UTILITY OF ULTRA-WIDEFIELD RETINAL IMAGING FOR THE STAGING AND MANAGEMENT OF SICKLE CELL RETINOPATHY
UTILITY OF ULTRA-WIDEFIELD RETINAL IMAGING FOR THE STAGING AND MANAGEMENT OF SICKLE CELL RETINOPATHY
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DOI：
10.1097/iae.0000000000002057
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发表时间：
2019-05-01
影响因子：
3.3
通讯作者：
Scott, Adrienne W.
中科院分区：
文献类型：
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作者：
Han, Ian C.;Zhang, Alice Y.;Scott, Adrienne W.
目的：确定与临床检查相比，超广角（UWF）视网膜成像是否会改变镰状细胞视网膜病变的分期或治疗。
方法：前瞻性观察研究，包括镰状细胞病患者。所有患者均由一名接受过专科培训的视网膜专家进行散瞳眼底检查，以及超广角眼底照相（FF）和荧光素血管造影（FA）。分别在临床检查、超广角 - 眼底照相和超广角 - 荧光素血管造影之后确定每只眼睛的镰状视网膜病变分期和治疗建议，并比较视网膜病变分期和治疗建议的差异。
结果：共纳入35名患者的70只眼睛（17名女性，占48.6%），平均年龄30.4岁。镰状基因型包括26名镰状细胞SS型患者（74.3%）、7名SC型（20.0%）和2名β（+）地中海贫血患者（5.7%）。根据检查，大多数眼睛（42/70；60.0%）无可见的视网膜病变。根据超广角 - 眼底照相，约一半的眼睛处于戈尔茨坦2期或以上（36/70；51.4%）。根据超广角 - 荧光素血管造影，几乎所有眼睛都处于戈尔茨坦2期或以上（63/70；90%）。然而，临床检查能够可靠地检测到新生血管形成，并且在任何情况下，超广角成像的加入相对于单独的检查都没有改变治疗。
结论：与单独的临床检查相比，超广角成像可检测到更高分期的镰状细胞视网膜病变，但这些差异可能在临床上并不显著。
Purpose: To determine whether ultra-widefield (UWF) retinal imaging changes the staging or management of sickle cell retinopathy compared with clinical examination.Methods: Prospective, observational study including patients with sickle cell disease. All patients underwent dilated fundus examination by a fellowship-trained retina specialist, as well as UWF fundus photography (FF) and fluorescein angiography (FA). Sickle retinopathy stage and treatment recommendation per eye were determined after clinical examination, UWF-FF, and UWF-FA, respectively, and differences in retinopathy stage and treatment recommendation were compared.Results: A total of 70 eyes from 35 patients (17 women, 48.6%), mean age 30.4 years, were included. Sickle genotypes included 26 patients with sickle SS (74.3%), 7 SC (20.0%), and 2 beta(+) thalassemia (5.7%). Based on examination, most eyes (42/70; 60.0%) had no visible retinopathy. Based on UWF-FF, about half of the eyes were found to be Goldberg Stage 2 or above (36/70; 51.4%). Based on UWF-FA, nearly all eyes were Goldberg Stage 2 or above (63/70; 90%). However, clinical examination reliably detected neovascularization, and in no case did the addition of UWF imaging change management relative to examination alone.Conclusion: Ultra-widefield imaging detects a higher stage of sickle cell retinopathy compared with clinical examination alone, but these differences may not be clinically significant.