早产儿视网膜病变筛查结果分析

目的 探索适合成都及周边地区早产儿视网膜病变(retinopathy of prematurity,ROP)的筛查模式.方法 回顾性调查分析研究.对2007年12月至2011年3月在四川省人民医院及成都市妇女儿童中心出生的332例体重2500g以下或孕周小于34周的早产儿,自生后4～6周或矫正胎龄32周开始筛查至周边视网膜血管化.结果 332例早产儿中有41例发生了早产儿视网膜病变,占12.35％.其中严重的4例(7只眼)接受了激光治疗,1例(1只眼)接受视网膜冷凝联合巩膜环扎手术治疗,占1.20％.按照卫生部制定的筛查标准,仅259例受检儿符合标准,ROP检出率为14.29％,有4例ROP患儿漏诊.眼底正常组患儿出生孕周和体重均明显高于ROP组,两组间有吸氧史者所占比例及不同严重程度ROP组与未发生ROP组吸氧时间的差异有统计学意义.结论 出生体重、胎龄、吸氧为早产儿视网膜病变发生的重要危险因素,婴儿出生的成熟度越低,早产儿视网膜病变尤其是严重的早产儿视 网膜病变发病可能性越高.成都及周边地区ROP筛查标准应在卫生部制定的ROP筛查标准的基础上适当扩大范围.     

我国早产儿视网膜病变的筛查现状

早产儿视网膜病变(ROP)是一种属于可避免、可控的儿童主要致盲性及低视力眼病。筛查是早检出、早干预和早治疗的前提和关键措施,对降低儿童致盲率及视力损伤具有重要意义。本文主要对我国ROP筛查和发病现状作一综述,以期为ROP的防治提供参考。     

基层医院早产儿视网膜病变筛查方式及筛查标准探讨

目的 了解广州市番禺区早产儿视网膜病变发生情况,探讨现阶段适合我国基层医院早产儿视网膜病变筛查的方式及标准.方法 按照广州市的筛查标准,用带视频录像的双目间接眼底镜对番禺区1270例早产儿及低体重儿进行眼底检查,观察早产儿视网膜病变的发生情况.将筛查结果与按照我国卫生部制定的ROP筛查标准筛查结果进行比较.结果 发现ROP者14例,如果按照卫生部的筛查标准进行筛查,有1例漏诊.按照卫生部的筛查标准计算,发病率为7.5％.其中,ROPⅢ区Ⅰ期者7例,Ⅲ区Ⅱ期者3例,Ⅲ区Ⅲ期者2例,Ⅱ区Ⅲ期者2例,未发现Ⅳ期及V期病变,需要治疗的2例.在检查过程前后,35例患儿发生不同程度的球结膜下出血;2例患儿头皮下见大量出血点;1例患儿发生急性结膜炎;28例患儿家属诉患儿筛查后睡觉时常惊叫.未发现有呼吸暂停、休克等严重并发症.结论 带视频录像的双目间接检眼镜检查适合基层医院眼科行早产儿视网膜筛查.我国卫生部制定的筛查标准适合番禺地区ROP的筛查工作.     

早产儿视网膜病变筛查结果分析

目的 了解早产儿视网膜病变(ROP)的发病情况,并探讨相关危险因素.方法 对符合ROP筛查标准的早产儿201例(402只眼),用间接眼底镜进行眼底筛查,记录眼底检查情况.结果 出生孕周27～ 36周,出生体重750～ 2500g早产儿201例,正压给氧48人次,持续1～17d.鼻导管吸氧53人次,持续1～55d,无1例出现ROP.结论 严格控制吸氧可以控制ROP的发病.     

