Objective: To investigate whether the wide field imaging system (WFIS), 25G optical fiber and intraoperative optical coherence tomography (iOCT) can perform real-time screening and diagnosing in patients with highly suspected fundus diseasesintraoperatively. Methods: A cross-sectional study was carried out. One hundred and eighty-three densely cataractous eyes of 183 patients with suspected fundus diseases were included in the Affiliated Hospital of Nantong University from July 2019 to June 2020. Lens phacoemulsification combined with intraocular lens implantation was performed in these eyes. Following the opaque lens was removed, the patients were divided into 4 groups according to fundus examination methods: WFIS SW-8000 group (49 eyes), 25G optical fiber group (40 eyes), iOCT group (36 eyes), and combination group of three examination methods (58 eyes). Optical coherence tomography and/or fundus fluorescence angiography were used to detect the fundus after surgery. The intraoperative and postoperative examination results were compared to verify the accuracy of intraoperative diagnosis in each group. Chi-square test was used for statistical analysis. Results: There were 79 males and 104 females in all patients, and the mean age was (69±10) years. Intraoperative examinations showed 82 eyes with fundus disease (positive rate was 44.81%), while postoperative examinations revealed 93 eyes with fundus disease (positive rate was 50.82%). In the WFIS SW-8000 group, fundus disease was found in 19 eyes intraoperatively and 26 eyes postoperatively (sensitive rate was 73.08%). In the 25G optical fiber group, fundus disease was found in 18 eyes intraoperatively and 20 eyes postoperatively (sensitive rate was 90.00%). In the iOCT group, fundus disease was observed in 20 eyes administratively and 22 eyes postoperatively (sensitive rate was 90.91%). In the combination group, fundus disease was observed in 25 eyes intraoperatively, which was consistent with the results of postoperative examinations (sensitive rate was 100.00%). There were statistically significant differences in the diagnostic sensitivity of fundus diseases among different methods (χ²=9.26; P<0.05). The diagnostic sensitivity of fundus diseases of the WFIS SW-8000 group was lower than that of the the combination group, the difference was statistically significant (χ²=7.80, P<0.01), and there was no significant difference between the other two groups (all P>0.05). Forty-nine eyes with fundus neovascular disease or severe macular edema requiring drug intervention were identified intraoperatively, and intravitreal anti-inflammatory and/or anti-vascular endothelial growth factor drugs were injected in 41 eyes. Conclusions: The WFIS, 25G optical fiber and iOCT can be used to examine the fundus and detect fundus disease intraoperatively, facilitating timely diagnosis and treatment of retinopathy in patients with dense cataract. The combined application of the three methods has the highest sensitivity. (Chin J Ophthalmol, 2021, 57: 850-856).
目的： 探讨和比较广域数字化视网膜成像系统（视网膜照相）、25G导光纤维及非手术显微镜内置的直立式术中相干光层析成像术（iOCT）在白内障摘除手术中对术前无法窥清眼底病变患者进行实时眼底检查和诊断的可行性。 方法： 横断面研究。收集2019年7月至2020年6月在南通大学附属医院行超声乳化白内障吸除联合人工晶状体（IOL）植入术的183例（183只眼）白内障患者资料，所有术眼均为术前相关病史疑有眼底病变但无法窥入眼底。根据术中眼底检查方法分为4组：（1）视网膜照相组（49只眼）；（2）导光纤维组（40只眼）；（3）iOCT组（36只眼）；（4）3种方法联合组（58只眼）。术后行相干光层析成像术（OCT）和（或）荧光素眼底血管造影术（FFA）等检查眼底，将术后与术中检查结果进行比较，以验证各组术中诊断的准确性。统计学方法主要采用χ²检验。 结果： 所有患者中男性79例，女性104例；年龄（69±10）岁。术中检查共发现有眼底病变者82只眼（阳性率为44.81%），术后检查共发现有眼底病变者93只眼（阳性率为50.82%）。视网膜照相组术中、术后检查发现有眼底病变者分别为19、26只眼，以术后检查结果为标准，术中检查灵敏度为73.08%（19/26）；导光纤维组术中、术后检查发现有眼底病变者分别为18、20只眼，术中检查灵敏度为90.00%；iOCT组术中、术后发现有眼底病变者分别为20、22只眼，术中检查灵敏度为90.91%；3种方法联合组术中、术后检查结果一致，发现有眼底病变者均为25只眼，术中检查灵敏度为100.00%；4个组间术中检查灵敏度差异有统计学意义（χ²=9.26，P<0.05），视网膜照相组低于3种方法联合组，差异有统计学意义（χ²=7.80，P<0.01），其余两组间差异均无统计学意义（均P>0.05）。术中检查发现眼底新生血管性疾病或黄斑严重水肿需要药物干预者共49只眼，经患者知情同意对其中41只眼术中行玻璃体腔注射抗血管内皮生长因子等药物治疗。 结论： 白内障摘除手术中用广域视网膜照相、25G导光纤维及iOCT方法进行实时眼底病变检查和诊断具有可行性，有助于术前无法窥清眼底的白内障合并眼底病患者的及时诊断和治疗，3种方法联合应用灵敏度相对最高。（中华眼科杂志，2021，57：850-856）.