早产儿视网膜病经间接检眼镜激光治疗后视网膜脱离分析

目的分析严重早产儿视网膜病(ROP)经间接检眼镜激光治疗后出现视网膜脱离的特点。方法回顾性收集2006年1月至2008年2月经间接检眼镜激光治疗后出现视网膜脱离的ROP患儿,统计其性别、孕周、出生体重、ROP诊断、激光治疗参数、眼底随访情况、RetCam图片等临床资料,分析激光治疗后视网膜脱离的发生时间、部位和范围等特点。结果7例患儿(共12只眼)经间接检眼镜激光治疗后出现视网膜脱离,其平均孕周为29.9周(28～35周),平均出生体重1366g(1140～1810g)。激光治疗前诊断为阈值病变8只眼(占66.7%),阈值前病变1型4只眼(33.3%)。所有患眼激光治疗后平均5.8周出现视网膜脱离,其中11只眼(91.7%)在治疗后2～7周出现视网膜脱离,仅1只眼(8.3%)于激光治疗后24周出现4B期。所有患眼中,9只眼(75.0%)表现为颞侧、局限性的牵引性视网膜脱离,脱离范围<4个钟点,1只眼(8.3%)表现为鼻侧、局限性视网膜脱离,脱离范围4个钟点,另2只眼(16.7%)为累及各象限的完全性视网膜脱离。所有患儿激光治疗后平均随访27.2周。结论严重早产儿视网膜病经间接检眼镜激光治疗后7周内出现视网膜脱离的可能性比较大,主要表现为颞侧玻璃体增殖、牵引而导致的局限性视网膜脱离。

Characteristics of retinal detachment after indirect ophthalmoscopic photocoagulation of retinopathy of prematurity

Objectives To analyze the characteristics of retinal detachment(RD)after indirect ophthalmo-scopic photocoagulation for severe retinopathy of prematurity(ROP). Methods A retrospective analysis was made for ROP patients with RD after indirect ophthalmoscopic photocoagulation from January 2006 to February 2008. Their clinical data including sex,gestational age(GA),birth weight(BW),diagnosis,laser parameters,ROP evolution and RetCam fundus photos were collected. Characteristics of RD including time of onset,location and range of retinal detachment were analyzed. Results Twelve eyes(7 ROP patients)developed into RD after laser treatment. The mean GA and mean BW of the patients were 29.9 weeks(28 - 35 weeks)and 1 366 g(1 140 g - 1 810 g),respectively. The diagnoses before treatment were threshold disease(8 eyes,66.7%) and type 1 prethreshold ROP(4 eyes, 33.3%). The mean duration between photocoagulation and RD was 5.8 weeks. Eleven eyes(91.7%)developed RD in 2 - 7 weeks after laser treatment. Only one eye(8.3%)progressed to stage 4B ROP at 24 weeks after treatment. Among the 12 eyes,9(75%)showed partial temporal traction RD with a range less than 4 points,1(8.3%)with nasal traction RD ranging 4 points,2 with total RD. All patients were followed up for 27.2 weeks after photocoagulation. Conclusions This study revealed that in severe ROP most RD occurred in about 7 weeks after indirect ophthalmoscopic photocoagution. Partial retinal detachment caused by temporal traction RD was the most common type.