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目的研究免散瞳眼底照相白内障筛查法以眼底像的模糊程度反映白内障混浊程度的可行性,并以此预测白内障术后视力的效果。设计前瞻性病例系列。研究对象北京同仁医院眼科中心连续的白内障手术患者123例(171眼)。方法在暗室进行眼底照相,自然瞳孔<4mm时需药物散瞳,并加照外眼视网膜反光像,以此鉴别晶状体或角膜混浊。眼底模糊度分5级:0级为眼底清晰;1级为视网膜小血管隐见;2级为视网膜大血管隐见;3级为视盘隐见;4级为眼底结构全不见。于术前及术后2周内查矫正视力。主要指标矫正视力、眼底像模糊度。结果术前眼底模糊程度为1、2、3、4级的眼,术后视力分别平均提高0.37±0.24,0.45±0.26,0.53±0.24和0.60±0.31。眼底像模糊度与术前视力负相关(r=-0.59,P=0.000);眼底像模糊度与视力改善行数正相关(r=0.54,P=0.000);白内障术后矫正视力<0.5者(21眼)主要的眼底病变为视盘周萎缩环14眼(66.7%)、视神经萎缩3眼(14.3%)、黄斑病变4眼(19.0%)。结论免散瞳眼底照相的眼底像模糊程度可以反映白内障混浊程度,可能成为白内障手术前预测术后效果的评价指标之一。
Objective To study the feasibility of no-mydriasis fundus photography cataract screening method to reflect the degree of opacity of cataract with the degree of blur of fundus image, and to predict the effect of cataract surgery after vision. Design prospective case series. The study included 123 consecutive patients (171 eyes) with cataract surgery in Beijing Tongren Hospital Ophthalmic Center. Methods fundus photography in the darkroom, the natural pupil <4mm medication dilated, and add the outer retinal reflex image, in order to identify lens or corneal opacity. Fundus ambiguity at 5 levels: 0 for the fundus clear; 1 for the retina of small blood vessels hidden; 2 for retinal vascular vagueness; 3 for the disc hidden; 4 for the fundus structure of all gone. In the preoperative and postoperative 2 weeks to check corrected visual acuity. The main indicators of vision correction, fundus ambiguity. Results The degree of preoperative fundus blur was 1, 2, 3, 4 eyes, the postoperative visual acuity increased by 0.37 ± 0.24, 0.45 ± 0.26, 0.53 ± 0.24 and 0.60 ± 0.31 respectively. The degree of fundus ambiguity was negatively correlated with preoperative vision (r = -0.59, P = 0.000). The degree of blurred vision was positively correlated with the number of eyes with improved visual acuity (r = 0.54, P = 0.000) (21 eyes). The major fundus lesions included 14 eyes (66.7%) with optic atrophy, 3 eyes (14.3%) with optic atrophy, and 4 eyes (19.0%) with macular degeneration. Conclusion The degree of blurring of fundus image of funduscopic fundus photography can reflect the degree of cataract opacity and may be one of the evaluation indexes for predicting the postoperative effect of cataract surgery.