冷冻治疗早产儿视网膜病变研究的结果及其意义

冷冻治疗早产儿视网膜病变（ROP）研究（CRYO-ROP）为美国国立眼科研究所于1986年发起的一项设计严密、覆盖面广的前瞻性多中心、随机对照临床试验。该研究观察周期长达15年，开创了ROP临床研究的先河。虽然冷冻治疗现已被激光光凝治疗逐步取代，但该研究得到的许多客观可信的结果对目前认识ROP仍具有指导意义；该研究的设计理念和研究方法更值得借鉴和参考。     

早产儿视网膜病变以证据为基础的筛查标准-自然病史资料来自CRYO—ROP和LIGHT—ROP研究

背景：早产儿视网膜病变冷冻治疗(CRYO—ROF)的多中心验证表明了阈值性ROP，治疗的有效性，并指出世界范围ROP筛查的必要性。以前的ROP筛查标准大多依据临床印象；现在我们能提出以证据为基础的筛查建议。     

早产儿视网膜病变抗VEGF治疗进展

早产儿视网膜病变(retinopathy of prematurity, ROP)是发生于早产儿的一种未成熟视网膜血管增生性眼病,是发展中及发达国家儿童致盲的主要因素。ROP的传统治疗方法是视网膜激光光凝或冷冻治疗,但凝固治疗可导致视网膜永久性破坏,存在发生视野缺损、高度近视等并发症风险。玻璃体腔注射抗血管内皮细胞生长因子(VEGF)药物治疗ROP后视网膜功能的发育比凝固治疗更趋向正常,再加上操作简便、耗时短等优点,玻璃体腔注射抗VEGF药物逐渐成为ROP的重要治疗方式; 在Ⅰ区ROP、Ⅱ区后部ROP和急进型ROP治疗中为首选治疗方式。但是抗VEGF药物治疗ROP所致的严重系统并发症、最低有效剂量及后期复发情况等问题尚待进一步研究。本文将对ROP抗VEGF治疗现状进行综述。     

早期治疗早产儿视网膜病变的多中心临床试验

视网膜消融是公认的治疗早产儿视网膜病变(retinopathy of prematurity,ROP)的有效方法,寻求最佳的治疗时机意义重大。在评估早期治疗的优越性和安全性的临床研究中,以美国国立眼科研究所发起的早期治疗ROP研究临床试验的规模最大,影响最深。该试验得出的客观和翔实的结果,已成为目前ROP临床工作重要的循证医学证据。     

早产儿视网膜病变治疗后黄斑发育研究现状及进展

早产儿视网膜病变（ROP）是一种增生性血管性视网膜疾病,冷冻治疗、激光光凝治疗、玻璃体腔注射抗血管内皮生长因子（VEGF）药物治疗、巩膜扣带手术和玻璃体切割手术等是其主要治疗手段。接受非手术治疗后的ROP患儿的黄斑中心凹厚度都相对增厚,中心凹形态和黄斑区视网膜血管发育受到影响,导致视力发育的异常。但目前有关ROP各种治...     

早产儿视网膜病变的临床分析

目的 观察早产儿视网膜病变(ROP)发生发展特点、危险因素及冷冻治疗疗效，探讨其合 理的筛查时机及治疗模式。方法 采用间接检眼镜合并巩膜压迫器加压 的方法对829例胎龄 ≤35周，体重≤2000g的早产、低体重儿进行ROP筛查；对32例阈值前病变Ⅰ型及阈值 病变患 儿行视网膜冷冻手术治疗。手术后随访3~16个月，以附加(plus)病变消退，血管嵴消退，冷冻斑形成，玻璃体视网膜出血吸收及无视网膜不良结构出现作为病情控制指标；若有病变遗漏区、血管嵴发展或附加病变不消退甚至加剧者则再次冷冻；若玻璃体积血不吸收，病情仍进展，发展 为视网膜皱 襞或脱离者则行玻璃体切割手术。结果 发现ROP86例172只眼。ROP各组与未发生ROP组吸氧时 间有显著性差异；出生体重≤1000 g、1001~1500 g、1501~2000 g的早产儿ROP发病比例 分别为69.56%、16.38%、4.14%；出生胎龄≤30周、31~32周、33~35周的早产儿ROP发病 比例分别为37.14%、10.43%、2.91%；单生子早产儿中ROP患病率为7.52%，双生子及 多生子早产儿中ROP患病率为20.22%。32例接受视网膜冷冻手术治疗的患儿，30例病情控制 满意, 2例病情发展为视网膜脱离，伴有后部附加病变，周边视网膜出血。32周内发病患儿 冷冻手术成功机 率高。 结论吸氧时间长、出生体重≤1000 g，胎龄≤30周ROP发病 风险显著增高，建议加强筛查。32周内发病或伴后部附加病变、周边视网膜出血的ROP患儿要严密随访；阈值前病变Ⅰ型及阈值病变行视网膜冷冻手术效果满意且安全。     

