半导体与倍频Nd:YAG间接检眼镜激光治疗高危阈前期ROP的比较

目的 比较倍频Nd:YAG间接检眼镜激光(波长532 nm)、半导体间接检眼镜激光(波长810 nm)治疗高危阈前期早产儿视网膜病变(ROP)的效果.方法 回顾分析分别用半导体间接检眼镜激光、倍频Nd:YAG间接检眼镜激光治疗的20例40眼高危阈前期ROP的临床资料.患儿激光时的年龄(8.25±3.54)周,胎龄(30.25±1.65)周,出生体重(1 488.15±326.13)g,治疗时矫正胎龄(39.15±3.69)周.结果 19例(38眼)ROP回退,1例(2眼)病变进展为4期,其余病变均得到控制,无并发症出现.两种激光能量基本相同,激光点数的比较无统计学意义(t=0.735,P=0.471).结论 倍频Nd:YAG间接检眼镜激光和半导体间接检眼镜激光治疗高危阈前期早产儿视网膜病变同样有效.     

早产儿视网膜病变间接检眼镜激光治疗及危险因素分析

目的评价早产儿视网膜病变(retinopathy of prematurity,ROP)间接检眼镜激光光凝治疗的临床疗效,并分析影响预后的相关因素。方法回顾分析间接检眼镜光凝治疗的ROP患儿103例(197眼)临床资料,随访37～856d,观察治疗后视网膜血管区与无血管区病变消退或进展情况,记录视网膜血管扩张、迂曲、消退情况及角膜、虹膜、瞳孔、晶状体情况。结果 179眼ROP病变消退,治愈率90.86%。病变消退组的出生胎龄、出生体质量、治疗时矫正胎龄分别为(29.40±2.08)周、(1293.52±311.99)g、(37.12±3.03)周,病变进展组分别为(29.17±1.85)周、(11291.36±290.57)g、(36.67±2.42)周,差异均无统计学意义(均为P>0.05)。Ⅰ区病变74眼,病变消退60眼(81.08%),病变进展14眼(18.92%);Ⅱ区病变123眼,病变消退119眼(96.75%),病变进展4眼(3.25%),Ⅰ区病变进展率明显高于Ⅱ区,差异有显著统计学意义(χ2=11.838,P=0.001)。阈值前病变1型94眼,其中90眼(95.74%)病变消退,4眼(4.26%)病变进展;阈值期病变103眼,其中89眼(86.41%)病变完全消退,14眼(13.59%)病变进展,阈值前病变Ⅰ型病变进展率明显高于阈值期病变,差异有统计学意义(χ2=4.97,P=0.043)。结论双目间接检眼镜激光治疗阈值前期1型和阈值期ROP病变是安全有效的,治疗效果与病变区域、病变程度有关。     

早产儿视网膜病变激光治疗的疗效分析

目的 比较激光治疗各区域早产儿视网膜病变（ROP）的临床效果.方法 回顾性分析波长810 nm的二极管激光治疗的42例（73眼）的临床资料.结果 42例患儿中Ⅰ区病变10例19眼（平均胎龄30周）,Ⅱ区病变32例54眼（平均胎龄30.33周）;治疗时矫正胎龄分别为（37.4±3.89）周和（39.41±6.44）周,Ⅰ区病变与Ⅱ区病变的出生体重、胎龄及治疗时矫正胎龄无统计学意义;Ⅰ区病变2例4眼（4/19,21.05%）进行二次激光,Ⅱ区病变3例5眼（5/54,9.26%）进行再激光;Ⅰ区病变中3例5眼（5/19,26.31%）进展为4期,而Ⅱ区病变的患儿病变全部得到控制;激光时年龄与胎龄负相关而与矫正胎龄正相关.结论 二极管激光治疗Ⅰ区病变和Ⅱ区病变是安全有效的;Ⅰ区病变激光治疗的预后较差.激光时年龄与胎龄及矫正胎龄有关.     

