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.     

吸氧和早产儿视网膜病变的相关研究

目的:探讨吸氧时间和吸氧浓度与早产儿视网膜病变(retinopathy of prematurity,ROP)病变分期的关系,以期揭示ROP的关键影响因素和发病机制。方法:选择我院新生儿科住院的出生体质量≤2500g和(或)胎龄≤32wk的早产儿156例作为研究对象。16wk时采用双目间接眼底镜进行眼底检查并记录。结果:确诊为ROP的患儿43例86眼,随着吸氧浓度的升高和时间的延长,ROP的病变程度逐步加重。吸氧浓度≥40%时,35.3%的患儿ROP病变超过3期,吸氧时间≥7d时,27.8%的患儿ROP病变超过3期。结论:规范化的氧疗应当是持续低流量的给氧,即使病情需要高流量给氧,通过缓慢逐步减量的方法也可以有效减少ROP的发生。     

早产儿视网膜病变的筛查及其相关因素分析

目的　探讨发生早产儿视网膜病变(ROP)的全身高危因素。方法　对2002年7月1日至2003年6月30日在北京妇产医院出生的胎龄≤34周或体重≤2000g的早产儿进行眼部检查,并分析发生ROP的相关因素。结果　北京妇产医院98例早产儿中,有17例发生ROP,ROP发生率为17 .3%。出现阈值病变需进行激光治疗者4例(7只眼),占4. 1%。ROP组与正常眼底组早产儿在胎龄、出生体重、吸氧时间( >5d)和最高氧分压及发生败血症方面的差异均有统计学意义(均P<0. 05)。Logistic回归分析结果表明小胎龄、低出生体重等是发生ROP的基本因素,长时间吸氧是发生ROP的危险因素。结论　小胎龄、低出生体重、长时间吸氧等因素与ROP的发生有关。     

本期导读

本期以眼底病研究为重点报道内容。早产儿视网膜病变(retinopathyofprematurity,ROP)是在早产儿和低体重儿中发生的一种视网膜血管增生性疾病,主要与治疗时用氧不当等因素有关。据有关调查资料显示,目前我国的ROP发生率有上升迹象,已引起各级政府、各医疗单位及眼科医师的高度重视。为了指导医务人员规范开展早产儿、低体重儿的抢救及诊疗工作,中华人民共和国卫生部委托中华医学会组织儿科学、围产医学、新生儿重症监护、眼科等专业的专家,就早产儿治疗用氧和视网膜病变防治问题进行了专门研究,拟定了《早产儿治疗用氧和视网膜病变防…     

吸氧浓度和血氧饱和度与早产儿视网膜病变的相互关系

吸氧是引起早产儿视网膜病变(ROP)发生的三大主要高危因素之一。持续高浓度和低浓度吸氧所引起的高、低氧血症以及不适宜的血氧饱和度均与ROP有关。对早产儿的氧气治疗应个体化，不应以限制吸入氧浓度为标准；应尽量避免反复的高氧血症或持续的低氧血症；停止用氧时应逐渐降低氧浓度，而不是突然停止，以保证血氧水平的相对稳定。寻找适宜的血氧饱和度范围是解决临床用氧与ROP矛盾的关键。     

早产儿视网膜病变高危致病因素分析

目的 探讨早产儿视网膜病变(ROP)发生的高危致病因素.方法 对2005年1月1日至2008年6月30日在深圳市儿童医院、深圳市妇幼保健院及深圳市眼科医院就诊的胎龄≤34周或出生体重≤2000 g的早产儿进行眼底检查,并对ROP高危致病因素进行多因素分析.结果 完成筛查的219例早产儿中,21例(42只眼)发生ROP,占9.6%,其中阈值病变6例(12只眼),占2.7%.单因素分析显示,ROP的发生与出生体重、孕周、首次救治医院有无新生儿重症监护(NICU)、吸氧＞5d、窒息以及贫血等6项高危因素有关.结论 ROP的发生与孕周短、出生体重低和吸氧时间长有关.     

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.     

