免散瞳眼底照相在糖尿病视网膜病变筛查中的价值

目的探讨对比免散瞳彩色眼底照相技术与直接检眼镜检查方法针对糖尿病视网膜病变在社区流行病学筛查中的应用价值。方法随机调查辽宁省沈阳市大东区3个社区糖尿病患者88例（176眼）,对其进行免散瞳彩色眼底照相检查以及直接检眼镜眼底检查,并对其病变进行分级,分析两种方法的一致性。结果诊断出糖尿病性视网膜病变患者16例。其中,使用免散瞳彩色眼底照相技术查出26眼,使用直接检眼镜检查查出28眼。免散瞳彩色眼底照相与直接检眼镜检查在诊断糖尿病性视网膜病变上具有一致性（P〉0.05）。结论免散瞳彩色眼底照相技术可以应用于糖尿病性视网膜病变社区流行病学筛查。     

眼底造影助诊老年糖尿病无临床症状眼底视网膜病

目的分析荧光素眼底血管造影术(FFA)对于老年2型糖尿病无临床症状患者糖尿病眼底视网膜病变(DR)的诊断价值。方法老年2型糖尿病初诊患者120例240眼,均无视网膜临床症状,均行FFA检查,同时按照2014年《糖尿病视网膜诊断治疗指南》中推荐检查的内容和方法检查患者散瞳后眼底照相及裂隙灯生物显微镜下眼底情况。采用指南规定的临床分期标准对两种方法检查结果分别进行分期。将按照指南推荐的DR诊断方案设为对照组,指南诊断方案联合FFA检查诊断方案设为观察组,比较两种诊断方法对DR诊断结果的差异性。分析FFA在助诊老年糖尿病DR中的临床价值。结果对照组和观察组诊断结果分别为:无明显视网膜病变54例108眼vs 12例24眼,不严重的视网膜病变58例116眼vs 90例180眼,不严重的视网膜病变合并黄斑水肿6例12眼vs 16例32眼,严重的视网膜病变合并黄斑水肿各2例4眼。观察组检出DR率明显高于对照组(P0. 05)。结论 FFA对老年2型糖尿病初诊无临床症状眼底视网膜病患者的DR检出率明显提高,对于无眼底视网膜病变临床症状的老年糖尿病患者治疗方案的选择提供参考,及早采取防治措施,对保护蓝糖尿病患者视力具有重要临床价值。     

62例Ⅱ型糖尿病患者眼底血管造影分析

目的 探讨眼底血管造影对Ⅱ型糖尿病患者早期视网膜病变的诊断价值。方法 对有视力模糊主诉的６２例Ⅱ型糖尿病患者进行眼底血管造影,并与常规检眼镜眼底检查结果作对照,结果 眼底血管荧光造影阳性率为８７．７％,检眼镜检查阳性率为３５．５％。结论 眼底血管荧光造影是早期发生糖尿病视网膜病变的优良方法。     

免散瞳眼底照相在糖尿病视网膜病变筛查中的应用

目的:讨论免散瞳眼底照相在糖尿病视网膜病变(DR)筛查中的应用价值.方法:此次研究对象为我院近年来收治的60例糖尿病患者,共计120眼,针对患者进行直接检眼镜眼底检查和免散瞳眼底照相检查,把直接检眼镜眼底检查当作金标准,对免散瞳眼底照相检查实际检出的情况作出分析.结果:通过实验观察,60例糖尿病患者共计120眼,通过直...     

探讨眼底荧光血管造影在糖尿病性视网膜病变诊断及治疗中的应用价值

目的研究眼底荧光血管造影在诊断与治疗糖尿病性视网膜病变中的应用价值。方法对糖尿病患者拟诊为视网膜疾病的500例患者的临床资料进行分析,患者实施检眼镜检查后进行荧光素眼底血管造影,对患者的视网膜病变情况进行诊断与分级,并根据诊断结果进行治疗。结果 965只眼中,检眼镜检查后共有670只眼发生视网膜病变,病变率为69.43%,其中I期、II期、III期、IV期、V期分别为220只、135只、147只、85只、83只;荧光素眼底血管造影后存在视网膜病变的眼有868只,病变率为89.95%,其中I期、II期、III期、IV期、V期分别为288只、210只、173只、103只、94只;荧光素眼底血管造影的诊断正确率明显高于检眼镜检查,(P0.05)差异存在统计学意义。结论在糖尿病患者视网膜病变的检查中,眼底荧光血管造影的检出率较高,能够进行分期,是进行疗效评价与指导治疗的重要手段,应用价值显著。     