玻璃体内注射雷珠单抗治疗早产儿视网膜病变疗效观察

目的 观察玻璃体内注射雷珠单抗治疗早产儿视网膜病变(retinopathy of prematurity,ROP)的疗效及安全性.方法 将2014年6月至2015年8月在我院确诊并首次进行抗VEGF治疗的连续性Ⅰ、Ⅱ区ROP患儿49例95眼纳入研究.将患儿依据病变分区分为Ⅰ区组和Ⅱ区组,主要比较2组患儿出生体质量、孕周、治疗时矫正胎龄、治疗好转、复发及再治疗时间之间的差异.用30G 1 mL注射器抽取10 mg·mL-1的雷珠单抗0.025 mL(含雷珠单抗0.25 mg)于患儿角膜缘后1.5 mm穿刺注射.注射结束时妥布霉素地塞米松眼膏包眼.注药后3d运用手持裂隙灯及眼压计观察患眼有无眼压增高、眼内新鲜出血及眼内炎情况,治疗后1周间接检眼镜观察视网膜血管迂曲扩张及病变嵴消退情况.同时观察有无与治疗相关的其他全身不良反应.结果 本研究病例首次治疗后血管迂曲、扩张消失或程度减轻,新生血管及嵴消退93眼,占95.9％.其中,Ⅰ区组58眼,Ⅱ区组35眼.两组ROP好转率比较,差异无统计学意义(P＞0.05).随访期间复发22眼.其中,Ⅰ区组17眼,占Ⅰ区ROP消退患眼的29.3％;Ⅱ区组5眼,占Ⅱ区ROP消退患眼的14.3％.两组复发率比较,差异有统计学意义(P＜0.05).复发后再次行雷珠单抗或激光光凝治疗.复发至再次治疗时间为(6.50±2.54)周.Ⅰ区组和Ⅱ区组复发至再次治疗时间分别为(6.44±2.74)周、(6.67±2.31)周,两组差异无统计学意义(P＞0.05).末次随访时,可观察到继续血管化.随访期间和末次随访时,未见与治疗方式和药物相关的其他眼部并发症和全身不良反应发生.结论 雷珠单抗治疗Ⅰ、Ⅱ区ROP疗效较好,但ROP复发率较高.未见明确与药物有关的局部和全身并发症.     

早产儿视网膜病变的临床分析

目的 探讨早产儿视网膜病变(retinopathy of prematurity,ROP)发病的临床特点及相关的危险因素.方法 筛查出生体质量≤2500 g、胎龄≤37周的315例早产儿,分析其ROP的临床特点.结果 315例(630眼)患儿中发生ROP42例(84眼,13.33%);ROP患儿胎龄为(29.79 ±2.29)周,非ROP患儿胎龄为(32.81±1.88)周,二者差异具有显著统计学意义(P<0.001);ROP患儿出生体质量为(1 440.00±359.57)g,明显低于非ROP患儿(1 863.65±347.38)g(P<0.001);吸氧患儿ROP 36例(18.27%)明显高于未吸氧惠儿6例(5.08%;X2=11.110,P=0.001);需要机械辅助呼吸的早产儿发生ROP者(29.47%)比不需机械辅助呼吸患儿(6.36%)多(X2=30.665,P=0.000);多胎6例(9.68%)与单胎36例(14.23%)间发生ROP的差异无统计学意义(X2=0.893,P=0.345).结论 ROP发病与出生胎龄、出生体质量、吸氧时间、机械辅助呼吸等因素相关.早产儿应及时行规范的眼底检查,尽早发现ROP,及时治疗.     