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。     

胰岛素样生长因子-1与早产儿视网膜病变

早产儿视网膜病变(ROP)是儿童主要的致盲眼病之一。氧调节和非氧调节生长因子均参与ROP的发生。血管内皮生长因子(VEGF)是一种重要的氧调节因子,其在新生血管形成中的重要作用已逐渐被认识,而非氧调节生长因子(胰岛素样生长因子-1,IGF-1)可能与早产儿脱离子宫内环境有关。本文主要讨论IGF-1和VEGF在ROPⅠ、Ⅱ期病变中的作用,以期能在早期评价个体的ROP发生倾向,及早进行干预,降低ROP发生率。     

Poor postnatal weight gain: A risk factor for severe retinopathy of prematurity

PURPOSE: This study aimed to investigate the relationship between rate of postnatal weight gain and severity of retinopathy of prematurity (ROP). METHODS: All infants (n = 111) screened for ROP at a single tertiary intensive care nursery over a 2-year period with an estimated gestational age of 30 weeks or less and follow-up to at least 42 weeks' postconception were included. The authors performed a retrospective review of records and statistical analysis of risk factors for ROP using multivariate analysis. RESULTS: Infants with severe (stage 3 or greater) ROP gained an average 10.9 g/kg per day in the first 6 weeks of life, compared to a mean of 9.6 g/kg per day for those with mild or no ROP (P =.04). By multiple regression, which included birth weight, gestational age, and 9 other reported risk factors, there was an association between rate of postnatal weight gain and severity of ROP (P =.02). By stepwise regression, 4 variables were associated with ROP severity: estimated gestational age at birth (P =.002), rate of postnatal weight gain (P = .0002), volume of transfused erythrocytes (P =.0001), and culture-proven sepsis (P = .02). CONCLUSION: Poor postnatal weight gain is a risk factor for the development of severe (stage 3 or greater) ROP. Ophthalmologists should take note of those infants who gain less than 50% of their birth weight in the first 6 weeks of life.     

Incidence of ROP in two consecutive Swedish population based studies

AIMS: To prospectively analyse the present incidence of ROP (retinopathy of prematurity) in a well defined geographical area in Sweden, and to compare it with that from a decade earlier in exactly the same area. METHODS: Infants born between 1 August 1998 and 31 July 2000 with a birth weight of 1500 g or less were studied. They were screened for ROP from 5 weeks of postnatal age until the retina was entirely vascularised. The incidence of ROP, with its various stages, was compared with that of a previous (1988-90) population based study in the same geographical area. RESULTS: The incidence of ROP in the present study was 36.4% (mild (18.2%) and severe ROP (18.2%)), which was similar to that of the previous study. Gestational age at birth remained the most important risk factor for ROP. We found a change in the distribution of ROP. The probability of ROP, particularly severe ROP, was highest in the most immature infants while it was lower in the least immature ones. CONCLUSIONS: The incidence of ROP remained the same in two consecutive population based studies. The more "mature" infants developed ROP, particularly severe ROP, less often, while the most immature infants had ROP more often, particularly severe ROP.     

Evaluation of bilirubin as possible protective factor in the prevention of retinopathy of prematurity.

Retinopathy of prematurity (ROP) appears to be a multifactorial disease, the prevention of which is probably impossible even with the most accurate methods of blood-gas monitoring and oxygen restrictions. The oxidative processes and consequent formation of free radicals are probably influenced by the availability of various antioxidants in the immature retina. Bilirubin, the end product of haem catabolism, has recently been regarded as a potential physiological antioxidant. In order to test the suggestion as to the possible effect of bilirubin in reducing the incidence of ROP a retrospective study was undertaken of the medical records of 151 neonates born between 1984 to 1988 who weighed less than 1500 g. Of these, 78 had various degrees of ROP, whereas 73 had no ROP and served as a control group. The daily mean bilirubin values were analysed in accordance with gestational age and birth weight as well as the severity of ROP, and the results were compared with those obtained for the control group. The results showed no correlation between bilirubin levels and severity of ROP in all subgroups of gestational age and birth weight. These findings indicate that there is no apparent protective effect of bilirubin on the development of ROP.     

Pathogenese der Frühgeborenenretinopathie

Retinopathy of prematurity (ROP) is a complex disease with a multifactorial pathogenetic cascade that is still only partially understood. Important pathogenetic factors are gestational age at birth and birth weight. Potent postnatal factors are exposure to supplemental oxygen, slow weight gain and expression of angiogenic growth factors. Some of these crucial aspects of ROP pathogenesis will be discussed in this article and put into clinical context. With the introduction of intravitreal anti-VEGF (vascular endothelial growth factor) treatment into ROP therapy, the pathomechanistic role of VEGF in ROP deserves a special focus. Apart from VEGF, other factors will be discussed that may precede VEGF upregulation and thus may represent targets for an earlier and potentially protective intervention. Among these insulin-like growth factor 1 (IGF-1) appears to be most prominent. Finally, factors such as postnatal weight gain will be discussed in light of their potential role as screening parameters and their ability to predict ROP severity.     