基于风险因素构建早产儿视网膜病变筛查模型

目的分析早产儿视网膜病变(ROP)的风险因素,构建列线图筛查模型并进行效能验证,为临床提供一款量化、简便的评估工具。方法回顾性病例分析。总结2020年5月至2022年5月于我院新生儿重症监护病房(NICU)初步判断为高危ROP共788例为研究对象,以3:1随机分为训练组591例和验证组197例。根据广域眼底成像系统检查结果最终确诊85例ROP,其中训练组66例和验证组19例。纳入临床因素包括孕周、剖宫产、多胎妊娠、前置胎盘、羊水污染、妊娠期高血压和糖尿病、流产史、胎儿出生体重、性别、宫内窒息、胎儿生长受限(FGR)、胎膜早破(PROM)、1 min和5 min Apgar评分、临床治疗(肺表面活性物质、机械通气、输血)、体重增加量、合并疾病(呼吸窘迫综合征、缺血缺氧性脑病、凝血障碍、支气管肺发育不良)、胎儿血清N末端-B型脑利钠肽前体(NT-proBNP)。结果首先对训练组ROP与无ROP单因素比较发现,ROP孕周和出生体重较小,1 min和5 minApgar评分降低,体重增加量减少,NT-proBNP水平升高,宫内窒息、FGR和羊水污染增多,肺表面活性物质、机械通气和输血增多,呼吸窘迫综合征、缺血缺氧性脑病、凝血障碍和支气管肺发育不良增多,差异均有统计学意义(P<0.05)。然后经Lasso回归分析筛选出5个非共线性因素,多因素Logistic回归分析显示,孕周减小(OR=5.234,95%CI=3.524~6.527,P<0.001)、出生体重减小(OR=4.012,95%CI=2.657~5.232,P<0.001)和体重增加量减小(OR=2.124,95%CI=1.568~3.201,P<0.001)、NT-proBNP升高(OR=1.625,95%CI=1.124~2.659,P=0.001)和机械通气(OR=1.758,95%CI=1.323~2.547,P=0.001)是ROP发生的独立危险因素。R软件建立列线图模型,总分240分。受试者工作曲线(ROC)计算列线图预测训练组和验证组ROP的曲线下面积(AUC)分别为0.895和0.842,提示模型具有较好的区分度。校正曲线显示训练组和验证组的模型预测结果与实际发生率吻合较好。Hosmer-Lemeshow拟合优度检验显示,训练组和验证组差异均无统计学意义(χ^(2)=1.023和0.859,均P>0.05)。决策曲线显示,训练组和验证组均有较好的临床净获益。结论本研究开发一款可视化较强的列线图模型可用于指导临床筛选高危ROP,并提供早期恰当的临床治疗,具有较好的临床价值,值得推广应用。     

早产儿视网膜病变筛查相关意外和并发症分析

早产儿视网膜病变(ROP)筛查在很多国家中已成为新生儿重症监护病房(NICU)中的一项常规检查.我国2004年《早产儿治疗用氧和视网膜病变防治指南》[1]颁布以来,ROP筛查工作也在全国各地陆续开展.尽管ROP筛查是一个基本无创性检查,但筛查本身会造成受检儿的一些生理变化,也存在一定风险和并发症[2],有些严重意外一旦发生,会危及受检儿生命.所以随着ROP筛查工作的逐渐普及,筛查的规范性和安全性也日益受到关注[3].为此,我们对一组早产儿和低体重儿ROP筛查的相关意外和并发症进行了观察和分析,现将结果报道如下.1对象和方法回顾分析2009年7月1日至2011年7月1日在我院眼科门诊就诊和NICU及外院会诊的早产儿和低体重儿833例1666只眼ROP筛查资料.对出生体重＜2000 g的早产儿和低体重儿,在出生后4～6周或矫正胎龄32周开始进行ROP筛查,并随诊直至周边视网膜血管化,对于有严重疾病的早产儿与新生儿科医师共同会诊后适当扩大筛查范围[1].其中,男性524例,女性309例;胎龄27～34周,平均胎龄(33.8±2.6)周;出生体重800～2600 g,平均体重(1875.6士237.8)g.     

山东省济南地区早产儿视网膜病变的筛查结果及相关因素分析

背景早产儿视网膜病变（ROP）威胁早产儿的视功能,在早产儿中进行ROP筛查并早期进行干预对保存患儿的视力有着极其重要的意义。目前相关的筛查工作已相继在中国多个地区开展或完成,但山东省济南地区尚缺乏相关的筛查研究。目的分析山东省济南地区ROP的筛查结果以及相关影响因素。方法采用横断面调查研究设计。对2008年6月至2010年6月在山东省眼科医院眼底病科就诊且来自山东省济南地区的早产儿和低体重儿144例288眼进行筛查。筛查标准参照2004年中国卫生部颁发的ROP筛查标准和国内多中心的筛查结果,纳入对象为出生体重≤2500g或矫正胎龄≤34周的早产儿和低体重儿,ROP分类标准采用ROP国际分类标准。检查前询问、记录受检儿的病史并对全身情况进行评估。对ROP患儿组与眼底正常儿组的平均出生孕周和出生体重、患儿有持续吸氧史者所占比例进行统计学分析。结果本次调查发现,济南地区符合早产儿和低体重儿标准者144例288眼,共筛查出不同程度的ROP患儿15例30眼,其中男8例,女7例;均为双眼患病;ROP检出率为10．42％。ROP患儿出生孕周平均为（30．85±1．79）周;出生体重平均为（1408．89±259．93）g。其中ROP1期者有6例12眼,2期者4例8眼,3期伴附加病变者4例8眼,5期者1例2眼。受检者中129例眼底正常,出生孕周平均为（32．38±1．48）周,出生体重平均为（1763．19±338．62）g。ROP组患儿的出生孕周明显短于眼底正常组,差异有统计学意义（t=3．71,P〈0．01）,ROP组患儿的出生体重明显低于眼底正常组,差异有统计学意义（t=2．88,P〈0．01）。眼底正常组与ROP组有持续吸氧史者所占的比例分别为58．91％和60．00％,差异无统计学意义（P=1．900）。依据中国卫生部的筛查标准所得的ROP检出率为12．93％（15／116）,按山东省的标准检出率为10．42％（15／144）,差异无统计学意义（χ^2=0．398,P=0．528）。结论济南地区ROP检出率与国内其他地区报道的数据较接近。中国卫生部制定的ROP筛查标准适合济南地区的ROP筛查工作。孕周短和出生体重低是导致ROP发生的危险因素。     