眼底荧光血管造影在糖尿病性视网膜病变诊断及治疗中的应用价值

目的对眼底荧光血管造影用于糖尿病性视网膜病变的诊断意义和应用价值探究。方法回顾性分析该院眼科于2016年10月—2018年7月间收治的420例疑似糖尿病性视网膜病变患者临床资料,分别对其进行检眼镜检查和眼底荧光血管造影术检查,比较两种检测方法的正确检出率。结果研究对象共有802只眼睛接受相关检查,检眼镜检测结果判定为视网膜病变Ⅰ期165只,Ⅱ期123只,Ⅲ期109只,Ⅳ期88只,Ⅴ期75只,病变检出率69.83%(560/802)。眼底荧光血管造影术检测结果判定为视网膜病变Ⅰ期204只,Ⅱ期171只,Ⅲ期152只,Ⅳ期104只,Ⅴ期89只,病变检出率89.78%(720/802)。两种检测方法的检出率相比差异有统计学意义(χ~2=99.012,P=0.000)。结论眼底荧光血管造影术相较于传统的检眼镜检查方法对糖尿病性视网膜病变有更高的检出率,并且分期明确,有利于患者病情的早期诊断和治疗,有着重要的临床诊断价值和应用价值。     

糖尿病患者荧光素眼底血管造影分析

目的对糖尿病患者应用荧光素眼底血管造影的结果进行分析,并对于应用于诊断糖尿病视网膜病变的临床价值进行分析。方法选取于2014年5月—2016年4月期间在该院就诊的糖尿病患者150例(264眼),对以上患者均分别进行检眼镜检查以及荧光素眼底血管造影,并对两种不同检查方式的结果进行对照研究。结果荧光素眼底血管造影诊断视网膜病变的病变率明显高于检眼镜检查[90.15%VS 68.94%],其中非增生性糖尿病性视网膜病变、增生前糖尿病性视网膜病变、增生型糖尿病性视网膜病、糖尿病性黄斑病变、糖尿病性视神经乳头病变分别占比21.85%、28.99%、26.05%、13.87%、9.24%。结论荧光素眼底血管造影应用于糖尿病患者视网膜病变中具有显著的临床诊断价值,值得大力推广。     

糖尿病视网膜病变与血清生长激素(附31例分析)

糖尿病性视网膜病变(DR)是糖尿病患者常见的并发症之一,随着糖尿病患者平均寿命的延长,DR的发病率有逐年增长的趋势。本文对31例糖尿病患者血清生长激素(GH)水平与视网膜病变的关系进行了探讨。临床资料一、研究对象Ⅱ型糖尿病(按WHO标准)患者31例,男20例,女11例;年龄45～70岁;病程0.5～12年。所有病例均除外高血压、肾病及结缔组织病等。非糖尿病对照组15例,男8例,女7例;年龄45～60岁;口服葡萄糖耐量(100g葡萄糖法)均正常。二、方法所有病例均在直接检眼镜下检查眼底,31例糖尿病患者分为DR组15例、无DR组16例,对照组眼底无改变。所有病例均测定空腹血糖     

高度近视眼底病变与糖尿病性视网膜病变相关性的研究

目的研究分析高度近视眼底病变和糖尿病性视网膜病变相关性。方法以回顾性分析法,选择该院接收的2型糖尿病患者,时间2013年9月—2016年1月,病例数共27例,共54只眼,收集患者资料,通过散瞳眼验光证实病人有一眼是高度近视,所有患者均予以荧光素眼底血管造影检查以及检眼镜检查,分析病人视网膜病变情况。结果正视眼中,无DR2只,轻度NPDR6只,中度NPDR5只,重度NPDR4只,PDR10只,于各期糖尿病视网膜病变中均可发现正视眼病人;高度近视眼中,无DR12只,轻度NPDR7只,中度NPDR4只,重度NPDR4只,无PPDR。结论高度近视眼底病变和糖尿病性视网膜病变之间有着密切的关系,高度近视为重要保护性因素,随着近视度数的上升其保护程度也就越高。     