早产儿视网膜病变筛查及危险因素的临床研究

目的了解我院早产儿视网膜病变(retinopathy of prematurity,ROP)的发病状况,并对其相关危险因素进行分析探讨。方法对2007年1月至2008年11月在我院出生的124例(248只眼)早产儿(出生体重≤2500g或胎龄≤35周)进行ROP的筛查。所有患儿瞳孔散大后,通过巩膜外顶压详细检查患儿视网膜情况。按照ROP国际分类法的规定记录检查结果。将患儿全身状况及吸氧、母孕期吸氧、先兆子痫、胎盘早剥等因素进行统计。结果 124例患儿全部完成了眼底筛查,在周边视网膜血管化或病变退化后终止随访。9例(13只眼)出现ROP,发生率分别占患儿例数和眼数的7.26%和5.24%。其中6例(8只眼)ROP患儿未达到阈值前病变,3例(5只眼)为阈值前Ⅰ型病变,此3例ROP患儿给予间接检眼镜视网膜激光光凝术。所有激光治疗患儿术后随访观察,直至膜病变静止、消退,均未出现视网膜脱离。母孕期吸氧、先兆子痫、胎盘早剥等因素与ROP发病无关。结论低体重是ROP发生的最重要因素。对早产儿适时进行ROP筛查,并对发现的ROP早期进行有效视网膜激光光凝术,可控制病变,降低早产儿的致盲率。     

计算机辅助间接检眼镜成像技术条件下的早产儿视网膜光凝手术模式

目的:观察使用计算机辅助双目间接检眼镜成像技术对早产儿视网膜病变(retinopathy of prematurity,ROP)进行表面麻醉下光凝手术的效果,探讨计算机辅助双目间接检眼镜成像技术条件下进行ROP光凝手术模式的应用价值。方法:回顾性研究,阈值前1期及阈值期ROP患儿58例116眼在术前、术中、术后分别使用计算机辅助的双目间接检眼镜成像技术对患儿视网膜进行检查,术前检查用于设计手术方案,术中检查用于检测病变区激光治疗的遗漏区,手术结束时用于记录手术效果。手术在实施心电监护后的表面麻醉下进行。随访3~12mo。结果:本组病例中术中使用计算机辅助双目间接检眼镜成像技术检查可及时发现36眼(31.0%)存在遗漏区,立即补充激光治疗。所有116眼一次激光治疗后ROP病变得到控制。随访结束时所有术眼均未出现视网膜不良结构。结论:表面麻醉条件下的早产儿视网膜光凝手术过程中,使用计算机辅助双目间接检眼镜成像技术进行眼底检查,可及时发现激光遗漏区,立即补充激光治疗后能够有效避免二次手术。     

早产儿视网膜病变玻璃体腔注射雷珠单抗治疗后病变复活的临床分析及疗效观察

目的观察早产儿视网膜病变(ROP)患眼玻璃体腔注射雷珠单抗(IVR)治疗后病变复活的临床特点及治疗效果。方法回顾性病例系列研究。2019年1月至2021年10月于深圳市眼科医院经IVR治疗后病变复活的ROP患儿11例21只眼纳入研究。其中, 男性6例11只眼, 女性5例10只眼;出生胎龄(27.6±2.2)周;出生体重(1 034.6±306.5)g。首次IVR治疗时, 急进型ROP(AROP)者14只眼(63.7%, 14/22);阈值病变者8只眼(36.3%, 8/22)。病变复活后治疗包括IVR、视网膜激光光凝(LP)或微创玻璃体切割手术(MIVS)。治疗后随访时间12～18个月。记录患儿出生胎龄、出生体重、治疗方式、治疗时矫正胎龄、治疗前后病变分期、病变复活及消退时间。观察和分析其临床特征和疗效。结果首次IVR治疗至出现病变复活的时间为(8.2±3.5)周;患儿矫正胎龄(43.62±4.08)周。21只眼中, 复活时病变分期为AROP、阈值病变、阈值前病变、4期病变分别为2、4、12、3只眼。行IVR、LP、IVR+LP、IVR+MIVS治疗分别为2、13、4、2只眼。首次复活...     

