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.     

Chronic retinopathy of prematurity

A pathologic analysis of 40 autopsy cases of chronic retinopathy of prematurity is presented. The type of retinal detachment in chronic retinopathy is unique, resulting from progressive changes in the peripheral retina: folding at the site of extraretinal vasoproliferation; scroll-like rolling anteriorly towards the lens; foreshortening of entire retina with detachment; and closure of the retinal "funnel." The biomechanical intraretinal and extraretinal factors operating during this process are discussed. Also presented are some interesting atypical features found in this series: arrested retinopathy; "sea fan" extraretinal vascular fronds; retinopathy in anencephaly; cribriform vanguard; and extramedullary erythropoiesis.     

早产儿视网膜病变筛查和阈值期治疗的研究

目的研究早产儿视网膜病变(ROP)的发生率,评估ROP阈值期治疗效果。方法使用双目间接检眼镜对108例早产儿进行ROP筛查,将筛查结果进行统计学分析,达到阈值病变的患儿及时进行视网膜激光光凝或经巩膜、视网膜冷凝术。结果筛查108例早产儿,发现ROP23例,发生率为21.3%。在所有ROP患儿中,ROP1期13例,占56.5%;ROP2期3例,占13.0%;ROP3期7例,占30.4%。其中ROP3期患儿均伴有附加病变,达到阈值病变标准。ROP患儿出生体重为(1.43±0.25)kg(t=4.059,P<0.001);孕周为(31.0±2.3)周(t=2.637,P=0.013);吸氧时间为1~49d,平均17d(n=23,Z=-3.630,P<0.001);需要机械辅助呼吸患儿18例(χ2=12.009,P=0.001);上述指标与非ROP患儿比较,差异均有统计学意义;而与是否多胎的差异无统计学意义(χ2=1.013,P=0.314)。Logistic回归分析:出生体重低(β=-2.542,OR=0.079,P=0.032)和使用机械辅助呼吸(β=1.341,OR=3.823,P=0.025)的患儿是发生ROP的相关高危因素。7例阈值期病变患儿中,6例进行激光光凝或冷凝治疗。术后随访2个月至2年,手术眼的结构和视功能未见异常。1例阈值期病变患儿未予治疗,于1个月后出现视网膜脱离。结论出生体重轻、孕周少、吸氧时间长、需要机械辅助呼吸的早产儿发生ROP的风险较高。对阈值期病变患儿应及时进行激光光凝或冷凝治疗。     

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。     

Management of retinopathy of prematurity

During the last year, ophthalmology has continued to benefit from an ordered approach to unraveling the pathophysiology and treatment of retinopathy of prematurity. Over the last year, new incidence and treatment information from the Cryotherapy for Retinopathy of Prematurity Study has been presented. The use of the indirect laser to treat retinopathy of prematurity has been introduced. Scleral buckling and vitrectomy continue to define themselves in the management of advanced retinopathy of prematurity. Oxygen continues to be deemphasized as a solitary causative agent in retinopathy of prematurity, and other biochemical agents are being explored as playing a role in the pathogenesis and treatment.     

Management of retinopathy of prematurity

Seventeen patients with symmetrical stage 3 retinopathy of prematurity (ROP) and plus disease as described in the International Classification of ROP had one eye randomized to cryotherapy and the other to control. Seventy-seven percent of the patients were under 1000 grams at birth and females outnumbered males by a 2 to 1 ratio. The average chronologic age at which cryotherapy was performed was three months. Twelve of seventeen treated eyes (71%) showed resolution of the ROP and 10 of 17 untreated eyes (59%) became significantly worse. However, only five patients had improvement in the treated eye and progression in the untreated eye, a number too small to provide statistical significance. Six eyes with Stage IV ROP were operated by encircling scleral buckling techniques because of total retinal detachment secondary to peripheral traction and cicatrization arising from the ridge. In five patients the unoperated eye had already developed a retrolental membrane, and in one patient bilateral detachments were present. Five of the six operated retinas were reattached.     

早产儿视网膜病变发病情况分析

目的 分析早产儿视网膜病变(ROP)的发病情况.方法 回顾性分析2005年9月至2008年5月来就诊的胎龄小于36周、体重低于2500g的210例早产儿的眼底筛查情况及高危因素.结果 210例早产儿中,ROP的发生率为12.9%,其中ROP3期以上的发生率为3.8%;低孕周、低体重、出生后吸氧时间过长、严重的新生儿疾病的早产儿ROP发生率高;双生子ROP发生率(20.5%)高于单生子(10.8%),且ROP发生严重.结论 低孕周、低体重、出生后吸氧时间过长、患严重的新生儿疾病、非单生子等是引起早产儿视网膜病变的高危因素.     

Prevention of retinopathy of prematurity

Retinopathy of prematurity (ROP) is related to oxygen-regulated vascular endothelial growth factor and to insulin-like growth factor-I. After premature birth, supplemental oxygen induces a retinal hyperoxic condition with vasoconstriction and to a definitive interruption of retinal vasculogenesis. Peripheral ischemia may stimulate retinal neovascularization and the onset of additional ROP-related complications. The natural course of the disease may result in irreversible blindness if not promptly diagnosed and attended. Recently, a significant increase in the prevalence of ROP has been observed in survival rates of preterm infants, especially in emerging-economy countries in Latin America, Asia, and Eastern Europe. This article addresses the main preventive measures in ROP.     

Thrombocytopenia and retinopathy of prematurity

BACKGROUND: Platelets may act as vascular endothelial growth factor (VEGF) scavengers, possibly limiting neovascularization in retinopathy of prematurity (ROP). The purpose of this study was to investigate the association between thrombocytopenia (platelets <150,000/μL) and the development of type 1 ROP. METHODS: This was a retrospective 1:1 matched case-control study. Cases required laser; controls developed no or stage 1 ROP and were matched for birth weight within 100 g and gestational age within 1 week. Most recent platelet count prior to laser (case) and matched postmenstrual age (control) were abstracted. Conditional logistic regression was used. RESULTS: A total of 91 cases and 91 controls were reviewed. Of the cases, 25% had thrombocytopenia; of controls, 13% (P = 0.034; OR = 2.38; 95% CI, 1.04-5.43). Birth weight, gestational age, postmenstrual age, and culture-proven sepsis were not confounders in multivariate analysis. The association was significant for zone 1 (n = 16; OR = 9.00; 95% CI, 1.14-71.0) but not for zone 2 (OR = 1.43; 95% CI, 0.54-3.75) cases and controls. CONCLUSIONS: Thrombocytopenia was associated with type 1 ROP, primarily among infants with zone 1 ROP. This effect may result from disease location or disease timing, as posterior disease occurs at an earlier postmenstrual age. Longitudinal studies are required to further examine the roles of cumulative platelet deficits, thresholds, or critical time windows in the observed association.     

Cryocoagulation in retinopathy of prematurity

Transconjunctival cryocoagulation was performed on 38 eyes of 21 premature infants. The eyes were in stages 2-4 of retinopathy of prematurity. In stage 2 cryocoagulation was performed only if there were hemorrhages and/or a dilatation of the retinal vessels or (once) a rubeosis iridis. Cryocoagulation in stage 2, often considered superfluous, was effective in every case, but in stage 3 it was ineffective in many cases.     

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.     

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   

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.