光学相干断层扫描联合间接检眼镜检查对白内障患者术前眼底评估的优势

目的探讨光学相干断层扫描(OCT)联合间接检眼镜检查对白内障患者进行术前眼底评估的优势。方法通过OCT对黄斑区进行扫描,再联合间接检眼镜检查对年龄相关性白内障患者进行术前眼底检查。结果 126例(180眼)白内障患者中,112例(132眼,73.3%)患者可通过OCT来检查黄斑区视网膜结构,89例(108眼,60.0%)患者可通过间接检眼镜来观察眼底,二者差异显著(χ2=7.20,P=0.007)。通过OCT检查发现的黄斑区异常有27例(30眼),主要包括视网膜出血、玻璃膜疣、黄斑水肿、色素上皮脱离和视网膜前膜等。通过间接检眼镜检查发现的黄斑区异常有23例(25眼),主要包括视网膜出血、玻璃膜疣、硬性和软性渗出、视网膜前膜等。结论通过OCT的检查,可清晰地观察视网膜(包括部分脉络膜)各层的细微结构,但其无法对整个眼底进行平面形态学观察,而间接检眼镜检查则可弥补OCT的这一缺陷。通过OCT联合间接检眼镜检查,可对大多数年龄相关性白内障患者在术前进行详细准确的眼底检查,可及早发现并诊断眼底病变,为术后视力的预测提供详实的客观依据。     

Automated Analysis of Diabetic Retinopathy Images: Principles, Recent Developments, and Emerging Trends

Diabetic retinopathy (DR) is a vision-threatening complication of diabetes. Timely diagnosis and intervention are essential for treatment that reduces the risk of vision loss. A good color retinal (fundus) photograph can be used as a surrogate for face-to-face evaluation of DR. The use of computers to assist or fully automate DR evaluation from retinal images has been studied for many years. Early work showed promising results for algorithms in detecting and classifying DR pathology. Newer techniques include those that adapt machine learning technology to DR image analysis. Challenges remain, however, that must be overcome before fully automatic DR detection and analysis systems become practical clinical tools.     

眼底荧光血管造影对早期诊断糖尿病性视网膜病变的意义

目的研究眼底荧光血管造影(FFA)对糖尿病性视网膜病变(DR)早期诊断的临床价值。方法选取2017年2月-2019年2月该院完成FFA检查的T2DM患者87例(174眼)临床资料进行回顾性研究,分析FFA图像特征并以临床诊断结果为金标准,探讨其诊断和分期准确性。结果 174眼中FFA检查诊断为DR者135眼(77.59%),其中非增生性DR 38眼(28.15%),增生前DR 41眼(30.37%),增生性DR 35眼(25.93%),糖尿病性黄斑病为16眼(11.85%),糖尿病性视神经乳头病变5眼(3.70%);与临床诊断结果相比,FFA检查诊断灵敏度为94.20%,特异度为86.11%,阳性预测值为96.30%,阴性预测值为79.49%,准确率为92.53%,一致性Kappa值为0.779;FFA检查和临床诊断对DR分期结果差异无统计学意义(P>0.05)。结论 FFA用于DR早期诊断不仅准确率较高,同时还有助于病情严重程度判断,为治疗方案选择提供参考信息。     

Screening for Diabetic Retinopathy Using Computer Vision and Physiological Markers

Background

Hyperglycemia and diabetes result in vascular complications, most notably diabetic retinopathy (DR). The prevalence of DR is growing and is a leading cause of blindness and/or visual impairment in developed countries. Current methods of detecting, screening, and monitoring DR are based on subjective human evaluation, which is also slow and time-consuming. As a result, initiation and progress monitoring of DR is clinically hard.

Methods

Computer vision methods are developed to isolate and detect two of the most common DR dysfunctions—dot hemorrhages (DH) and exudates. The algorithms use specific color channels and segmentation methods to separate these DR manifestations from physiological features in digital fundus images. The algorithms are tested on the first 100 images from a published database. The diagnostic outcome and the resulting positive and negative prediction values (PPV and NPV) are reported. The first 50 images are marked with specialist determined ground truth for each individual exudate and/or DH, which are also compared to algorithm identification.

Results

Exudate identification had 96.7% sensitivity and 94.9% specificity for diagnosis (PPV = 97%, NPV = 95%). Dot hemorrhage identification had 98.7% sensitivity and 100% specificity (PPV = 100%, NPV = 96%). Greater than 95% of ground truth identified exudates, and DHs were found by the algorithm in the marked first 50 images, with less than 0.5% false positives.

Conclusions

A direct computer vision approach enabled high-quality identification of exudates and DHs in an independent data set of fundus images. The methods are readily generalizable to other clinical manifestations of DR. The results justify a blinded clinical trial of the system to prove its capability to detect, diagnose, and, over the long term, monitor the state of DR in individuals with diabetes.     