广东省部分三级医院早产儿视网膜病变发生率调查

早产儿视网膜病变(ROP)是导致早产儿视力损害的主要原因,出生体重越低、胎龄越小,ROP发生率越高;ROP早期行视网膜激光光凝或冷冻可以阻止病变发展,使患儿有一个相对良好的视力预后[1-3],但ROP晚期合并视网膜脱离后的治疗效果差且费用高[4,5].所以早期预防和治疗ROP至关重要,但是,目前我国尚缺乏大规模的ROP流行病学研究.我们对2006年1月1日至2007年12月30日在广东省6家三级医院新生儿科住院的出生体重<2000 g的早产儿进行了调查,分析ROP的发生率以及不同出生体重、胎龄ROP发生率及严重情况,以期为ROP的防治提供依据.现将结果报告如下.     

广东省部分三级医院早产儿视网膜病变发生率调查

早产儿视网膜病变(ROP)是导致早产儿视力损害的主要原因,出生体重越低、胎龄越小,ROP发生率越高;ROP早期行视网膜激光光凝或冷冻可以阻止病变发展,使患儿有一个相对良好的视力预后[1-3],但ROP晚期合并视网膜脱离后的治疗效果差且费用高[4,5].所以早期预防和治疗ROP至关重要,但是,目前我国尚缺乏大规模的ROP流行病学研究.我们对2006年1月1日至2007年12月30日在广东省6家三级医院新生儿科住院的出生体重<2000 g的早产儿进行了调查,分析ROP的发生率以及不同出生体重、胎龄ROP发生率及严重情况,以期为ROP的防治提供依据.现将结果报告如下.     

广东省部分三级医院早产儿视网膜病变发生率调查

早产儿视网膜病变(ROP)是导致早产儿视力损害的主要原因,出生体重越低、胎龄越小,ROP发生率越高;ROP早期行视网膜激光光凝或冷冻可以阻止病变发展,使患儿有一个相对良好的视力预后[1-3],但ROP晚期合并视网膜脱离后的治疗效果差且费用高[4,5].所以早期预防和治疗ROP至关重要,但是,目前我国尚缺乏大规模的ROP流行病学研究.我们对2006年1月1日至2007年12月30日在广东省6家三级医院新生儿科住院的出生体重<2000 g的早产儿进行了调查,分析ROP的发生率以及不同出生体重、胎龄ROP发生率及严重情况,以期为ROP的防治提供依据.现将结果报告如下.     

早产儿视网膜病变药物治疗研究新进展

早产儿视网膜病变(retinopathy of prematurity ,ROP)是一种未成熟或低体重出生婴儿的增生性视网膜病变,目前国内临床上治疗主要是冷冻治疗和激光光凝,近年来药物性治疗及基础研究已有一些报道,本文对贝伐单抗、雷珠单抗及其他几个研究性药物治疗ROP研究新进展进行综述。     

Pathogenesis of Purtscher's retinopathy and Purtscher-like retinopathy

PURPOSE: The pathogenesis of Purtscher's retinopathy (PR) or Purtscher-like retinopathy (PIR) is illustrated on two case reports. MATERIAL AND METHODS: Five patients with PR or PIR were examined ophthalmologically. Fluorescein angiography, fundus photography, visual field testing, and electroretinography were also performed. RESULTS: In three cases, the PIR was observed after acute pancreatitis, in one case it arosed from cryoglobulinemy, because of hepatitis C, and in one case it was due to a classic PR after the thorax trauma. In the case of a slow resolution of retinal edema, atrophy of the retinal pigment epithelium and optic nerve, occurred. The therapy has been based on the internal medicine treatment of the causal disease and the administration of corticosteroids, to reduce retinal edema. CONCLUSIONS: PR and PIR are interdisciplinary diseases caused by microembolization of retinal vessels. If changes are intensive and long lasting, visual prognosis is poor.     