双目间接检眼镜联合RetCam Ⅱ进行ROP筛查的比较研究

目的:研究联合使用双目间接检眼镜与RetCam Ⅱ广域数字眼底照相系统的必要性,分析联合使用两种方法进行早产儿视网膜病变(retinopathy of prematurity,ROP)筛查的结果。方法:2009-10-01/2010-10-31通过使用计算机辅助的双目间接检眼镜成像系统和RetCam Ⅱ对我院眼科门诊、新生儿科病房和新生儿重症监护室的早产低出生体重儿进行定期的眼底检查,眼底定期复查至早产儿的鼻、颞侧周边视网膜完全血管化为止。对确诊患儿建立图像和数据档案,及时追踪其病变发展与转归,当病情进展至阈值前期和阈值期病变时进行手术治疗,术后定期复查至其病变已完全消退或静止无进展。最后对确诊患儿资料进行统计分析。结果:在筛查时间内,对1431例符合早产儿视网膜病变筛查条件的早产低出生体重儿(胎龄27～35周;出生体质量0.8～2.5kg)进行眼底检查和定期复查,确诊ROP患儿111例(7.76%),其中单独使用RetCam Ⅱ检查发现ROP确诊者53例,对疑似病例同时使用计算机辅助双目间接检眼镜成像行检查后ROP确诊者58例。定期复查后病变消退者占67.57%,病变进展为ROPⅠ型阈值前期者19例和ROP阈值期及以上者15例,34例患儿进行视网膜激光光凝术,31例术后效果良好,2例ROP4A期患者术后效果不明显。结论:本研究发现早产儿孕周越小,出生体质量越低,ROP的发生率越高,其病变程度越重,需要及时筛查早期干预治疗。通过联合使用计算机辅助的双目间接检眼镜成像系统和RetCam Ⅱ进行早产儿眼底检查有助于提高ROP的诊断率,有利于资料客观保存和ROP筛查培训。     

巴西南部第三中心早产儿视网膜病变

目的:评估2002-10/2006-10在巴西de Clinicas de Porto Alegre医院出生的所有早产儿的早产儿视网膜病变(ROP)的发生率,其治疗和预后的比率.方法:对323例出生体质量低于或等于1 500 g或者出生时孕龄等于或者少于32wk的早产儿进行前瞻性队列研究.所有的新生儿都在出生后6wk内进行开睑器开睑,瞳孔散大,间接检眼镜及28D透镜眼底检查,根据疾病的分类进行复查.结果由均数表示,发病率为于95%的可信区间,主要的临床结果为任何分期的ROP发生.结果:新生儿82例发生了ROP,发生率为25.7%.患者中只有17例((5.3%)发生了阈病变,他们的病变都累及后部第Ⅱ区,需要激光治疗.除了3例经治疗的患儿需要两次激光治疗外,没有一个经过治疗的患儿有Ⅰ区病变或者严重的后部病变.重复治疗组的1例患儿因发展成为4期ROP而需要行赤道部硅胶带巩膜环扎术.结论:ROP的发生率和阈病变同国际其它的研究结果类似.本研究显示了孕期28wk以内或出生后体重1 000 g的新生儿高生存率(70.1%)、高视网膜病变发病率和激光治疗的高度必要性.这组患儿需要眼科专家和新生儿专家为发现ROP进行仔细筛查和随访.本组患儿中没有确诊1例有Ⅰ区后部病变,此点是本研究值得引起注意之处.     

