广角激光扫描检眼镜用于眼全科门诊近视患者周边视网膜病变筛查的研究

陈剑英; 胡欣欣; 王盛展; 陈婷婷

doi:10.16766/j.cnki.issn.1674-4152.002710

广角激光扫描检眼镜用于眼全科门诊近视患者周边视网膜病变筛查的研究

doi: 10.16766/j.cnki.issn.1674-4152.002710

宁波大学附属人民医院眼科中心，浙江宁波 315040

基金项目:

国家自然科学基金项目 82000887

宁波市科技计划项目 2018A27

宁波市公益性科技计划项目 2022S052

详细信息

通讯作者:
陈剑英, E-mail: 1657868248@qq.com

中图分类号: R443.8 R774.1
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出版历程
- 收稿日期: 2022-06-01
- 网络出版日期: 2022-12-30

Screening to detect peripheral retinal lesions in myopic eyes using ultrawide field scanning laser ophthalmoscopes in the outpatient general ophthalmology clinics

Department of Ophthalmology, the Affiliated People ' s Hospital of Ningbo University, Ningbo, Zhejiang 315040, China

摘要

摘要: 目的应用超广角激光扫描检眼镜检测“健康”近视人群中周边视网膜病变的发生情况，探讨其在眼科全科门诊进行近视患者周边视网膜病变筛查的可行性和意义。方法本研究采用回顾性分析，收集2021年10月—2022年3月于宁波大学附属人民医院眼科中心眼全科门诊就诊进行眼科体检的近视患者210例共210只右眼，根据等效球镜绝对值分为3组，低度近视组(≤3.00 D，43例)、中度近视组(3.00~6.00 D，98例)、高度近视组(≥6.00 D，69例)。IOL-Master测量眼轴和角膜曲率，应用Optomap Daytona 200T超广角激光扫描检眼镜拍摄视网膜，记录周边视网膜病变发生情况。结果患者年龄为(24.97±7.39)岁，等效球镜为(-5.02±2.11)D。周边视网膜病变检出率为30.95%(65例)，视网膜非压迫白(WWOP)检出率为26.19%(55例), 格子样变性(LD)检出率为6.67%(14例)。其中高度近视组周边视网膜病变[46.38%(32例)]、WWOP[39.13%(27例)]检出率最高，低度近视组周边视网膜病变[11.63%(5例)]和WWOP[9.30%(4例)]检出率最低。高度近视组LD检出率[14.49%(10例)]高于中度近视组[3.06%(3例)]与低度近视组[2.32%(1例)]。近视眼周边视网膜病变检出率、WWOP检出率和LD检出率分别与近视等效球镜绝对值、眼轴呈正相关关系(均P < 0.05)。结论超广角激光扫描检眼镜是检查近视性周边视网膜病变的有用筛查工具。无论近视程度如何，都需要仔细进行周边眼底检查，以便更好地进行早期诊断和管理。
- 近视 /
- 周边视网膜病变 /
- 超广角激光扫描检眼镜 /
- 检出率
Abstract: Objective To detect the incidence of peripheral retinal lesions in healthy myopic eyes using ultrawide field scanning laser ophthalmoscopes, and further explore the feasibility and significance of screening to detect peripheral retinal lesions in myopic eyes using ultrawide field scanning laser ophthalmoscopes in the outpatient general ophthalmology. Methods This retrospective study included a total of 210 healthy myopic patients (210 eyes), who had visited the outpatient general ophthalmology clinics of the Affiliated People ' s Hospital of Ningbo University. The eyes were divided into three groups based on the spherical equivalent refraction (SER): low myopia (≤ 3.00 D, 43 cases), moderate myopia (3.00-6.00 D, 98 cases) and high myopia (≥ 6.00 D, 69 cases). An IOL-Master was used to measure the axial length and corneal curvature. The retina was photographed with Optomap Daytona 200T ultrawide field scanning laser ophthalmoscopes and the peripheral retinal lesions was recorded. Results The mean age of the patients was (24.97±7.39) years, and the mean SER was (-5.02±2.11) D. The detection rate was 30.95% (65 cases) in peripheral retinal lesions, 26.19% (55 cases) in white without pressure (WWOP), and 6.67% (14 cases) in the lattice degeneration (LD), respectively. The high myopia group showed the highest detection rate of peripheral retinal lesions (46.38%, 32 cases) and WWOP (39.13%, 27 cases). Meanwhile, low myopia group showed the lowest detection rate of peripheral retinal lesions (11.63%, 5 cases) and WWOP (9.30%, 4 cases). The detection rate of LD in high myopia group [14.49% (10 cases)] were higher than that in moderate myopia group [3.06% (3 cases)] and low myopia group [2.32% (1 cases)]. The detection rate of peripheral retinal lesions, WWOP and LD in myopic eyes were positively correlated with the axial length and absolute values of SER, respectively (all P < 0.05). Conclusion Ultrawide field scanning laser ophthalmoscope is a potentially useful screening tool for the detection of peripheral retinal lesions in myopic eyes. Careful peripheral fundus examinations are needed for better early diagnosis and management regardless of myopia severity.
- Myopia /
- Peripheral retinal lesions /
- Ultrawide field scanning laser ophthalmoscopes /
- Detection rate

