目的:研究联合使用双目间接检眼镜与RetCam Ⅱ广域数字眼底照相系统的必要性,分析联合使用两种方法进行早产儿视网膜病变(retinopathy of prematurity,ROP)筛查的结果。方法:2009-10-01/2010-10-31通过使用计算机辅助的双目间接检眼镜成像系统和RetCam Ⅱ对我院眼科门诊、新生儿科病房和新生儿重症监护室的早产低出生体重儿进行定期的眼底检查,眼底定期复查至早产儿的鼻、颞侧周边视网膜完全血管化为止。对确诊患儿建立图像和数据档案,及时追踪其病变发展与转归,当病情进展至阈值前期和阈值期病变时进行手术治疗,术后定期复查至其病变已完全消退或静止无进展。最后对确诊患儿资料进行统计分析。结果:在筛查时间内,对1431例符合早产儿视网膜病变筛查条件的早产低出生体重儿(胎龄27～35周;出生体质量0.8～2.5kg)进行眼底检查和定期复查,确诊ROP患儿111例(7.76%),其中单独使用RetCam Ⅱ检查发现ROP确诊者53例,对疑似病例同时使用计算机辅助双目间接检眼镜成像行检查后ROP确诊者58例。定期复查后病变消退者占67.57%,病变进展为ROPⅠ型阈值前期者19例和ROP阈值期及以上者15例,34例患儿进行视网膜激光光凝术,31例术后效果良好,2例ROP4A期患者术后效果不明显。结论:本研究发现早产儿孕周越小,出生体质量越低,ROP的发生率越高,其病变程度越重,需要及时筛查早期干预治疗。通过联合使用计算机辅助的双目间接检眼镜成像系统和RetCam Ⅱ进行早产儿眼底检查有助于提高ROP的诊断率,有利于资料客观保存和ROP筛查培训。

AIM:To study the essentiality of combining use of computer-assisted imaging system of indirect ophthalmoscope and wide-field digital retinal imaging system and analyze the result of two methods in the retinopathy of premature (ROP) screening.METHODS:Using the computer-assisted imaging system of indirect ophthalmoscope and wide-field digital retinal imaging system,the ophthalmologist examined the premature infants regularly in the ophthalmologic clinic,neonate department and neonate intensive care department from the 1st October 2009 to the 31st October 2010.The examination would be finished till infants’ retinal vascularization completed in nasal and temple retina.The ROP infants’ information would be preserved and their eye disease process would be followed up timely.It would be chosen to be operated on for those patients whose disease process developed to the pre-threshold and threshold and be followed up regularly till their ROP were complete regression and stationary.Finally the data of ROP patients were statistically analysed.RESULTS:From the 1st October 2009 to the 31st October 2010,1431 premature infants who were the objects of ROP screening (gestational age :27-35 weeks;birth weight:0.8-2.5kg)were examined and followed up regularly and found 111 ROP cases(7.76%).53 ROP cases were examined only by RetCamⅡ,and 58 ROP cases who were borderline cases were examined with combining use of computer-assisted imaging system of indirect ophthalmoscope and wide-field digital retinal imaging system.67.57% of patients were found their disease regression after follow-up.19 cases’diseases developed to styleⅠ of the pre-threshold and 15 cases developed to or above the threshold,34 cases were done by laser photocoagulation and 31 cases had good outcomes after operation and 2 ROP 4A stage cases had bad outcome.CONCLUSION:The study was found when the premature infants were shorter in their gestational weeks and the lighter in birth weight,their incidence of ROP were higher and their disease extent were more serious,and they needed ROP screening timely and early intervention treatment.Combining use of computer-assisted imaging system of indirect ophthalmoscope and wide-field digital retinal imaging system is helpful to increase the rate of ROP diagnosis,to preserve the object data and to ROP screening training.

R774.1

中国广州市科学技术局基金资助项目(No.2005Z1E0102)~~