摘要目的:评估免散瞳眼底照相在糖尿病性视网膜病变(DR)筛查中的应用价值。方法:前瞻性研究。金华眼科医院2017年7月至2018年7月在农村糖尿病患者828人(1 656眼)中筛查DR，进行免散瞳眼底照相及散瞳后7方位眼底照相，并以荧光素眼底血管造影(FFA)结果为标准，比较两种眼底照相方法筛查DR的效果。结果:FFA筛查出DR 140例(274眼)，DR患病率为16.91%，散瞳后7方位眼底照相筛查出DR 137例(267眼)，占16.55% ，免散瞳眼底照相筛查出DR 139例(260眼)，占16.79%。免散瞳眼底照相诊断DR的敏感度为94.89%、特异度为98.11%及准确度为97.58%与散瞳后7方位眼底照相的97.45%、98.05%及97.95%基本相同，差异均无统计学意义( χ2＝2.426，0.019，0.498； P＝0.119，0.890，0.481)。免散瞳眼底照相诊断非增生性DR的敏感度、特异度及准确度为95.51%、特异度为95.94%及准确度为95.89%与散瞳后7方位眼底照相的92.70%、96.96%及96.50%基本相同，差异无统计学意义( χ2＝1.265，2.222，0.008； P＝0.261，0.136，0.930)。免散瞳眼底照相的检查时间低于散瞳后7方位眼底照相的检查时间，差异有统计学意义( t＝8.668， P＝0.000)。 结论:与散瞳后7方位眼底照相比较，免散瞳眼底照相能够有效的筛查糖尿病视网膜病变，且具有操作简单、无创伤性等优点。

abstractsObjective:To evaluate the application value of non-mydriatic fundus photography in screening diabetic retinopathy (DR).Methods:This was a prospective study. Total of 1 656 eyes of 828 rural patients with diabetes from Jul.2017 to Jul.2018 in Jinhua Eye Hospital received screening of DR.All patients underwent non-mydriatic fundus photography and 7-direction fundus photography after mydriasis.The fundus fluorescence angiography (FFA) was used as the standard to compare the efficacy of screening DR with two different methods.Results:FFA screening detected 274 eyes of 140 cases of DR, and the prevalence of DR was 16.91%.There were 267 eyes of 137 cases(16.55%) of DR were screened by 7-direction fundus photography after mydriasis, and 260 eyes of 139 cases (16.79%) of DR were screened by non-mydriatic fundus photography.The sensitivity of screening DR in non-mydriatic fundus photography was 94.89%, specificity was 98.11%, and accuracy was 97.58%, which were basically the same as 97.45%, 98.05%, and 97.95% of 7-direction fundus photography after mydriasis. There was no significant difference ( χ2 = 2.426, 0.019, 0.498, P=0.119, 0.890, 0.481). The sensitivity of screening nonproliferative DR in non-mydriatic fundus photography was 95.51%, specificity was 95.94%, and accuracy was 95.89%, which were basically the same as 92.70%, 96.96%, and 96.50% of 7-direction fundus photography after mydriasis.There was no significant difference ( χ2=1.265, 2.222, 0.008, P=0.261, 0.136, 0.930). The examination time of non-mydriatic fundus photography was lower than that of 7-direction fundus photography after mydriasis.The difference was statistically significant ( t=8.668, P=0.000). Conclusion:Compared with 7-direction fundus photography after mydriasis, non-mydriatic fundus photography can effectively screen for DR, and has the advantages of simple operation, non-invasiveness, etc.