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表 1 不同程度近视患者临床特征比较

Table 1. Comparison of clinical features among the three groups with different degrees of myopia

组别	例数	年龄[M(P₂₅, P₇₅)，岁]	性别(例)		眼压[M(P₂₅, P₇₅)，mm Hg]	眼轴(x±s，mm)
组别	例数	年龄[M(P₂₅, P₇₅)，岁]	男性	女性	眼压[M(P₂₅, P₇₅)，mm Hg]	眼轴(x±s，mm)
低度近视组	43	23.0(19.0, 32.0)	23	20	17.0(15.0, 18.0)	24.72±0.71
中度近视组	98	23.0(18.0, 30.0)	58	40	17.0(15.7, 19.0)	25.60±0.91^b
高度近视组	69	22.0(18.0, 29.5)	33	36	17.0(16.0, 19.0)	26.43±0.96^bc
统计量		1.373^a	2.108^a		1.269^a	49.010^d
P值		0.503	0.348		0.530	＜0.001
注：^a为χ²值，^d为F值。与低度近视组比较，^bP < 0.05；与中度近视组比较，^cP < 0.05。

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表 2 有周边视网膜病变和无周边视网膜病变患者临床特征比较

Table 2. Comparisons of parameters and clinical features between eyes with and without peripheral retinal lesions

组别	例数	年龄[M(P₂₅, P₇₅)，岁]	性别(例)		眼压[M(P₂₅, P₇₅)，mm Hg]	SE绝对值(x±s，D)	眼轴(x±s，mm)
组别	例数	年龄[M(P₂₅, P₇₅)，岁]	男性	女性	眼压[M(P₂₅, P₇₅)，mm Hg]	SE绝对值(x±s，D)	眼轴(x±s，mm)
无病变组	145	22.0(18.0, 29.0)	82	63	17(16, 19)	4.60±2.06	25.50±1.05
有病变组	65	24.0(19.5, 31.0)	32	33	16(15, 18)	5.95±1.94	26.13±1.02
统计量		-1.307^a	-0.982^b		-1.508^a	-4.286^c	-4.120^c
P值		0.191	0.326		0.132	＜0.001	＜0.001
注：^a为Z值，^b为χ²值，^c为t值。

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表 3 不同近视程度患者周边视网膜病变情况比较[例(%)]

Table 3. Comparisons of rate of peripheral retinal lesions in patients with different degrees of myopia[case(%)]

