Laser treatment for retinopathy of prematurity

Threshold retinopathy of prematurity is a level of disease at which 50% of affected infants are predicted to go blind without treatment. The Cryotherapy for Retinopathy of Prematurity Study has shown that this number can be halved with treatment. Cryotherapy, however, is stressful on the infant, leaves large scars, and is more difficult for the surgeon to administer. Laser photocoagulation with the indirect ophthalmoscope has been shown in pilot studies to be as effective as cryotherapy, less stressful on the infant, and easier for the surgeon to administer. This form of therapy may become the preferred method for treating threshold retinopathy of prematurity.     

Laser photocoagulation for stage 3+ retinopathy of prematurity

Twenty-two infants with "threshold" stage 3+ retinopathy of prematurity (ROP) were entered into a prospective, randomized clinical trial to compare the efficacy of transscleral cryotherapy versus laser photocoagulation delivered by the indirect ophthalmoscope. Eighteen infants have been followed for at least 3 months. Fifteen of 16 eyes randomized to laser and 9 of 12 eyes randomized to cryotherapy showed regression. The results suggest that laser therapy is as effective as cryotherapy in the treatment of ROP (P = 0.285).     

玻璃体腔注射抗VEGF药物治疗早产儿视网膜病变的研究进展

早产儿视网膜病变(ROP)是发生于早产儿的一种未成熟视网膜血管增殖性眼病，是一种严重的儿童致盲性眼病。视网膜激光光凝术是治疗ROP的经典方法，然而激光治疗是破坏性的，尤其是在ROP Ⅰ区病变的情况下，视网膜激光光凝治疗会引起严重的并发症。研究表明，血管内皮细胞生长因子(VEGF)在ROP发生及发展过程中具有关键作用，而玻璃体腔注射抗VEGF药物不仅能有效控制ROP，并且为视网膜继续发育争取了机会。本文就玻璃体腔内注射抗VEGF药物治疗ROP的治疗指征、药物筛选、注射部位、给药剂量、疗效观察以及并发症对其进行综述。     

Surgical therapy for stage V retinopathy of prematurity

Between February 1985 and February 1986, ten eyes from a larger series of infants operated on for stage V retinopathy of prematurity were seen with the open funnel type of retinal detachment and vascularly active eyes. We have developed a technique for these eyes involving two-step treatment. The first step is cryotherapy to the avascular peripheral retina which rarely detaches, even in stage V retinopathy of prematurity, followed by lensectomy, vitrectomy and membrane peeling. This technique has allowed us to operate on these ten eyes much earlier than would generally have been possible if the eyes were allowed to become vascularly inactive on their own. We were able to achieve anatomic reattachment of zone 1 as described in the International Classification of Retinopathy of Prematurity in 80% of these eyes. Light perception or better visual function was achieved in 70%, with 30% of the eyes capable of grasping brightly colored unlit objects of 1 in. (2.5 cm) in diameter. This represents a marked improvement in both anatomic and visual results. We feel that this improvement is due to the earlier treatment by lensectomy, vitrectomy and membrane peeling seemingly allowed by pretreating with cryotherapy. In addition, close attention was paid to the refractive status in visual stimulation during the post-operative period.Presented at the XVth Meeting of the Club Jules Gonin, Copenhagen, 10–15 August 1986     

Laser treatment for retinopathy of prematurity through the incubator wall

In this era of early treatment for retinopathy of prematurity, sick infants who develop aggressive diseases or remain oxygen and temperature dependent may be treated while they are inside the incubator itself, thus avoiding unnecessary delays. This article describes the treatment of eight infants with retinopathy of prematurity who were dependent on an incubator by using a laser indirect ophthalmoscope delivery system through the slanting transparent wall of the incubator. In this series, which is the largest to date, the relative advantages and disadvantages of the procedure are discussed.     

糖尿病視網膜病變的激光幹预

糖尿病视网膜病变(Diabetic retinopathy,DR)是导致失明的严重眼病之一。我国近年来DR发病趋势也日益上升。本文就DR激光干预相关内容作一综述,包括DR的流行病学,病理变化,临床分期,以及眼用激光在治疗DR的可能作用机理,方法及治疗参数等方面的新进展。资料表明,激光治疗DR是一种有效的治疗方法,可以降低DR致盲的发病率,提高糠尿病患者的生活质量。     