Evaluation of automated fundus photograph analysis algorithms for detecting microaneurysms,haemorrhages and exudates,and of a computer-assisted diagnostic system for grading diabetic retinopathy

AimsThis study aimed to evaluate automated fundus photograph analysis algorithms for the detection of primary lesions and a computer-assisted diagnostic system for grading diabetic retinopathy (DR) and the risk of macular edema (ME).MethodsTwo prospective analyses were conducted on fundus images from diabetic patients. Automated detection of microaneurysms and exudates was applied to two small image databases on which these lesions were manually marked. A computer-assisted diagnostic system for the detection and grading of DR and the risk of ME was then developed and evaluated, using a large database containing both normal and pathological images, and compared with manual grading.ResultsThe algorithm for the automated detection of microaneurysms demonstrated a sensitivity of 88.5%, with an average number of 2.13 false positives per image. The pixel-based evaluation of the algorithm for automated detection of exudates had a sensitivity of 92.8% and a positive predictive value of 92.4%. Combined automated grading of DR and risk of ME was performed on 761 images from a large database. For DR detection, the sensitivity and specificity of the algorithm were 83.9% and 72.7%, respectively, and, for detection of the risk of ME, the sensitivity and specificity were 72.8% and 70.8%, respectively.ConclusionThis study shows that previously published algorithms for computer-aided diagnosis is a reliable alternative to time-consuming manual analysis of fundus photographs when screening for DR. The use of this system would allow considerable timesavings for physicians and, therefore, alleviate the time spent on a mass-screening programme.     

Retinal Imaging Techniques for Diabetic Retinopathy Screening

Due to the increasing prevalence of diabetes mellitus, demand for diabetic retinopathy (DR) screening platforms is steeply increasing. Early detection and treatment of DR are key public health interventions that can greatly reduce the likelihood of vision loss. Current DR screening programs typically employ retinal fundus photography, which relies on skilled readers for manual DR assessment. However, this is labor-intensive and suffers from inconsistency across sites. Hence, there has been a recent proliferation of automated retinal image analysis software that may potentially alleviate this burden cost-effectively. Furthermore, current screening programs based on 2-dimensional fundus photography do not effectively screen for diabetic macular edema (DME). Optical coherence tomography is becoming increasingly recognized as the reference standard for DME assessment and can potentially provide a cost-effective solution for improving DME detection in large-scale DR screening programs. Current screening techniques are also unable to image the peripheral retina and require pharmacological pupil dilation; ultra-widefield imaging and confocal scanning laser ophthalmoscopy, which address these drawbacks, possess great potential. In this review, we summarize the current DR screening methods using various retinal imaging techniques, and also outline future possibilities. Advances in retinal imaging techniques can potentially transform the management of patients with diabetes, providing savings in health care costs and resources.     

Non-invasive skin autofluorescence as a screening method for diabetic retinopathy

Diabetic retinopathy (DR) is a public health problem and a common cause of blindness. It is diagnosed by fundus examination; however, this is a costly and time-consuming method. Non-invasive skin autofluorescence (SAF) may be an accessible, fast and simple alternative for screening and early diagnosis of DR. The aim of this study was to evaluate the accuracy of SAF as a screening method for DR. A systematic search of MEDLINE, Scopus, and Web of Science databases was performed. Random effects models for sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR), diagnostic odds ratio (dOR) value and 95% CIs were used to calculate test accuracy. In addition, hierarchical summary receiver operating characteristic curves (HSROC) were used to summarise the overall test performance. Four studies were included in the meta-analysis. Pooled sensitivity and specificity were 0.79 (95% CI 0.72–0.88; I² = 0.0%) and 0.54 (95% CI 0.32–0.92; I² = 97.0%), respectively. The dOR value for the diagnosis of DR using SAF was 5.11 (95% CI 1.81–14.48: I² = 85.9%). The PRL was 2.17 (95% CI 0.62–7.64) and the NRL was 0.27 (95% CI 0.07–1.03). Heterogeneity was not relevant in sensitivity and considerable in specificity. The 95% confidence region of the HSROC included all studies. SAF as a screening test for DR shows sufficient accuracy for its use in clinical settings. SAF may be an appropriate method for DR screening, and further research is needed to recommend it as a diagnostic method.     

