Clinical versus fundus photographic evaluation of the status of cytomegalovirus retinitis in AIDS patients.
Clinical versus fundus photographic evaluation of the status of cytomegalovirus retinitis in AIDS patients.
复制标题
艾滋病患者巨细胞病毒视网膜炎状态的临床与眼底照相评估。
DOI：
10.1097/00006982-199616050-00001
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Freeman,WR
中科院分区：
文献类型：
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作者：
Flores-Aguilar,M;Munguia,D;Besen,G;Gangan,P;Arevalo,JF;Freeman,WR
用途：为了评估的准确性，临床检查和系列眼底照相读数在确定巨细胞病毒视网膜炎的抗病毒治疗的患者与获得性免疫缺陷综合征。方法：52例连续巨细胞病毒视网膜炎的前瞻性评价超过30个月的时间，至少6个月（或直至死亡）被纳入本研究。共有708名患者就诊。临床评价包括间接检眼镜检查、眼底绘图、60度眼底照片以及与上次访视照片的比较。以盲法重新评价眼底照片。巨细胞病毒性视网膜炎分为活动性（自上次检查以来边界的进展），中间（边界活动无进展），愈合（自上次访视以来无活动），或正常（无视网膜炎）。临床与影像学评估的敏感性和特异性随视网膜炎状态而变化。在治愈的视网膜炎中，临床检查的敏感性为98%，特异性为83%。在边界混浊无进展的情况下，敏感性为80%，特异性为96%。在临床活动性视网膜炎的情况下，敏感性为63%，特异性为100%。活动性视网膜炎和边界混浊无进展的临床检测减少时，潜在的问题，使可视化的视网膜炎边界困难，如阴燃性视网膜炎，进行性视网膜破坏无边界混浊，媒体差，或fundus pigmentation.Conclusions：进行性视网膜破坏和视力丧失的患者巨细胞病毒视网膜炎，尽管抗病毒治疗。仅通过间接检眼镜检查患者可能导致无法检测到细微变化。
Purpose: To evaluate the accuracy of clinical examinations and serial fundus photographic readings in determining the response of cytomegalovirus retinitis to antiviral therapy in patients with acquired immune deficiency syndrome.Methods: Fifty two consecutive patients with cytomegalovirus retinitis who were prospectively evaluated over a 30-month period for a minimum of 6 months (or until death) were included in this study. There was a total of 708 patient visits. The clinical evaluations included indirect ophthalmoscopy, fundus drawings, 60 [degrees] fundus photographs, and a comparison of the photographs with those of the previous visit. The fundus photographs were reevaluated in a blinded fashion. Cytomegalovirus retinitis was classified as active (progression of border since last examination), intermediate (border activity without progression), healed (no activity since last visit), or normal (no retinitis).Results: Using the photographic data as the measure of cytomegalovirus retinitis activity, the sensitivity and specificity of clinical assessments were determined. The sensitivity and specificity of clinical versus photographic evaluations varied with retinitis status. In healed retinitis the sensitivity of the clinical examination was 98%, and the specificity was 83%. In cases of border opacification without progression the sensitivity was 80%, and the specificity was 96%. In cases of clinically active retinitis the sensitivity was 63% with a specificity of 100%. Clinical detection of active retinitis and border opacification without progression was reduced when potential problems were present that made visualization of the retinitis border difficult, such as smoldering retinitis, progressive retinal destruction without border opacification, poor media, or fundus pigmentation.Conclusions: Progressive retinal destruction and visual loss can occur in patients with cytomegalovirus retinitis despite antiviral therapy. Examining the patient through indirect ophthalmoscopy only can result in failure to detect subtle changes.