目的 采用直接眼底镜检查、数码彩色眼底照相、荧光素眼底血管造影及光学相干断层扫描等4种方法,对糖尿病视网膜病变患者进行检查和评估,探讨早期糖尿病视网膜病变筛查方法.方法 对2009年1月～2010年1月就诊我院眼科门诊的糖尿病患者,进行直接眼底镜检查、数码彩色眼底照相、荧光素眼底血管造影及光学相干断层扫描检查.以荧光素眼底血管造影诊断为标准,分析各种检查结果的敏感性、特异性及与眼底荧光血管造影诊断的一致性.结果 以糖尿病视网膜病变l期为筛查阈值时,眼底彩色照相的敏感性、特异性均明显高于直接眼底镜检查,Kappa检验有高度一致性;以糖尿病视网膜病变2期为筛查阈值时,直接眼底镜检查与眼底彩色照相的特异性基本一致,但眼底彩色照相的敏感性明显高于直接眼底镜检查,Kappa检验有高度一致性.同正常组相比,糖尿病视网膜病变1期视网膜各方位厚度并无明显增加,糖尿病视网膜病变2期各方位神经上皮层厚度比相应方位的正常组增加.结论 数码彩色眼底照相可作为糖尿病视网膜病变2期以上患者的主要筛查诊断方法.%Objective Diabetic retinopathy (DR) in patients with diabetic mellitus (DM) are estimated and detected through direct funduscopy, digital fundus imaging, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). Methods All diabetes who received examination in ophthalmic outpatient department of our hospital underwent direct funduscopy, digital fundus imaging, FFA and OCX, Then taking the diagnosis of FFA as the standard, we could not only analyse the sensitivity and specificity, but also analyse consistency diagnosed by FFA, Macular thickness in all the quadrants and foveal volume were evaluated. Results When diabetic retinopathy in first stage is being taken as referable DR threshold, ocular digital fundus imaging gave higher sensitivity and specificity than direct funduscopy, Kappa inspection has high consistency; when diabetic retinopathy phasez is being taken as referable DR threshold, direct funduscopy gives an identical specificity with ocular digital fundus imaging, but a lower sensitivity, Kappa inspection has high consistency. No obvious differences in the various positions retina thickness were found between mild nonproliferative diabetic retinopathy and healthy controls. However, there were significant differences between diabetic retinopathy phase and healthy control, in mean foveal volume and sectoral macular thickness in all the quadrants. Conclusion Digital ocular fundus imaging is suitable for diagnosing screening of early DR, especially diabetic retinopathy phase or more severe.
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