Daytona超广角激光扫描眼底成像与FFA在老年白内障病人糖尿病性视网膜病变筛查中的一致性分析

doi:10.3969/j.issn.1003-9198.2024.11.014

摘要/Abstract

摘要： 目的探讨Daytona超广角激光扫描眼底成像与荧光素眼底血管造影(fundus fluorescein angiography,FFA)筛查老年白内障病人糖尿病性视网膜病变(diabetic retinopathy,DR)的一致性。方法采用横断面研究方法,选取2021年4月至2023年8月在大庆油田总医院眼科门诊就诊的年龄≥60岁合并糖尿病的老年白内障病人172例(323眼),所有病人均接受Daytona超广角激光扫描眼底成像以及FFA检查,分别记录2种检查方法诊断DR以及DR分期情况。采用卡方检验、加权Kappa一致性检验、Spearman偏回归分析对2种检查结果的相关性进行分析。结果 2种检查方法的可阅片率差异无统计学意义(93.8%比94.1%,P=0.869)。Daytona 超广角系统检查时间较FFA检查时间明显缩短(Z=16.85,P＜0.001)。排除未得到眼底图像25眼,最终153例298眼纳入一致性研究。Daytona 超广角系统与FFA检测DR分期完全一致278只眼(93.29％),Kappa值为0.925,95％CI:0.892～0.958。以FFA为金标准,Daytona 超广角系统检测增生型DR的敏感度和特异度分别为90.00％、100.00%,Kappa值为0.926;检测非增生型DR的敏感度、特异度分别为94.47％、90.91％,Kappa值为0.900 。Daytona 超广角系统与FFA检测DR分期结果呈高度正相关(r=0.921)。结论 Daytona超广角激光扫描眼底成像对合并糖尿病的老年白内障病人DR筛查效果及分期与FFA有很好的一致性。

关键词: Daytona 超广角激光扫描眼底成像, 眼底荧光血管造影检查, 糖尿病性视网膜病变, 白内障, 糖尿病

Abstract: Objective To explore the consistency between Daytona ultra-wide-field scanning laser ophthalmoscope and fundus fluorescein angiography (FFA) in screening diabetic retinopathy (DR) in the elderly patients with cataract and diabetes mellitus (DM). Methods A cross-sectional study was conducted. A total of 172 (323 eyes) elderly patients with cataract complicated with DM aged ≥ 60 years old admitted to Ophthalmology Clinic of Daqing Oilfield General Hospital from April 2021 to August 2023 were enrolled in this study. Daytona ultra-wide-field scanning laser ophthalmoscope and FFA were applied to screen DR.The data were analyzed using chi-square test, weighted Kappa test and Spearman partial regression analysis. Results No significant difference was found in readability of fundus imaging betweeen Daytona ultra-wide-field scanning laser ophthalmoscope and FFA (93.8% vs. 94.1%, P=0.869).The examination duration of Daytona ultra-wide-field scanning laser ophthalmoscope was 2.3(1.7, 5.2) min, compared with 9.5(7.3, 12.0) min of FFA (Z=16.85, P＜0.001). The complete consistency rate in determining DR stage between Daytona ultra-wide-field scanning laser ophthalmoscope and FFA was 93.29% (278/298) (Kappa=0.925, 95%CI: 0.892-0.958). The sensitivity and specificity of Daytona ultra-wide-field scanning laser ophthalmoscope in detecting non-proliferative DR was 94.47% and 90.91%, respectively, with a Kappa value of 0.900. The sensitivity and specificity of Daytona ultra-wide-field scanning laser ophthalmoscope in detecting proliferative DR was 90.00% and 100.00%, respectively, with a Kappa value of 0.926. The results of DR stage diagnosed by Daytona ultra-wide-field scanning laser ophthalmoscope were significantly correlated with FFA (r=0.921). Conclusions There is a high consistency between Daytona ultra-wide-field scanning laser ophthalmoscope and FFA in screening and staging DR in the elderly patients with cataract and DM.

Key words: Daytona ultra-wide-field scanning laser ophthalmoscope, fundus fluorescein angiography, diabetic retinopathy, cataract, diabetes mellitus

中图分类号:

刘戈, 刘洋, 罗杰. Daytona超广角激光扫描眼底成像与FFA在老年白内障病人糖尿病性视网膜病变筛查中的一致性分析[J]. 实用老年医学, 2024, 38(11): 1148-1152.

