝0.25，2.29，0.80；P>0.05)。广角激光扫描检眼镜与间接检眼镜在鼻下象限病变检出总数的比较，差异有统计学意义(Z＝-2.67；P<0.05)，鼻上、颞上及颞下象限病变检出总数的比较，差异无统计学意义(Z＝-1.41，-0.83，-0.33；P>0.05)；广角激光扫描检眼镜与前置镜在鼻上、鼻下象限病变检出总数的比较，差异有统计学意义(Z＝-2.11，-2.07；P<0.05)，在颞上、颞下象限病变检出总数的比较，差异无统计学意义(Z＝-1.67，-0.45；P>0.05)；间接检眼镜与前置镜在鼻上、鼻下、颞上及颞下各象限病变检查总数的比较，差异均无统计学意义(Z＝-1.00，-0.30，-0.82，-0.73；P>0.05)。调查问卷结果显示，间接检眼镜光照强度、配合度及总体满意度分别为69%(36/52)、88%(46/52)及88%(46/52)；广角激光扫描检眼镜为53%(28/52)、31%(16/52)及60%(31/52)；前置镜为35%(18/52)、77%(40/52)及75%(39/52)。在光照强度、配合度及总体满意度方面，间接检眼镜优于广角激光扫描检眼镜及前置镜。在报告出具形式方面，46%(24/52)的患者喜欢广角激光扫描检眼镜，喜欢间接检眼镜及前置镜的均为17%(9/52)。

结论

广角激光扫描检眼镜具有免散瞳、成像快及范围大的优势，且可用于患者长期随访，对近视眼相关眼底病变具有较高检出率，用于近视眼等屈光不正矫治术前的眼底筛查比传统方法更有优势。同时，需进一步改善广角激光扫描检眼镜拍摄时光照过强、配合较难等缺点。

关键词: 广角激光扫描检眼镜, 近视, 眼底病变
Objective

This study was aim to compare the wide-field laser ophthalmoscope with present methods in the fundus examination of myopia before refractive surgery.

Methods

104 eyes of fifty-two patients were included in the study before refractive surgery from March 2019 to April 2019 in Beijing Tongren Hospital. All subjects underwent wide-field laser ophthalmoscope, binocular indirect ophthalmoscope an front mirror. The image of wide-field laser ophthalmoscope was taken with the pupil under natural light, two others were examined with mydriasis. The results of three methods were compared and analyzed at last. Meanwhile, the subjective feelings of patients were investigated through questionnaires. The results were compared by paired chi-square test in wide-field laser ophthalmoscope and indirect ophthalmoscope, wide-field laser ophthalmoscope and front mirror, indirect ophthalmoscope and front mirror.

Results

No significant statistical differences were observed in the retinopathy of posterior perioptic choroid atrophy arc, posterior scleral staphyloma, and leopard fundus (χ2=0.00, 0.00, 0.00; P>0.05), (χ2= 0.00, 0.00, 0.00; P>0.05), (χ2= 2.25, 2.25, 0.00; P>0.05). There were also no significant differences in peripheral non-compression white, frost degeneration and depigmentation, Fuchs spot and pigment degeneration, dry retinal hole and retinal detachment, retinal proliferative or vascular membrane (χ2=0.00, 0.08, 0.00; P>0.05); (χ2= 1.50, 3.20, 0.00; P>0.05); (χ2= 0.57, 0.00, 0.10; P>0.05); (χ2= 0.50, 0.00, 0.00; P>0.05); (χ2= 0.25, 0.25, 0.50; P>0.05). There were statistically differences in peripheral retinopathy of retinal protuberance and lattice degeneration between indirect ophthalmoscope and front mirror(χ2=4.17, P<0.05), and no statistically significant differences were observed in the comparison of wide-field laser ophthalmoscope with indirect ophthalmoscope and front mirror(χ2=0.00, 2.29; P>0.05). And the detection rate of wide-field laser ophthalmoscope for the mentioned above lesions was 71.15%. For the patients with low, moderate and high myopia(χ2=1.33, 0.17, 0.00, P>0.05); (χ2= 0.00, 0.00, 0.00; P>0.05); (χ2= 0.25, 2.29, 0.80; P>0.05). There were no significant differences in the number of eye diseases detected between wide-field laser ophthalmoscope and indirect ophthalmoscope, wide-field laser ophthalmoscope and front mirror, indirect ophthalmoscope and front mirror. Wilcoxon sign rank test was used to analyze the total peripheral lesions in each quadrant, and there were statistically significant differences between wide-field laser ophthalmoscope and indirect ophthalmoscope in the inferior nasal quadrant (Z=-2.67; P<0.05), but no statistically significant differences were found in the superior nasal, superior temporal and inferior temporal quadrants(Z=-1.41, -0.83, -0.33; P>0.05). There were statistically significant differences between wide-field laser ophthalmoscope and front mirror in the superior and inferior nasal quadrants (Z=-2.11, -2.07; P<0.05), and no statistically significant differences in the superior and inferior temporal quadrants (Z=-1.67, -0.45; P>0.05). No significant statistical differences were found between the indirect ophthalmoscope and front mirror in four quadrants (Z=-1.00, -0.30, -0.82, -0.73; P> 0.05). The light intensity, patient coordination and overall satisfaction of the indirect ophthalmoscope was 69%(36/52), 88%(46/52), 88%(46/52), which was 53%(28/52), 31%(16/52), 60%(31/52) in the wide-field laser ophthalmoscope and 35%(18/52), 77%(40/52), 75%(39/52) in front mirror. The questionnaires showed that the indirect ophthalmoscope was better than the wide-field laser ophthalmoscope and front mirror in the light intensity, patient coordination and overall satisfaction. Meanwhile, 46%(24/52) patients preferred wide-field laser ophthalmoscope, while both 17% (9/52) patients preferred the indirect ophthalmoscope and front mirror in the report form.