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。     

泰州市早产儿视网膜病变筛查结果分析

目的了解泰州市早产儿视网膜病变（ROP）的患病情况并分析与ROP相关的高危因素。方法收集泰州市2008年3月至2011年3月286例（572只眼）早产儿和低体重儿ROP筛查资料进行回顾性分析。结果 286例（572只眼）早产儿和低体重儿中,共筛查出36例（72只眼）患有不同程度的ROP,ROP检出率约为12.6%,所有患儿均为双眼患病,其中包括ROP 1期12例（24只眼）,ROP 2期14例（28只眼）,ROP 3期4例（8只眼）,ROP4期2例（4只眼）,AP-ROP 1例（2只眼）,ROP 5期3例（6只眼）,提示早产、低出生体重、缺血和缺氧性脑病、胎盘早剥等影响胎儿发育的相对缺氧因素与ROP的发生密切相关。结论早产、低出生体重及相对缺氧因素是ROP发生的高危因素,早筛查、早发现、早治疗是预防ROP致盲的关键。     

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.     

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.     

Non-ophthalmologist screening for retinopathy of prematurity

AIM: To determine if a non-ophthalmologist can accurately screen for retinopathy of prematurity (ROP) by evaluating the posterior pole blood vessels of the retina. ROP is a common ocular disorder of premature infants and may require multiple screening examinations by an ophthalmologist to allow for timely intervention. Since there is a strong correlation between posterior pole vascular abnormalities and vision threatening ROP, screening examinations performed by non-ophthalmologist may yield useful clinical information in high risk infants. METHODS: Infants born at the Medical University of South Carolina who met screening criteria (n = 142) were examined by a single non-ophthalmologist using a direct ophthalmoscope to evaluate the posterior pole blood vessels for abnormalities of the venules and/or arterioles. To determine the accuracy of the non-ophthalmologist's clinical observations, infants were also examined by an ophthalmologist, using an indirect ophthalmoscope, who graded the posterior pole vessels as normal, dilated venules, or dilated and tortuous venules and arterioles (including "plus disease"). RESULTS: There was significant correlation (p <0.001) between the non-ophthalmologist's and ophthalmologist's diagnoses of posterior pole vascular abnormalities. 47 infants had normal posterior pole blood vessels by the non-ophthalmologist examination. Of these, 31 (66%) were considered to have normal vessels and 16 (34%) to have dilated venules by the ophthalmologist. The non-ophthalmologist correctly identified abnormal posterior pole vessels in all 21 infants diagnosed with abnormal arterioles and venules by the ophthalmologist. No infants with clinically important ROP ("prethreshold" or worse) would have failed detection by this screening method. CONCLUSION: Using a direct ophthalmoscope, a non-ophthalmologist can screen premature infants at risk for ROP by evaluating the posterior pole blood vessels of the retina. While not necessarily recommended for routine clinical practice, this technique may nevertheless be of value to those situations where ophthalmological consultation is unavailable or difficult to obtain.     

数字广角小儿眼底成像系统在早产儿视网膜病变筛查中的应用

早产儿视网膜病变(ROP)是世界范围内儿童致盲的主要原因,数字广角小儿眼底成像系统(RetCam)在ROP筛查中发挥着重要作用.本文回顾文献,结合自己临床实践中的应用体会,总结了RetCam在ROP筛查中的应用优势和局限性,强调RetCam用于ROP筛查具有安全性高,敏感性和特异性较好,简便快捷等优势,具有在我国推广应用的前景.     

