摘要目的 探讨免散瞳超广角眼底照相仪筛查人类免疫缺陷病毒(HIV)感染者或获得性免疫缺陷综合征(AIDS)患者眼底疾病效果与传统散瞳后前置镜眼底检查的一致性.方法 横断面研究.选取2018年10至12月就诊于首都医科大学附属北京佑安医院眼科的HIV感染或AIDS患者80例(158只眼),年龄(36.34±10.75)岁;其中男性77例(96.3％),女性3例(3.7％).应用非接触式超广角眼底照相,进行免散瞳眼底图像采集,而后由另一位眼科医师进行散瞳后裂隙灯显微镜下前置镜眼底检查,分别记录每种检査方法下受检眼是否存在眼底改变,病变类型及位置.检査结果不一致时由眼底病专家结合多种检查进行评判.两种检查结果进行Kappa一致性检验及配对四格表卡方检验.结果 80例(158只眼)患者中有52例(65.0％)有眼底改变,28例(35.0％)双眼均正常;79只眼(50.0％)眼底正常,79只眼(50.0％)患病.有眼底改变的79只眼中,61只眼(77.2％)为HIV相关的眼底病变,18只眼(22.8％)为非HIV相关的眼底改变;79只患眼中52只眼(65.8％)表现为后极部或以后极部为主的病变,27只眼(34.2％)表现为单纯周边视网膜病变.超广角眼底照相和前置镜眼底检查对HIV相关性视网膜微血管病变的检出率分别是17.7％(28/158)和18.4％(29/158)(χ2=47.909,P=1.000);对巨细胞病毒性视网膜炎的检出率均为8.2％(13/158)(χ2=158.00,P=1.000);对HIV相关性眼底病变检出率均为36.1％(57/158)(χ2=71.066,P=1.000);对眼底病灶检出率分别为41.8％(66/158)和47.5％(75/158)(χ2=63.514,P=0.136);对后极或后极部为主的病变检出率分别为33.5％(53/158)和31.0％(49/158)(χ2=108.268,P=0.388);对单纯周边部病变的检出率分别为6.4％(10/158)和16.5％(26/158)(χ2=42.001,P=0.000).两种检査方法对眼底病灶、HIV相关性眼底病变、HIV相关性视网膜微血管病变和单纯周边部病变检出结果一致性属中等水平(Kappa值分别为0.630、0.671、0.551和0.450);对后极或后极部为主的病变的检出结果一致性好(Kappa值=0.826);对巨细胞病毒性视网膜炎的检出结果完全一致(Kappa值=1.0).结论 免散瞳超广角眼底照相对HIV感染者或AIDS患者巨细胞病毒性视网膜炎或其他后极部病变筛查效果与传统散瞳前置镜眼底检查结果有较好的一致性.

abstractsObjective To screen the retinopathy in HIV/AIDS patients with both non-mydriatic ultra-wide-field (UWF) retinal imaging and mydriatic fundus examinations with the Superfield lens and a slit lamp biomicroscope, and to evaluate the consistency of two methods and provide reference for future clinical screening work and even technological innovation (such as telemedicine screening and artificial intelligence). Methods Cross sectional study. One hundred and fifty-eight eyes of 80 HIV-positive patients from the Ophthalmology Department of Beijing Youan Hospital were enrolled in this prospective observational study. All patients underwent comprehensive ophthalmological examination. A single image was obtained from each eye using the UWF fundus imaging system (Daytona, Optos, Dunfermline, UK), and then a dilated fundal examination with the Superfield lens was conducted by another expert. The possible type and location of the lesion with these two methods was recorded respectively. The consistency was compared using the detection rate and Kappa value. Results Fifty-two patients (65％) had fundus changes, and 28 patients (35％) were normal. Seventy-nine eyes (50％) were normal and 79 eyes (50％) had fundus lesions. Sixty-one eyes (77.2％) had HIV-related fundus lesions, while 18 eyes (22.8％) had non-HIV-related fundus lesions. Fifty-two eyes (65.8％) suffered posterior or posterior involving lesions, and 27 eyes (34.2％) suffered isolated peripheral lesions. The detection rate of UWF retinal imaging and slit lamp biomicroscopy with the Superfield lens was 17.7％ (28/158) and 18.4％ (29/158) (P=1.000>0.05) for HIV-related microvascular retinopathy, 8.2％ and 8.2％ (13/158) (χ2=158.00, P=1.000) for cytomegalovirus retinitis (CMVR), 36.1％and 36.1％(57/158) (χ2=71.066, P=1.000) for HIV-related fundus lesions, 41.8％(66/158) and 47.5％ (75/158) (χ2=63.514, P=0.136) for fundus lesions, 33.5％ (53/158) and 31.0％ (49/158) (χ2=108.268, P=0.388) for posterior/posterior involving lesions, and 6.4％ (10/158) and 16.5％ (26/158) (χ2=42.001, P=0.000) for isolated peripheral lesions, respectively. In general, the consistency of these two methods was moderate in detecting fundus lesions (Kappa=0.630), HIV-related fundus lesions (Kappa=0.671), HIV-related microvascular retinopathy (Kappa=0.551), and isolated peripheral lesions (Kappa=0.450). According to the fundus location, the two methods showed high consistency in the detection of posterior/posterior involving lesions (Kappa=0.826>0.75) and perfect consistency for CMVR (Kappa=1.0). Conclusions The UWF retinal imaging system and the Superfield lens showed reasonable consistency in fundus screening in HIV/AIDS patients, especially for CMVR, or lesions in the posterior pole.