Radiation retinopathy: a mistaken diagnosis of hypertensive retinopathy

Radiation retinopathy is a vision‐threatening complication following therapeutic irradiation of ocular, orbital, facial, nasopharyngeal and cranial structures. It is characterised by a delayed onset, slowly progressive, occlusive retinal microangiopathy that develops several years after initial radiotherapy. We present the case of a 44‐year‐old man who developed radiation retinopathy, initially diagnosed as a case of hypertensive retinopathy, following irradiation of a nasopharyngeal carcinoma. A careful history along with classical clinical features and fundus fluorescein angiography helped establish the diagnosis.     

Solar retinopathy

319 patients with a solar retinopathy were seen in an eye clinic in Nepal within 20 months. All patients had either a positive history of sun-gazing or typical circumscribed scars in the foveal area. In more than 80% of the patients the visual acuity was 6/12 or better and did not deteriorate over time. 126 (40%) patients had a history of gazing at the sun during an eclipse, 33 (10%) were sun worshipers and 4 (1%) were in both categories. Three years later 29 patients were re-examined in a follow-up study. Only 16 had had visual disturbances directly after they had gazed into the sun. No colour vision defects were seen in any of the 44 affected eyes, when tested with Panel D 15, while four patients (6 eyes) had some uncertainty with the tritan plates of the Ishihara test charts. Metamorphopsia were recorded in 11 eyes. Five German patients with solar retinopathy were examined in more detail. Colour contrast sensitivity (CCS) was tested for the central and the peripheral visual field. CCS for tritan axis was raised in all patients for the central visual field, while it was normal for the peripheral visual field. This revised version was published online in July 2006 with corrections to the Cover Date.     

Cartwheel retinopathy

A case of Valsalva retinopathy is presented, with a discussion of treatment options.     

Talc retinopathy

A 45 year old man presented with talc retinopathy that had been present for decades. The static nature of this condition indicates that, in the absence of ongoing intravenous drug use, ophthalmological follow up is not necessary     

Melanoma-associated retinopathy

A 63-year-old Taiwanese man with a history of cutaneous melanoma presented with a rapid onset of bilateral shimmering light and blurred vision. A fundoscopic examination was normal. However, visual field examination indicated generalized depression in both eyes. Scotopic rod-specific electroretinography (ERG) was undetectable and scotopic maximal combined-cone and rod-specific ERG showed the characteristics of negative ERG (a normal a-wave and a diminished b-wave, with the b-wave smaller than the a-wave), indicating dysfunction of the bipolar cells. Melanoma-associated retinopathy (MAR) was suspected and a systemic work-up gave a diagnosis of metastatic melanoma. This case shows the typical presentation of MAR. Greater awareness of MAR in patients with unexplained visual loss may help to identify an occult focus of metastatic melanoma.     

Canthaxanthin retinopathy

The eyes of a patient with canthaxanthin retinopathy were obtained at autopsy and examined by light and electron microscopy. Various tissues of one eye were also studied by physicochemical methods. Morphologically, there were red, birefringent, lipid-soluble crystals in the inner layers of the entire retina. They were particularly large and numerous perifoveally, where they were also clinically visible, but they also occurred frequently in a ring-shaped form peripherally and, less frequently, equatorially. The crystals were located in a spongy degeneration of the inner neuropil, where atrophy of the inner parts of the Müller cells was noticed. The compound isolated from the retina was identical with synthetic canthaxanthin according to mass and proton-resonance spectroscopy. Quantitatively, the retina contained up to 42 micrograms canthaxanthin per gram of tissue besides a minor amount of other carotenoids. Of the other tissues of the eye, only the ciliary body contained measurable concentrations of canthaxanthin. From the great number and size of the crystals, on the one hand, and the relatively small amount of isolated canthaxanthin on the other, it was concluded that the crystals presumably represent a canthaxanthin-lipoprotein complex rather than pure canthaxanthin alone. Examination showed that clinically, only the central portion of the canthaxanthin thesaurismosis, where crystals are packed most densely, can be seen.     

Canthaxanthin retinopathy

The authors examined 32 patients with light-dermatosis or vitiligo who were being treated with orally administered Canthaxanthin and betacarotene. Eight had crystalline retinopathy with typical "gold dust" particles in the inner retinal layers, forming a band-shaped zone around the macula and, in more severe cases, also around the optic disk. No deterioration of visual function was found in any of these patients. Crystal deposition was correlated significantly to the total Canthaxanthin dosage but not to the duration of treatment.