The outcome of retinopathy of prematurity: screening for retinopathy of prematurity using an outcome predictive program

PURPOSE: The purpose of this study was to compare the calculated risk of progression to threshold retinopathy of prematurity (ROP) and risk of an unfavorable structural outcome using the computer program, RM-ROP, with the observed incidence for infants born at Jackson Memorial Hospital (JMH) and to determine how many children would have been treated unnecessarily if the threshold criteria for treatment were lowered on the basis of the clinical findings and RM-ROP risk calculations. DESIGN: Noncomparative interventional case series. PARTICIPANTS: All 292 surviving premature infants weighing 1250 g or less at birth and born at JMH between January 1, 1997, and December 31, 1998, were included in the study. METHODS: Baseline demographic factors and data from sequential ophthalmic examinations were entered into the RM-ROP program for risk calculation. Infants reaching threshold disease received diode laser indirect photocoagulation of the avascular retina. Three-month follow-up was obtained for infants receiving laser treatment. MAIN OUTCOME MEASURES: The development of threshold ROP and an unfavorable structural outcome, defined as a posterior retinal fold or posterior retinal detachment occurring within 3 months of threshold disease. RESULTS: Thirty-eight eyes were diagnosed with threshold ROP, with 18 of 20 subjects having bilateral disease. Three-month posttreatment follow-up was obtained on all 20 children, with 19 having good structural outcomes. Thirty-two percent of eyes (12 of 38) reaching threshold never had a risk estimate greater than 0.10. However, only 6% of eyes (35 of 546) that did not reach threshold ever had a model predicted risk greater than 0.15. All right eyes with zone 1 prethreshold disease, 60% of those with zone 2 stage 2+ disease, and 23% with zone 2 stage 3 disease progressed to threshold ROP. CONCLUSIONS: The similarity between the risk distributions for the Miami and the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity study indicates the similarity in the populations with respect to risk factors identified as important by the model. The Miami data validated the model, with eyes reaching threshold having higher risks than eyes that did not. Actual risk estimates for eyes reaching threshold can be small. Changing the threshold criteria for treatment on the basis of various clinical and computer-generated prethreshold risk levels in our population would have resulted in the unnecessary treatment of many infants who never progressed to threshold disease. In the Miami population, if the model were used to manage an individual subject, close attention would have to be paid to small differences in risk. Although the RM-ROP software program may be a useful tool for following premature infants with ROP, the clinical examination remains the "gold standard."     

RetCam imaging for retinopathy of prematurity screening.

PURPOSE: Indirect ophthalmoscopy is the gold standard for retinopathy of prematurity (ROP) screening. Screening for ROP with digital imaging has been proposed as a possible alternative. Our goal was to evaluate the longitudinal clinical outcomes of employing digital imaging to detect high-risk ROP. METHODS: Serial RetCam imaging and indirect ophthalmoscopy were performed on 43 premature infants. A masked reader evaluated the images and made management recommendations that were compared with indirect ophthalmoscopy results. Successful screening was determined by correctly identifying progression to prethreshold or threshold disease with referral for indirect ophthalmoscopy. Unsuccessful screening was determined by failure to identify prethreshold or threshold disease, inaccurately detecting prethreshold or threshold disease, or inability to evaluate for ROP. RESULTS: No cases of prethreshold or threshold disease were missed by the reader. The reader overestimated prethreshold or threshold disease in 5% of cases. Initial screening in 21% of cases could not be evaluated for ROP secondary to poor image quality. Digital photography had a sensitivity of 100% and specificity of 97.5% in detecting prethreshold and threshold ROP. Positive-predictive value of digital photography was 67% and negative-predictive value was 100%. CONCLUSIONS: Screening and management of ROP using RetCam imaging did not fail to detect prethreshold or threshold disease when images could be obtained. Ophthalmologic examinations were needed in 20% of cases that did not reach threshold or prethreshold disease because of poor image quality or overestimation of ROP. RetCam screening may safely reduce the overall number of indirect ophthalmologic examinations required.     

Systemic effects of screening for retinopathy of prematurity.

AIMS: To detect systemic complications of screening for retinopathy of prematurity (ROP), paying particular attention to the physical examination. METHODS: Oxygen saturation, pulse rate, and blood pressure were monitored before, during, and after 110 ROP screening examinations. RESULTS: Following topical mydriatics diastolic blood pressure was elevated by a mean of 6 (SD 7.2) mm Hg. Immediately after the examination there was a further rise in both systolic and diastolic pressure of 4.3 (14.5) mm Hg and 3.3 (11.6) mm Hg, respectively. Oxygen saturation and pulse rate remained stable during the control period and administration of eyedrops. Saturation fell by a median of 3% (95% confidence interval plus or minus 1.2%) after the examination while there was rise in pulse rate of 7 (SD 23.1) beats per minute. This change in pulse rate was not observed in infants on concurrent methylxanthine therapy. No infant had clinically significant changes at the end of the study. CONCLUSION: The initial changes in blood pressure may represent side effects of topical mydriatics but the later changes following the physical examination may be an additional response to the stress of ROP screening.