早产儿视网膜病变注射雷珠单抗后荧光素眼底血管造影表现

目的　了解早产儿视网膜病变（ｒｅｔｉｎｏｐａｔｈｙｏｆｐｒｅｍａｔｕｒｉｔｙ，ＲＯＰ）注射雷珠单抗后的荧光素眼底血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓ-ｃｅｉｎａｎｇｉｏｇｒａｐｈｙ，ＦＦＡ）表现。方法　选取２０１４年３月至１１月在深圳市眼科医院确诊为ＲＯＰ的１５例（３０眼）患者纳入研究，其中急进性后部型ＲＯＰ（ａｇｇｒｅｓｓｉｖｅｐｏｓｔｅｒｉｏｒｒｅｔｉｎｏｐａｔｈｙｏｆｐｒｅｍａｔｕｒｉｔｙ，ＡＰ-ＲＯＰ）８眼，阈值期ＲＯＰ１３眼，阈值前期Ⅰ型ＲＯＰ９眼。在表面麻醉下，经颞下方睫状体平坦部进针，向玻璃体内注射雷珠单抗０．０３ｍＬ。在注药术后１～２个月，气管插管全身麻醉下行ＦＦＡ检查，观察附加病变消退情况及视网膜周边血管发育情况。结果　注射雷珠单抗后，所有眼底附加病变消退，但周边视网膜均存在不同程度的无血管区。８眼ＡＰ-ＲＯＰ中６眼Ⅲ区无血管形成，继续随访观察；２眼Ⅱ区大范围无血管形成，血管末梢分支增多呈毛刷样，无荧光素渗漏，１周后再次注射雷珠单抗。１３眼阈值期ＲＯＰ中，１眼可见颞下方牵拉性视网膜脱离，行局部激光光凝；１２眼嵴完全消退，其中２眼视网膜血管基本发育完全；４眼Ⅲ区无血管形成，４眼Ⅲ区及Ⅱ区鼻侧２个钟点无血管形成，均无荧光素渗漏，继续随访观察；２眼Ⅱ区累计４个钟点无血管区伴末梢血管扩张及新生血管荧光素渗漏，行激光光凝。９眼阈值前期Ⅰ型ＲＯＰ中７眼嵴全部消退，２眼嵴变低平；４眼Ⅲ区及Ⅱ区鼻侧２个钟点范围无血管形成，５眼Ⅲ区无血管形成，均见末梢血管扩张，但无荧光素渗漏，继续随访观察。结论　注射雷珠单抗可促使ＲＯＰ病变消退，且不干扰周边视网膜血管化。

Fundus fluorescein angiography in retinopathy of prematurity after intravitreal injection of ranibizumab

Objective To analyze the fundus changes of retinopathy of prematurity ( ROP) after intravitreal injection of ranibizumab by fundus fluorescein angiography ( FFA). Methods Fifteen cases ( 30 eyes) diagnosed as ROP by binocular indirect ophthalmoscope and RetCam m were collected from March to November 2014 in our hospital. Among them, there were 8 eyes of aggressive posterior ROP ( AP-ROP) . 13 eyes of threshold ROP,9 eyes of type I pre-threshold ROP. Under surface anesthesia, a dose of 0. 03 mL ranibizumab was injected into the vitreous cavity through pars plana of the inferior temporal quadrant. One or two months later , all infants received FFA with RetCam JII under tracheal intubation general anesthesia. Regression of the plus disease and vascular development of the peripheral retina were observed and analyzed. Results Plus disease disappeared after the injection of ranibizumab .but there were avascular areas in the peripheral retina to varying degrees. Among the 8 eyes of AP-ROP. non-perfusion rn zone III was found in 6 eyes. Large avascular area in zone II was detected in the other 2 eyes,in which the branches of the peripheral retinal blood vessels increased like a brush with no fluorescein leakage. This patient received a second injection of ranibizumab after I week. Among the 13 eyes of threshold ROP,tractional retinal detachment in the inferior temporal quadrant was seen in I eye of them and was treated by laser photocoagulation, while complete disappearance of the ridge was seen in the other 12 eyes. Among the 12 eyes, retinal blood vessels were almost developed in 2 eyes;Non-perfusion in zone III was observed in 4 eyes,non-perfusion in the whole peripheral area with no fluorescein leakage was found in 4 eyes ; the range of avascular area in zone II accumulated 4 clock points in 2 eyes with dilation of the peripheral blood vessels and fluorescein leakage , in which laser photocoagulation was performed. Among the 9 eyes of type I pre-threshold ROP , the ridge disappeared in 7 eyes and became flat in the other 2 eyes. Non-perfusion in the whole peripheral area and in the zone m was found in 4 eyes and 5 eyes,respectively. Expansion of the peripheral retinal vessels with no fluorescein leakage marufested in all of them. Conclusion Intravitreal injection of ranibizumab enables the regression of ROP without making interference with the peripheral retinal vascularization.