Conclusions

The wide-field laser ophthalmoscope was a convenient and feasible method in the fundus examination before refractive surgery with a high detection rate of myopia related fundus lesions, which had the advantages of avoiding pupil dilation, fast imaging and wide range, and could be used for long-term follow-up. And it is necessary to improve the disadvantages of strong light and difficult cooperation in wide-field laser ophthalmoscope.

Key words: Wide-field laser ophthalmoscope, Myopia, Fundus lesion
表1 后极部不同病变类型病眼数检出结果的对比[%(病眼数/总眼数)]
方法 例数 视盘旁脉络膜萎缩 后巩膜葡萄肿 豹纹状眼底
广角激光扫描检眼镜 104 17.31(18/104) 2.88(3/104) 19.23(20/104)
间接检眼镜 104 17.31(18/104) 2.88(3/104) 15.38(16/104)
前置镜 104 17.31(18/104) 2.88(3/104) 15.38(16/104)
表2 周边部不同病变类型病眼数检出结果的对比[%(病眼数/总眼数)]
方法 例数 非压迫样变白 霜样变性及脱色素 Fuchs斑及色素
广角激光扫描检眼镜 104 35.58(37/104) 7.69(8/104) 8.65(9/104)
间接检眼镜 104 34.62(36/104) 3.85(4/104) 5.77(6/104)
前置镜 104 35.58(37/104) 2.88(3/104) 7.69(8/104)
方法 例数 视网膜突起及格子样变性 干性视网膜裂孔及视网膜脱离 视网膜增殖膜或血管膜
广角激光扫描检眼镜 104 10.58(11/104) 1.92(2/104) 2.88(3/104)
间接检眼镜 104 11.54(12/104) 3.85(4/104) 0.96(1/104)
前置镜 104 5.77(6/104)# 2.88(3/104) 2.88(3/104)
图1 三种检查方法中不同屈光度患者周边部病变检出率的区别
表3 不同屈光度病眼数检出结果的对比[%(病眼数/总眼数)]
方法 例数 低度近视 中度近视 高度近视
广角激光扫描检眼镜 104 35.00(7/20) 47.50(19/40) 70.45(31/44)
间接检眼镜 104 20.00(4/20) 45.00(18/40) 65.91(29/44)
前置镜 104 25.00(5/20) 47.50(19/40) 59.09(26/44)
表4 不同部位病变总数检查结果的对比[M(P25，P75)]
方法 鼻上方 鼻下方 颞上方 颞下方
广角激光扫描检眼镜 0(0，0) 0(0，1) 0(0，0) 0(0，1)
间接检眼镜 0(0，0) 0(0，0)# 0(0，0) 0(0，1)
前置镜 0(0，0)# 0(0，0)# 0(0，0) 0(0，1)
图2 三种检查方法调查问卷结果的比较图
图3 视网膜周边部病变的广角激光扫描检眼镜检查图像　图A显示视网膜格子样变性及针尖样裂孔广角激光扫描检眼镜图像；图B显示激光光凝术后广角激光扫描检眼镜图像
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