Outcomes after laser therapy for threshold retinopathy of prematurity

OBJECTIVE: To determine the anatomic outcomes of eyes treated with laser photocoagulation for threshold retinopathy of prematurity and to identify potential risk factors for unfavorable outcomes after treatment. DESIGN: Retrospective, noncomparative case series. INTERVENTION: Photocoagulation of the peripheral avascular retina with an argon or diode laser indirect ophthalmoscope. PARTICIPANTS: One hundred twenty eyes of 81 infants with threshold retinopathy of prematurity treated with laser photocoagulation from 1989 through 1997 with at least 12 months of follow-up after treatment. MAIN OUTCOME MEASURES: The principal outcome was the presence of an unfavorable anatomic outcome defined as a retinal detachment, macular fold, or retrolental tissue. RESULTS: One hundred nine of 120 eyes (91%) had favorable outcomes. Eleven eyes (9%) had retinal detachments, and 1 of the 11 also had retrolental tissue. Zone 1 eyes appeared to be 3.3 times more likely to have an unfavorable outcome compared with zone 2 eyes, but the 95% confidence interval (0.8-14.5) did not support this statistically. Twenty-four of 109 eyes (22%) experienced dragging of the temporal vessels. Those with zone 1 disease were 13.7 times more likely to experience temporal dragging compared with zone 2 eyes (95% confidence interval, 3.3-57.2). CONCLUSIONS: After laser photocoagulation for threshold retinopathy of prematurity, 91% of eyes had a favorable anatomic outcome. Compared with zone 2 eyes, zone 1 eyes may be more likely to have temporal dragging of the retinal vessels. Laser therapy is effective in the treatment of threshold retinopathy of prematurity.     

治疗早产儿视网膜病变的一种新思路:分期手术

Dear Sir,We are Dr.Yu J,and Dr.Zhang Q,from Department of Ophthalmology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,China.We write to present a case report of a novel therapy concept:staged surgery as a therapy for retinopathy of prematurity(ROP).ROP is a neovascular retinal disorder.It can affect the vision of infants of low birth weight and young gestational age.Serious ROP can progress to childhood loss of vision,even     

Laser photocoagulation for retinopathy of prematurity: structural and functional outcome

BACKGROUND: To report the structural and refractive outcome after laser photocoagulation for retinopathy of prematurity (ROP). METHODS: Nineteen consecutive patients who had undergone photocoagulation for ROP between 1997 and 2002 at our clinic were examined for this non-comparative, consecutive, interventional, retrospective case series. A total of 37 eyes received either transscleral or transpupillary laser treatment. Data consisted of grade of ROP pre- and postoperatively, birth weight, perioperative and postoperative complications and refraction. Based on indirect ophthalmoscopy, independent observers graded the extent of ROP and determined the postoperative refraction by retinoscopy. RESULTS: A total of 97% of all eyes responded to laser treatment with regression of ROP. Only one eye out of 37 progressed to stage IV B despite photocoagulation and therefore an encircling procedure was performed. After further progression a vitrectomy was carried out. Perioperative complications included haemorrhages in 22% that resorbed spontaneously and cataract formation in one eye (3%). Postoperative refractive errors at mean ages of 23 +/- 12 months and 45 +/- 14 months were evaluated in 15/19 patients (79%). The spherical equivalents ranged between -8 D and +6 D at the first examination and between -12 D and +7 D at the second examination. In all only 14% of the refracted eyes were myopic. CONCLUSIONS: Photocoagulation for ROP in our patients resulted in regression of threshold ROP. In addition, the analyses of the refractive outcomes demonstrated a predominance of hypermetropia in our patients.     

早产儿视网膜病变的冷冻治疗

目的:观察早产儿视网膜病变(retinopathy of prematurity,ROP)阈值前病变I型及阈值病变的冷冻治疗疗效,探讨其合理的治疗时机及模式。方法:对胎龄≤35wk,质量≤2000g患儿进行ROP筛查,对阈值前病变I型及阈值病变进行冷冻治疗。结果:(1)共筛查829例符合条件的早产儿,发现早产儿视网膜病变患儿86例(172眼,占10.4%),如按照中华眼科学会制定的ROP筛查标准(出生胎龄≤35wk,质量≤2000g)则患病率为20.6%;其中4期6眼(3.5%),3期44眼(25.6%),发展快的2期14眼(8.1%),稳定或退行2期56眼(32.6%),1期52眼(30.2%);24眼有后部plus现象,58眼周边视网膜出血;50眼2区发病,122眼3区发病;32wk及以内发病的16眼,32~36wk发病的60眼,36wk及以后发病的96眼;(2)行冷冻手术32例(64眼),其中阈值前病变I型12例,阈值病变20例;24眼有后部plus现象;40眼周边视网膜出血;50眼2区发病,14眼3区发病;32wk及以内发病的16眼,32~36wk发病的36眼,36wk及以后发病的12眼;单生子21例,双生子10例,三生子1例;(3)30例病情控制满意;1例发展为后极部视网膜皱襞,周边视网膜脱离,最后行玻璃体切割手术;2例玻璃体出血,其中1例出血吸收,1例最后牵引性视网膜脱离;(4)3例术后短期角膜水肿,5例眼睑冻伤,2例玻璃体出血。结论:(1)后部plus现象、周边视网膜出血、2区发病、32wk内发病的ROP是高风险病变,病情发展迅速,往往需要行手术治疗;(2)对阈值前病变及阈值病变及时行视网膜冷冻术效果较满意且安全。     