组别	例数	周边视网膜病变	WWOP	LD	囊样突起	蜗牛迹样变	铺路石变	霜样变性	浅脱离	干性孔
低度近视组	43	5(11.63)	4(9.30)	1(2.32)	1(2.32)	0	0	0	0	0
中度近视组	98	28(28.57)	24(24.49)	3(3.06)	1(1.02)	3(3.06)	2(2.04)	2(2.04)	0	0
高度近视组	69	32(46.38)^a	27(39.13)^a	10(14.49)^b	0	3(4.35)	1(1.45)	1(1.45)	1(1.45)	1(1.45)
χ²值		15.455	12.467	8.604
P值		＜0.001	0.002	0.010
注：与低度近视组比较，^aP < 0.017；与中度近视组比较，^bP < 0.017。

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表 4 等效球镜、眼轴与视网膜病变的相关性分析

Table 4. Correlation between peripheral retinal lesions and variables(spherical equivalent refraction or axial length in participants

项目	等效球镜度绝对值		眼轴
项目	r值	P值	r值	P值
周边视网膜病变	0.222	0.004	0.239	0.002
WWOP	0.202	0.009	0.252	0.001
LD	0.225	0.004	0.177	0.022

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参考文献(21)

[1]	王玉林, 徐奇, 胡蝶, 等. 上海市城乡结合地区中小学生视力及屈光现况[J]. 中华全科医学, 2021, 19(8): 1336-1338, 1342. doi: 10.16766/j.cnki.issn.1674-4152.002054 WANG Y L, XU Q, HU D, et al. Analysis on vision and refraction of primary and middle school students in urban rural areas of Shanghai[J]. Chinese Journal of General Practice, 2021, 19(8): 1336-1338, 1342. doi: 10.16766/j.cnki.issn.1674-4152.002054
[2]	KHATWANI N, MAKHIJA S, AHUJA A. Clinical profile and distribution of peripheral retinal changes in myopic population in a hospital-based study in North India[J]. Indian J Ophthalmol, 2022, 70(4): 1280-1285. doi: 10.4103/ijo.IJO_946_21
[3]	陈珊, 于晓寒, 周晴霖, 等. 超广角扫描激光检眼镜的特点及其在眼科学中的临床应用[J]. 空军医学杂志, 2021, 37(5): 435-439. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJZY202105020.htm CHEN S, YU X H, ZHOU Q L, et al. Characteristic and clinical application of wide-field laser ophthalmoscope[J]. Medical Journal of Air Force, 2021, 37(5): 435-439. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJZY202105020.htm
[4]	ELNAHRY A G, KHAFAGY M M, ESMAT S M, et al. Prevalence and associations of posterior segment manifestations in a cohort of Egyptian patients with pathological myopia[J]. Curr Eye Res, 2019, 44(9): 955-962. doi: 10.1080/02713683.2019.1606252
[5]	CHEN D Z, KOH V, TAN M, et al. Peripheral retinal changes in highly myopic young asian eyes[J]. Acta Ophthalmol, 2018, 96(7): e846-e851. doi: 10.1111/aos.13752
[6]	ZHANG T, WEI Y T, HUANG W B, et al. Prevalence and characteristics of peripheral myopic retinopathy in Guangzhou office workers[J]. Int J Ophthalmol, 2018, 11(8): 1390-1395.
[7]	NGUYEN H T T, HOANG T T, PHAM C M, et al. Prevalence and related factors of myopic retinopathy: A hospital-based cross-section study in Vietnam[J]. Clin Exp Optom, 2022, 20(2): 1-4.
[8]	付彩云, 王刚, 郑燕, 等. 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, 9(4): 233-239. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYB201904008.htm FU C Y, WANG G, ZHENG Y, et al. Characteristic and clinical application of wide-field laser ophthalmoscope[J]. Chin J Ophthalmol (Electronic version), 2019, 9(4): 233-239. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYB201904008.htm
[9]	VENKATESH R, JAMES E, JAYADEV C. Screening and prophylaxis of retinal degenerations prior to refractive surgery[J]. Indian J Ophthalmol, 2020, 68(12): 2895-2898. doi: 10.4103/ijo.IJO_2101_20