激光光凝及抗血管内皮生长因子单克隆抗体bevacizumab玻璃体腔注射治疗早产儿视网膜病变的疗效观察

目的 观察激光光凝和抗血管内皮生长因子单克隆抗体bevacizumab（商品名Avastin）玻璃体腔注射治疗早产儿视网膜病变（ROP）的有效性及安全性。方法 经临床检查确诊的3期ROP患儿19例38只眼纳入研究。其中,1区病变9例18只眼;2区病变10例20只眼。所有患儿均采用间接检眼镜和二代广角数码视网膜成像系统（RetCam Ⅱ）行眼底检查及眼底摄像,双眼眼底病变相同。依据治疗方式分为激光光凝治疗组和注药治疗组。治疗时,随机选取1只眼行激光光凝治疗,另1只眼玻璃体腔注射25 mg/ml的bevacizumab 0.03 ml（含bevacizumab 0.75 mg）。治疗后随访12～66周,平均随访时间33周。比较两组嵴及附加病变（plus）消退时间。结果 1区病变18只眼中,嵴、plus消退时间注药治 疗组分别为（2.25±0.46）、（2.11±0.60）周;激光光凝治疗组均为（3.75±1.75）周。两组间嵴、plus消退时间比较,差异有统计学意义（F=18.29,15.56;P＜0.05）。2区病变20只眼中,嵴、plus消退时间注药治疗组分别为（3.1±1.72）、（2.1±0.56）周;激光光凝治疗组分别为（3.50±1.90）、（2.50±1.35）周。两组间嵴、plus消退时间比较,差异无统计学意义（F=0.38,2.62;P＞0.05）。治疗出现视网膜表面纤维膜增加8只眼。其中,激光光凝治疗组6只眼,注药治疗组2只眼。随访中未观察到与治疗相关的并发症发生。结论 激光光凝和抗血管内皮生长因子单克隆抗体bevacizumab玻璃体腔注射治疗3期ROP有效、安全。     

Prospective randomized evaluation of diode-laser and cryotherapy in prethreshold retinopathy of prematurity

PURPOSE: To study the efficacy of indirect diode laser photocoagulation and cryotherapy in prethreshold retinopathy of prematurity (ROP). METHODS: Thirty-six eyes of 18 premature infants less than 34 weeks gestational age and/or less than 1600 g birth weight with prethreshold ROP were prospectively randomized to treatment with either indirect laser photocoagulation or cryotherapy. Prethreshold ROP was defined as any stage of ROP in zone I with plus disease; or stage 3 with three or more contiguous clock hours or five or more total clock hours of involvement of retina in zone II with plus disease but less than threshold disease. Regression of the ROP was assessed for a minimum period of 6 months. RESULTS: Regression of ROP occurred in all 36 eyes (100%) in both groups. CONCLUSIONS: Excellent results are achieved if ROP is treated at the prethreshold stage with both indirect laser photocoagulation and cryotherapy. Although laser has definite advantages, cryotherapy can be considered as an alternative modality of treatment in developing countries due to economic reasons.     

激光光凝治疗早产儿视网膜病变的疗效分析

目的 观察激光光凝治疗早产儿视网膜病变（ROP）的临床效果。方法 临床确诊为阈值前Ⅰ型和阈值期的ROP患儿64例127只眼纳入研究。其中,阈值前Ⅰ型ROP 15例30只眼,占患眼的23.6%;阈值期ROP 49例97只眼,占患眼的76.4%。所有患儿均于确诊后72 h内在全身麻醉状态下行间接检眼镜引导的532 nm或810 nm激光光凝治疗。阈值前Ⅰ型ROP 15例30只眼中,行532 nm激光光凝治疗6例12只眼,行810 nm激光光凝治疗9例18只眼。阈值期ROP 49例97只眼中,行532 nm激光光凝治疗37例73只眼,行810 nm激光光凝治疗12例24只眼。治疗后随访时间12~36个月,平均随访时间18.4个月。观察患儿病变退化情况。以1次激光光凝治愈率、重复治疗率、不良预后发生率、全身及局部并发症的发生情况为疗效观察指标,对比分析阈值前Ⅰ型与阈值ROP,以及532 nm与810 nm激光光凝治疗的效果差异。结果 127只眼中,附加病变消失、嵴消退、病变完全退化125只眼,占98.4%;颞侧周边部残存膜状牵拉、视网膜血管颞侧牵拉移位2只眼,占1.6%。未出现进展为4期或5期严重不良预后者。经1次激光光凝治疗病变完全退化者118只眼,占92.9%;经2~3次激光光凝治疗病变完全退化者6只眼,占4.7%;因近周边部病变较重,激光光凝反应欠佳,行冷冻治疗者3只眼,占2.4%。64例127只眼中,发生麻醉意外1例,占患儿的1.6%;出现结膜下出血12只眼,占患眼的9.4%;发生白内障1只眼,占患眼的0.8%。经532 nm或810 nm激光光凝治疗阈值前Ⅰ型和阈值期ROP的治疗效果相当,差异无统计学意义（P＞0.05）。但需要重复激光光凝治疗、附加冷冻治疗、出现不良预后及严重并发症者主要出现在阈值期532 nm激光光凝治疗的患儿中。结论 激光光凝可有效治疗阈值前Ⅰ型和阈值期ROP。     