Screening for retinopathy of prematurity

The results of a prospective study of low birthweight infants (less than 1500 g) identifies those at risk of retinopathy of prematurity (R.O.P.) as being less than or equal to 1250 g birthweight or less than or equal to 30 weeks post-conceptional age (P.C.A.). In these infants the incidence of R.O.P. was 60% (14% grades 3 or 4). In the remainder the overall incidence of R.O.P. was 24%, exclusively grades 1 or 2. Onset of R.O.P. consistently presented at a mean age of 35 weeks P.C.A. (SD 2.25). Routine retinal examination of all infants less than or equal to 1250 g birthweight or less than or equal to 30 weeks gestation is recommended between 33 and 37 weeks P.C.A.     

Cryotherapy for retinopathy of prematurity

With the rapid progress in neonatology saving more lives of very immature infants, the occurrence of retinopathy of prematurity or retrolental fibroplasia has increased although most cases spontaneously resolve, severe visual damage and blindness still occur. The progressive case of retinopathy is a dilemma for ophthalmologists consulting in the intensive care nursery. The Japanese have been pursuing modalities of treatment of the acute case, but there are few reported cases in the United States and Canada. Four cases of retinopathy of prematurity treated by cryotherapy are presented with follow-up. This is done in an effort to stimulate further reporting and consideration of treatment of such cases.     

Screening for retinopathy of prematurity

AIM: A cross sectional (prevalence) study was performed to assess the usefulness and sensitivity of commonly employed criteria to identify infants for routine ophthalmoscopic screening for retinopathy of prematurity (ROP). METHODS: At a tertiary care centre between 1 January 1992 and 30 June 1998, experienced vitreoretinal specialists screened 438 premature infants for ROP. Retinal maturity and the presence of ROP were determined by indirect ophthalmoscopic examinations. RESULTS: Of the eligible infants surviving 28 days, 276 (91.7%) of 301 infants with birth weights 相似文献   

Pharmacological treatment for retinopathy of prematurity

Mandatory screening performed by an experience ophthalmologist remains the most important pillar in the management of retinopathy of prematurity (ROP). The current gold standard for treatment of proliferative ROP is still panretinal laser photocoagulation, depending on severity, in combination with vitreoretinal surgery if necessary. The first case series of off-label intravitreal anti-VEGF treatment are encouraging. In addition to intravitreal anti-VEGF therapy, other treatment concepts such as supplementation with IGF-1 or omega-3 fatty acids also represent interesting pharmacological approaches to the management of ROP. However, larger controlled trials are required to validate the benefits and safety of these systemic treatment approaches.     

Outcome of prematurity and retinopathy of prematurity

Retinopathy of prematurity is a disease that manifests soon after birth in the premature infant and may lead to a lifelong disability. More infants at risk for developing the retinopathy are surviving, and the ophthalmologist must be aware of possible vision abnormalities, such as decreased acuity, strabismus, nystagmus, retinal scarring, and retinal detachment, that occur during childhood and in adult life. These abnormalities may occur in children who developed only mild forms of retinopathy of prematurity during early life.     

Software for retinopathy of prematurity screening

BACKGROUND: The goal of retinopathy of prematurity (ROP) screening is complete detection of all preterm infants with threshold ROP. AIM: We wanted to develop software to facilitate registration of ROP findings, checking due dates of re-examination, and evaluation of screening data. By means of complete and faultless registration and evaluation of the data of preterm infants, the effectiveness and safety of the screening should increase. METHODS: We developed software that runs under Microsoft Windows 3.1 or Windows 95 and is programmed in Microsoft Access Basic and Microsoft Visual Basic. The software allows all screening data to be registered and evaluated. Intuitive handling, third level of normalization in database architecture, and automatic plausibility checks guarantee the utmost integrity of data and efficacy of database. RESULTS AND CONCLUSION: To date, the software has been used routinely in 2000 examinations in 1000 preterm infants. Our software facilitates clinical management and evaluation of ROP screening, which therefore becomes more safe.     

Smartphone fundoscopy for retinopathy of prematurity

PurposeThe utility of digital fundus images in retinopathy of prematurity (ROP) screening has been established. A smartphone can be a device available to most ophthalmologists to capture digital fundus photographs. In this study, fundus images were captured with original camera settings for ROP documentation.MethodsThe examination was performed under topical anesthesia. An assistant held a glass stick against the eye movement if infants moved their eyes too frequently. A hand-held smartphone and a 30D lens were used to record the fundus in video mode. A continuous flash was turned on to provide almost constant coaxial illumination. Fundus photographs were captured from the video film.ResultsFundus photographs can be captured successfully with a smartphone and a 30D lens under original camera settings.ConclusionFundus photographs of acceptable diagnostic quality can be obtained in ROP patients conveniently and inexpensively using a portable hand-held smartphone. It might be a useful tool in documentation, education, consultation, and telemedicine in ROP.