角膜缘分光照明法在角膜病诊断中的应用
The application of corneal limbus scatter illumination for the diagnosis of keratonosus
杨洁 1刘培培 1朱艳辉 1杜敏 1赵宏1
作者信息
- 1. 郑州市第二人民医院眼科,郑州 450006
- 折叠
摘要
目的 探讨角膜缘分光照明法在角膜病诊断中的应用.方法 回顾性病例系列研究.纳入郑州市第二人民医院2021年10月至2024年4月就诊的角膜病71例(85眼),采用临床常用的弥散光照明法、直接焦点照明法(宽裂隙光)和角膜缘分光照明法拍摄患眼角膜浑浊病灶.根据病灶大小,直接焦点照明法(宽裂隙光)拍摄一张或多张完全显示病灶,记录拍摄张数.分析病变类别,观察三种方法拍摄病变图片,分析显示病灶效果及特点.应用裂隙灯显微镜图像分析系统Measurement功能测量三种方法拍摄所显示病灶的宽度和面积与实际病灶的宽度和面积.应用直接焦点照明法(宽裂隙光)选取病灶宽度和面积最大的值,对测量结果进行统计学分析.结果 本研究包括角膜上皮病变21例(27眼),角膜基质层浑浊44例(52眼),角膜后沉着物(KP)6例(6眼).三种拍摄显示病灶的宽度和面积占实际病灶宽度和面积95.0％以上的患眼比例分别为:角膜缘分光照明法为98.8％(84/85)和97.6％(83/85);直接焦点照明法(宽裂隙光)为4.7％(4/85)和5.9％(5/85);弥散光照明法为14.1％(12/85)和8.2％(7/85)前者4眼病灶宽度均小于5 mm,后者7眼病变均为较致密病灶.Bland-Altman图法一致性分析显示三种照明方法显示病灶面积与实际面积的差值均值分别为:分光照明法0,宽裂隙光-17.9 mm2,弥散光照明法-18.6 mm2,且随着面积均值的增大,后两种的面积差值呈负性增大趋势.Pearson相关性分析显示直接焦点照明法(宽裂隙光)拍摄所使用张数与实际病灶的宽度呈正相关(r=0.76,P＜0.001),与实际病灶面积呈正相关(r=0.45,P＜0.001).三种照明方法显示病灶的宽度和面积与实际病灶的宽度和面积配对样本t检验,分光照明法显示病灶宽度(t=-1.55,P=0.126)和面积(t=0.03,P=0.979)与实际病灶宽度和面积差异均无统计学意义;直接焦点照明法(宽裂隙光)显示病灶宽度(t=-15.27,P＜0.001)和面积(t=-9.42,P＜0.001)与实际病灶宽度和面积差异均有统计学意义;弥散光照明法显示病灶宽度(t=-10.52,P＜0.001)和面积(t=-8.56,P＜0.001)与实际病灶宽度和面积差异均有统计学意义.结论 裂隙灯显微镜角膜缘分光照明法可观察各层角膜病病变,尤其对面积较大、细小、散在分布、不致密的病灶有独特优势,是观察角膜病变的一种有效而快捷的临床技术.
Abstract
Objective To investigate the application of the corneal limbus scatter illumination in the diagnosis of corneal diseases.Methods This was a retrospective case series study.Seventy-one patients(85 eyes)with corneal diseases in Zhengzhou Second People's Hospital from Oct.2021 to Apr.2024 were selected.All affected eyes were performed by diffusion light illumination,direct focal illumination(wide slit light)and corneal limbus scatter illumination.Direct focus illumination(wide slit light)was used to take one or more pictures depending on the size of the opacities,and the number of pictures was recorded.The categories of opacities were analyzed,and images taken by the three methods were observed to analyze the effects and characteristics of the opacities.The Measurement function of the slit-lamp microscope image analysis system was used to measure the width and area of the opacities displayed by the three methods and the actual width and area of the opacities.The maximum value of the width and area of the opacities displayed by the direct focus illumination method(wide slit light)was selected,and all the results were statistically analyzed.Results Among the 71 patients(85 eyes),there were 21 cases(27 eyes)of corneal epithelial opacities,44 cases(52 eyes)of corneal stromal opacity,and 6 cases(6 eyes)of keratic precipitates(KP).The proportion of eyes in which the width and area of the opacities accounted for more than 95.0％of the actual width and area of the opacities by the three methods respectively were 98.8％(84/85)and 97.6％(83/85)of eyes with corneal limbus scatter illumination,4.7％(4/85,the width of the 4 eyes was less than 5 mm)and 5.9％(5/85)of eyes with direct focal illumination wide slit-light,and 14.1％(12/85)and 8.2％(7/85,all opacities in the 7 eyes were dense)in diffusion light illumination.The consistency analysis of Bland-Altman plots showed that the mean difference between the area of the opacities showed by the three illumination methods and the actual area was 0 mm2 for the corneal limbus scatter illumination,-17.9 mm2 for direct focus illumination(wide slit light),and-18.6 mm2 for diffusion light illumination.With the increase of the mean area value,the difference of area value of the latter two methods showed a negative increasing trend.The Pearson correlation analysis showed that the actual width(r=0.76,P＜0.001)and the actual area(r=0.45,P＜0.001)of the opacities were positively correlated with the number of pictures taken by direct focus illumination wide slit light.The Pearson correlation analysis showed that the actual width(r=0.76,P＜0.001)and the actual opacities area(r=0.45,P＜0.001)of the opacities were positively correlated with the number of pictures taken by direct focus illumination wide slit light.There was no significant difference in the width(t=-1.55,P=0.126)and area(t=0.03,P=0.979)of the opacities displayed by corneal limbus scatter illumination and the actual width and area of the opacities.The width(t=-15.27,P＜0.001)and area(t=-9.42,P＜0.001)of the opacities displayed by direct focal illumination(wide slit light)were significantly different from the actual width and area of the opacities.The width(t=-10.52,P＜0.001)and area(t=-8.56,P＜0.001)of the opacities displayed by diffusion light illumination were significantly different from the actual width and area of the opacities.Conclusion The corneal limbus scatter illumination with slit lamp microscope can be used to observe the corneal opacities of different layers,especially for the opacities with large area,low density,small and scattered distribution.It is an effective and fast clinical technique.
关键词
照明法,分光,角膜缘/裂隙灯显微镜/照明法,焦点,直接/病,角膜Key words
Illumination,scatter,sclerotic/Slit-lamp microscope/Illumination,focal,direct/Keratonosus引用本文复制引用
出版年
2024
NETL
NSTL
万方数据