[10]	HAARMAN A E G, ENTHOVEN C A, TIDEMAN J W L, et al. The complications of myopia: A review and meta-analysis[J]. Invest Ophthalmol Vis Sci, 2020, 61(4): 49. doi: 10.1167/iovs.61.4.49
[11]	中华医学会眼科学分会眼底病学组, 中国医师协会眼科医师分会眼底病专业委员会. 我国超广角眼底成像术的操作和阅片规范(2018年)[J]. 中华眼科杂志, 2018, 54(8): 565-569. Fundus disease group of ophthalmology branch of the chinese medical association, Fundus disease committee of ophthalmologist branch of chinese medical doctor association. Manipulation and reading specifications of ultra-wide-angle fundus imaging in China in 2018[J]. Chin J Ophthalmol, 2018, 54(8): 565-569.
[12]	VENKATESH R, CHERRY J P, REDDY N G, et al. Inter-observer agreement and sensitivity of optomap images for screening peripheral retinal lesions in patients undergoing refractive surgery[J]. Indian J Ophthalmol, 2020, 68(12): 2930-2934. doi: 10.4103/ijo.IJO_2239_20
[13]	YANG D J, LI M Y, WEI R Y, et al. Optomap ultrawide field imaging for detecting peripheral retinal lesions in 1 725 high myopic eyes before implantable collamer lens surgery[J]. Clin Exp Ophthalmol, 2020, 48(7): 895-902.
[14]	LI M Y, YANG D J, SHEN Y, et al. Application of mydriasis and eye steering in ultrawide field imaging for detecting peripheral retinal lesions in myopic patients[J]. Br J Ophthalmol, 2022. DOI: 10.1136/bjophthalmol-2021-319809.
[15]	DENG X, TANUMIHARJO S, CHEN Q, et al. Myopic retinal changes screening: Comparison of sensitivity and specificity among 15 combinations of ultrawide field scanning laser ophthalmoscopy images[J]. Ophthalmic Res, 2021, 64(6): 1029-1036.
[16]	RAMKUMAR H L, KODURI M, CONGER J, et al. Comparison of digital widefield retinal imaging with indirect ophthalmoscopy in pediatric patients[J]. Ophthalmic Surg Lasers Imaging Retina, 2019, 50(9): 580-585.
[17]	JONG M, RESNIKOFF S, TAN K O, 等. 亚洲近视管理共识[J]. 中华眼视光学与视觉科学杂志, 2022, 24(3): 161-169.
[18]	NAIDOO K S, FRICKE T R, FRICK K D, et al. Potential lost productivity resulting from the global burden of myopia: Systematic review, meta-analysis, and modeling[J]. Ophthalmology, 2019, 126(3): 338-346.
[19]	中华人民共和国教育部. 教育部等八部门关于印发《综合防控儿童青少年近视实施方案》的通知[EB/OL]. (2018-8-30)[2022-03-26]. http://www.moe.gov.cn/srcsite/A17/moe_943/s3285/201808/t20180830_346672.html. Education Ministry of The People's Republic of China. The notice of the department of education and other eight departments on Issuing the "Implementation program in the integrated prevention and therapy of myopia in children and adolescents"[EB/OL]. (2018-8-30)[2022-03-26]. http://www.moe.gov.cn/srcsite/A17/moe_943/s3285/201808/t20180830_346672.html.
[20]	索倩, 张德勇, 蔡文茜, 等. 徐州市中小学生屈光不正调查及近视相关因素研究[J]. 中华全科医学, 2020, 18(12): 2054-2056. doi: 10.16766/j.cnki.issn.1674-4152.001687 SUO Q, ZHANG D Y, CAI W Q, et al. Investigation on refractive error and related factors of myopia among primary and middle school students in Xuzhou City[J]. Chinese Journal of General Practice, 2020, 18(12): 2054-2056. doi: 10.16766/j.cnki.issn.1674-4152.001687
[21]	XU T, WANG B, LIU H, et al. Prevalence and causes of vision loss in China from 1990 to 2019: Findings from the Global Burden of Disease Study 2019[J]. Lancet Public Health, 2020, 5(12): e682-e691.