LIU Ge, LIU Yang, LUO Jie. Consistency between Daytona ultra-wide-field scanning laser ophthalmoscope and FFA in screening diabetic retinopathy in elderly patients with cataract[J]. Practical Geriatrics, 2024, 38(11): 1148-1152.

参考文献

[1] THOMAS R L, DUNSTAN F D, LUZIO S D, et al. Prevalence of diabetic retinopathy within a national diabetic retinopathy screening service[J]. Br J Ophthalmol, 2015, 99(1): 64-68.
[2] 皇甫镜如. 白内障术后黄斑水肿的诊治新进展[J]. 中华实验眼科杂志, 2019, 37(4): 312-315.
[3] CHU C J, JOHNSTON R L, BUSCOMBE C, et al. Risk factors and incidence of macular edema after cataract surgery:a database study of 81984 eyes[J]. Ophthalmology, 2016, 123(2): 316-323.
[4] 高莎莎,秦廷玉,赵琳. 有无视网膜病变的糖尿病患者白内障手术后黄斑水肿发生率比较及相关因素分析[J]. 中华眼底病杂志,2017,33(6):593-596.
[5] CAI W, CHEN M, FAN J, et al. Fluorescein sodium loaded by polyethyleneimine for fundus fluorescein angiography improves adhesion[J].Nanomedicine: Lond, 2019, 14 (19): 2595-2611.
[6] SILVA P S, CAVALLERANO J D, SUN J K, et al. Nonmydriatic ultrawide field retinal imaging compared with dilated standard 7-field 35-mm photography and retinal specialist examination for evaluation of diabetic retinopathy[J]. Am J Ophthalmol, 2012, 154(3): 549-559. e2.
[7] LIEGL R, LIEGL K, CEKLIC L, et al. Nonmydriatic ultra-wide-field scanning laser ophthalmoscopy (Optomap) versus two-field fundus photography in diabetic retinopathy[J]. Ophthalmologica, 2014, 231(1): 31-36.
[8] WILKINSON C P, FERRIS F L 3rd, KLEIN R E, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales[J]. Ophthalmology, 2003, 110(9): 1677-1682.
[9] SCANLON P H, FOY C, MALHOTRA R, et al. The influence of age, duration of diabetes, cataract, and pupil size on image quality in digital photographic retinal screening[J]. Diabetes Care, 2005, 28(10): 2448-2453.
[10] NEUBAUER A S, KERNT M, HARITOGLOU C, et al. Nonmydriatic screening for diabetic retinopathy by ultra-widefield scanning laser ophthalmoscopy (Optomap)[J]. Graefes Arch Clin Exp Ophthalmol, 2008, 246(2): 229-235.
[11] MARUYAMA-INOUE M,KITAJIMA Y, MOHAMED S, et al. Sensitivity and specificity of high-resolution wide field fundus imaging for detecting neovascular age-related macular degeneration[J]. PLoS One, 2020, 15(8): e0238072.
[12] SHOUGHY S S, AREVALO J F, KOZAK I. Update on wide- and ultra-widefield retinal imaging[J]. Indian J Ophthalmol, 2015, 63(7): 575-581.
[13] 庄雪楠, 曹丹, 姚婕, 等. 基于超广角眼底成像的糖尿病视网膜病变周边病变特征分析[J]. 中华眼底病杂志, 2021, 37(7): 523-527.
[14] WESSEL M M, AAKER G D, PARLITSIS G,et al. Ultra-wide-field angiography improves the detection and classification of diabetic retinopathy[J]. Retina, 2012, 32(4): 785-791.
[15] HAFNER J, POLLREISZ A, EGNER B, et al. Presence of peripheral lesions and correlation to macular perfusion, oxygenation and neurodegeneration in early tye Ⅱ diabetic retinal disease[J]. Retina, 2020, 40(10): 1964-1971.
[16] 高丽琴, 张风, 周海英, 等. 眼底彩色照像与荧光素眼底血管造影对判断糖尿病视网膜病变临床分期的一致性研究[J]. 中华眼科杂志, 2008, 44(1): 12-16.
[17] 刘长颖, 王杰, 陈芳, 等. 多方位光相干断层扫描血管成像对Ⅳ期糖尿病视网膜病变患眼视网膜及视盘新生血管的检出分析[J]. 中华眼底病杂志, 2020, 36(5): 349-353.