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Abstract：
Background: Pregnant patients with pre-existing diabetes mellitus (DM) are at increased risk for development or progression of existing diabetic retinopathy (DR). A quality improvement project was initiated to improve DR screening during pregnancy at a safety net hospital. This article highlights the utility and generalizability of our telemedicine-based screening model. Materials and Methods: In April 2018, we implemented a photographic retinal screening system in the Maternal Fetal Medicine (MFM) clinic at Santa Clara Valley Medical Center in San Jose, CA. The system is intended to screen all pregnant patients with pre-existing diabetes (type 1 and 2). Retinal images are automatically uploaded to a secure server and interpreted by a retina specialist (C.K.P.). Results: A total of 71 pregnant patients with pre-existing DM were seen in the MFM clinic during the study period. Sixty-six of 71 patients (93.0%) were screened compared with 69.1% in the year prior. Of the 64 patients screened with readable images 11 (17.2%) had DR, whereas 53 did not. Forty-nine of the 64 (74.2%) patients screened underwent screening using the new nonmydriatic system in the MFM clinic. Only 7 out of 47 (14.9%) patients with readable images in the MFM clinic required referral to the ophthalmology clinic. Conclusion: Our model for DR screening in pregnant patients in safety net hospitals is effective in improving screening rates and expediting evaluation and treatment for those in need. This system can prevent irreversible vision loss in pregnant patients and provides an effective framework for ophthalmic care in a safety net hospital system.
摘要：
背景：先前患有糖尿病（DM）的孕妇患糖尿病视网膜病变（DR）的风险增加。在安全网医院启动了一项质量改进项目，以改善怀孕期间的DR筛查。本文重点介绍了我们基于远程医疗的筛查模型的实用性和通用性。材料和方法：2018年4月，我们在圣何塞圣克拉拉谷医疗中心的母胎医学（MFM）诊所实施了摄影视网膜筛查系统，CA.该系统旨在筛查所有患有预先存在的糖尿病（1型和2型）的怀孕患者。视网膜图像自动上传到安全服务器，并由视网膜专家（C.K.P.）解释。结果：在研究期间，在MFM诊所中发现了71例先前存在DM的孕妇。71例患者中有66例（93.0％）进行了筛查，而前一年为69.1％。在64例用可读图像筛查的患者中，有11例（17.2％）患有DR，而53则没有。在MFM诊所中，筛查的64名患者中有49名（74.2％）接受了使用新的无散瞳系统的筛查。在MFM诊所中，只有47名（14.9％）具有可读图像的患者需要转诊到眼科诊所。结论：我们在安全网医院中对孕妇进行DR筛查的模式可有效提高筛查率，并加快有需要的人的评估和治疗。该系统可以防止怀孕患者的不可逆视力丧失，并为安全网医院系统中的眼科护理提供了有效的框架。