Trans-scleral diode laser coagulation for therapy of acute retinopathia praematurorum

BACKGROUND: Lens opacities were noted in single cases after transpupillar laser photocoagulation in retinopathy of prematurity (ROP) using the laser indirect ophthalmoscope. The diode laser with its wavelength in the near infrared (810 nm) makes lens sparing transscleral retinal coagulation possible. PATIENTS AND METHODS: In a controlled clinical study 60 eyes of 30 very low birth weight infants (gestational age 23-31 weeks, mean 26.6 +/- 1.8 weeks; birth weight 510-1200 g, 856 +/- 170 g) with threshold ROP were treated with diode laser photocoagulation. One eye of each infant was coagulated transsclerally while the fellow eye had transpapillary coagulation using the laser indirect ophthalmoscope. Follow-up ranged from 2 to 38 months (19 +/- 11 months). RESULTS: In 29 (97%) out of 30 eyes treated transsclerally and in 30 (100%) out of 30 eyes treated transpapillary the outcome was a flat, attached retina. Three eyes had a second laser treatment and 2 eyes had additional retinal detachment surgery. One eye (3%) with zone I disease failed after transscleral laser treatment and additional retinal detachment surgery with partially detached retina (stage 4 B) No adverse side effects as a result of laser treatment were noted except for a small amount of retinal/preretinal bleeding in the ridge and a vitreous bleeding. There were no adverse side effects (e.g., bleeding, cataract formation) in the anterior segments of the eyes. CONCLUSION: Transscleral diode laser coagulation for treatment of threshold ROP proved to be as effective as transpapillary diode laser photocoagulation. Only minor side effects were noticed. Transscleral diode laser photocoagulation is an advantageous treatment method in eyes with preexisting risk of cataract formation in transpapillary laser treatment.     

Trends in the management of stage 3 retinopathy of prematurity.

AIMS/BACKGROUND: The clinical outcome of 66 consecutive infants with stage 3 retinopathy of prematurity (ROP) is reported. METHODS: Thirty four infants (64 eyes) were treated with cryotherapy and 32 infants (59 eyes) underwent laser photocoagulation. RESULTS: Infants with anterior-mid zone II ROP had a high rate of disease regression whether treated by cryotherapy or laser photocoagulation. Infants with posterior zone II or zone I ROP had a 40% success rate with cryotherapy, and 87.5% when treated with laser photocoagulation. CONCLUSION: Evolving experience and changing management policies in infants with posterior ROP has led to improved results.     

Time to consider a new treatment protocol for aggressive posterior retinopathy of prematurity?