芪明颗粒联合眼底激光治疗糖尿病性视网膜病变Ⅲ期疗效分析

目的：分析芪明颗粒与眼底激光联合治疗糖尿病性视网膜病变（DR）Ⅲ期的临床效果。方法选取100例DRⅢ期患者,平均分组,对照组予以羟苯磺酸钙治疗,治疗组予以芪明颗粒治疗。结果治疗组疾病疗效高于对照组（P＜0.05）。对照组不良反应率高于观察组（P＜0.05）。结论芪明颗粒联合眼底激光治疗DRⅢ期疗效显著,不良反应少,安全性有效,值得在DRⅢ期临床推广。     

Benefits of Ophdiat, a telemedical network to screen for diabetic retinopathy: A retrospective study in five reference hospital centres

AimOne objective of Ophdiat^®, a telemedical network using digital non-mydriatic cameras in Île-de-France, is to develop a comprehensive screening programme that provides access to annual fundus examinations to all diabetic patients. The aim of this study was to evaluate the benefits of this programme in a hospital setting.MethodsA retrospective analysis of 500 case reports of diabetic patients hospitalized before and after Ophdiat^® setup was performed in five reference hospital centres. At each centre, 100 case reports (50 before, 50 after) of patients aged greater than 18 years, hospitalized for their annual check-up, with no known diabetic retinopathy (DR) before hospitalization and with the last fundus examination performed greater than 11 months previously, were randomly selected. The primary endpoint was the proportion of patients whose fundus examinations were performed during hospitalization; secondary endpoints were the number of cases of DR found and the time taken by ophthalmologists to make the diagnosis.ResultsThe mean proportion of patients with fundus examinations was 50.4% and 72.4% before and after, respectively, Ophdiat^® (P < 0.01). The prevalence of DR was 11.1% before and 12.7% after (not significant). The mean time taken by an ophthalmologist per diagnosis of DR was 0.90 half-day before and 0.32 half-day after Ophdiat^®.ConclusionThis evaluation shows that Ophdiat^®, combined with the availability of modern and effective devices, has improved DR screening in diabetology departments in hospitals. Additional human resources would certainly ensure more effective use of the system.     

Prevalence of Diabetic Retinopathy and Cataract in Adult Patients With Type 1 And Type 2 Diabetes in Russia

AIM: The aim of the study was to identify the prevalence of diabetic retinopathy (DR) and diabetic cataract (DC) in type 1 and type 2 diabetic patients within the Russian Federation. Also, the stage of DR at the time of its identification and the proportion of new cases diagnosed with DR or DC were to be determined. METHODS: A random sample of 7,186 adult patients with diabetes was screened for DR and DC using fundoscopy and fundus photography. Levels of HbA1c, total cholesterol, triglycerides, creatinine and urinary albumin excretion rate were assessed. RESULTS: In diabetic patients, the prevalence of DR and DC was 45.9% and 30.6%, respectively. These complications appeared significantly more frequently in patients with type 1 diabetes than in type 2 diabetes. The prevalence of background, preproliferative and proliferative DR among diabetic patients was 28.1%, 8.1%, and 6.7%, respectively. Patients with DR were older, had a longer duration of diabetes, higher HbA1c, elevated plasma total cholesterol, increased triglicerides, and higher systolic BP, compared with patients without DR. Microalbuminuria and proteinuria were more prevalent among patients with DR compared with non-DR patients. CONCLUSIONS: The results showed that diabetic retinopathy and cataract are wide-spread complications among diabetic patients in Russia. However, the disease course is more aggressive and accelerated in patients with type 1 diabetes than in those having type 2 diabetes. Therefore, it is important to prevent DR by identifying diabetes and signs of retinopathy at the earliest possible stage of progression for timely and adequate retina laser coagulation or surgical treatment, compensation of carbohydrate and lipid metabolism, and normalization of blood glucose and pressure.     

Epidemiology of diabetic retinopathy: Expected vs reported prevalence of cases in the French population

Aim and methodsImpaired eyesight and vision loss due to retinopathy are among the most feared complications in diabetic patients. As the number of diabetic patients is predicted to increase, a corresponding increase in the number of patients with diabetic retinopathy (DR) is also to be expected. This review is an update of the published literature pertaining to the epidemiology of DR.ResultsOver the past 20 years, eight population-based studies have been conducted in Western countries using photographic evidence of DR. Their results have consistently suggested that the prevalence of DR is close to 28.7%, whereas proliferative DR and macular oedema account for 9% and 17%, respectively, of all diagnosed cases. Various longitudinal studies indicate an annual incidence of DR of 2–6%. However, in France, the epidemiology of DR has mostly been investigated by observational studies. The recorded prevalence of DR, based on physicians’ reports, is estimated to be 10%, suggesting that DR is underdiagnosed in the French diabetic population. The discrepancy between the expected and reported prevalences of DR could be explained by the number of patients whose retinal status is unknown. DR screening with non-mydriatic fundus photography is effective for identifying early and advanced DR. Screening programmes carried out over the past 5 years in different regions of France indicate that 10–20% of diabetic patients with previously unknown retinal status have retinopathy.ConclusionFurther implementation of screening programmes is the key to improving DR diagnosis and preventing vision loss in the French diabetic population.