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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