Purpose: To discuss treatment modalities for aggressive posterior retinopathy of prematurity (AP‐ROP). Methods: The medical charts of all infants with AP‐ROP at Uppsala University Hospital, Sweden, during a 2‐year period (2009 and 2010) were reviewed. Eight infants (16 eyes) with a mean gestational age of 23.8 weeks and a mean birth weight of 592 g were treated with laser and/or intravitreal injections of bevacizumab (0.4 and 0.625 mg). RetCam photography was used to document the retinal appearance before and after treatment. Results: All infants (16 eyes) had AP‐ROP in zone I. Mean time at initial treatment was 34 weeks postmenstrual age. Two eyes (one infant) were only treated with laser, and six eyes (three infants) were treated with laser therapy or cryopexy and, because of lack of regression, with bevacizumab as salvage therapy. Eight eyes (four infants) were treated with a first‐line bevacizumab injection and four of these eyes (two infants) with additional laser ablation for continued disease progression in zone II. Macular dragging occurred in one eye of one infant primarily treated with laser. Conclusions: Given the high complication rate of the extensive laser treatment for zone I ROP, it is worth considering anti‐vascular endothelial growth factor treatment as an alternative therapy. Further knowledge concerning side effects and long‐term ocular and systemic outcome is warranted before this drug becomes general clinical practice.     

Intravitreal injection of bevacizumab for retinopathy of prematurity

Purpose

To evaluate the outcomes of intravitreal injection of bevacizumab (IVB) for retinopathy of prematurity (ROP).

Methods

IVB was selected to be the first treatment for type 1 ROP in 8 eyes (4 patients). Bevacizumab (0.25 mg/eye) was injected into the vitreous cavity under either general anesthesia or sedation. Fundus photography and fluorescein angiography were performed before the IVB. One infant was observed to the age of 1 year 6 months, the second to 1 year 9 months, the third to 1 year 10 months, and the fourth to 2 years 0 month.

Results

Before the IVB, 6 eyes (3 patients) had ROP in zone II and 2 eyes (one patient) had ROP in zone I. The 3 infants with ROP in zone II weighed 652, 476, and 579 g with gestational ages of 24, 27, and 24 weeks at birth, respectively. The infant with ROP in zone I weighed 972 g with a gestational age of 26 weeks at birth. IVB was performed at postmenstrual ages of 33–37 weeks. The IVB was effective in all eyes with ROP in zone II and additional treatment was not required, whereas vitreous hemorrhage and cataract were found at 19 weeks and 5 months after the initial IVB in the two eyes with ROP in zone I. These two eyes required additional IVB, laser photocoagulation, and surgery.

Conclusions

Our findings suggest that eyes with type 1 ROP in zone II can be treated with IVB. Further studies are needed with a larger number of eyes.     

早产儿视网膜病变激光光凝治疗效果及预后影响因素分析

目的:观察激光光凝术治疗阈值前Ⅰ型和阈值期早产儿视网膜病变(ROP)的临床效果,分析光凝术后病变进展的影响因素。方法:回顾分析激光光凝治疗ROP患者46例89眼,其中阈值前Ⅰ型57眼,阈值期32眼。采用810nm激光对周边视网膜无血管区进行光凝治疗。根据光凝术后结果分为病变消退组和进展组。随访视网膜解剖结构和ROP病变的变化,分析ROP病变部位、病变程度、光凝点数量、机械辅助呼吸、败血症、新生儿肺炎等因素与光凝术后病变进展的相关性。结果:ROP89眼经激光光凝治疗后病变完全消退79眼(89%),病变进展10眼(11%)。光凝治疗ROP病变消退组与进展组比较,出生胎龄、出生体重、首次光凝校正胎龄差异无统计学意义(P=0.668,0.495,0.143)。病变进展组的Ⅰ区病变、阈值病变、急性进展性后极部早产儿视网膜病变(AP-ROP)、光凝点数量均较病变消退组明显增加,差异有统计学意义(P=0.035,0.017,0.000,0.031)。Logistic回归分析结果显示,AP-ROP与光凝术后病变进展有关(P=0.001)。AP-ROP患眼光凝术后病变进展的可能性是非AP-ROP患眼的12.167倍(95%CI:2.733～54.154)。结论:激光光凝术能有效控制早期ROP的病变进展,使大部分阈值前Ⅰ型和阈值期ROP病变完全消退。急性进展性后极部早产儿视网膜病变光凝术后容易发生视网膜脱离,是影响光凝术后疗效的最主要因素。