A population based, prospective study of the development of ROP in prematurely born children in the Stockholm area of Sweden.

A prospective population based study including 260 children with a birth weight of 1500 g or less was performed in the Stockholm county. The total incidence of retinopathy of prematurity (ROP) was 40.4%, while severe ROP--that is, stage 3 or more, was seen in 20.0%. Cryotherapy was performed in 10.8%. Logistic regression analysis revealed independent association of both gestational age and birth weight with ROP. The association of gestational age and ROP was significantly stronger, indicating that the degree of immaturity of the eye is a main predictive factor for the development of ROP. The purpose of a general screening for ROP is to identify children requiring cryotherapy. Based on these results it seems appropriate to include children with a gestational age of 32 weeks or less in such a programme and a first examination at 5-6 weeks of postnatal age is suggested.     

Regional differences in screening for retinopathy of prematurity in infants born before 27 weeks of gestation in Sweden – the EXPRESS study

Purpose: The primary aim was to analyse regional incidences of retinopathy of prematurity (ROP) and frequencies of treatment and their relation to perinatal risk factors during a 3‐year period. A secondary aim was to study adherence to the study screening protocol in the different regions. Methods: A population‐based study of neonatal morbidity in extremely preterm infants in Sweden (EXPRESS) was performed during 2004–2007. Screening for ROP was to start at postnatal age 5 weeks and to continue weekly until the retina was completely vascularized or until regression of ROP. Logistic regression analyses were used for evaluation of differences in incidence of Any ROP, ROP 3 or more and ROP Type 1 between the seven regions of the country. Results: The regional incidence of ROP varied between 54% and 92% for Any ROP, between 25% and 43% for ROP stage 3 or more and between 8% and 23% of infants with ROP Type 1, all of whom were treated. There was no significant difference between the regions regarding ROP Type 1, even when adjusting for known risk factors for ROP. Conclusion: The heterogeneity between the regions regarding the incidence of ROP was reduced with increasing severity of ROP, and there was no heterogeneity regarding frequency of treatment for ROP, which is the most important issue for the children. We cannot exclude observer bias regarding mild ROP and ROP stage 3 in this study.     

Retinopathy of prematurity: a review of risk factors and their clinical significance

Retinopathy of prematurity (ROP) is a retinal vasoproliferative disease that affects premature infants. Despite improvements in neonatal care and management guidelines, ROP remains a leading cause of childhood blindness worldwide. Current screening guidelines are primarily based on two risk factors: birth weight and gestational age; however, many investigators have suggested other risk factors, including maternal factors, prenatal and perinatal factors, demographics, medical interventions, comorbidities of prematurity, nutrition, and genetic factors. We review the existing literature addressing various possible ROP risk factors. Although there have been contradictory reports, and the risk may vary between different populations, understanding ROP risk factors is essential to develop predictive models, to gain insights into pathophysiology of retinal vascular diseases and diseases of prematurity, and to determine future directions in management of and research in ROP.     

Incidence and early course of retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group.

In the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (ROP), 4099 infants weighing less than 1251 g at birth underwent sequential ophthalmic examinations, beginning at age 4 to 6 weeks, to monitor the incidence and course of ROP. Overall, 65.8% of the infants developed ROP to some degree; 81.6% for infants of less than 1000 g birth weight. As expected, ROP incidence and severity were higher in lower birth weight and gestational age categories. Black infants appeared less susceptible to ROP, of all severity categories, than nonblack infants. The timing of retinal vascular events correlated more closely with postconceptional age than with postnatal age, implicating the level of maturity more than postnatal environmental influences in governing the timing of these vascular events. These results include the current incidence of various severity stages of ROP found in the United States and provide new insight into the development of ROP.     

Onset of retinopathy of prematurity as related to postnatal and postconceptional age.

The hypothesis that both perinatal events and stage of retinal development are important factors in determining the age at onset of retinopathy of prematurity (ROP) was tested by comparing gestational age at birth with postnatal and postconceptional age when ROP (using ICROP) was first seen. The study population consisted of 207 infants (111 placebo (P) treated, 96 vitamin E (E) treated) who developed ROP among a group of 914 premature infants (460 P, 454 E) enrolled in a randomised clinical trial of the effect of prophylactic use of vitamin E at pharmacological serum levels on incidence and severity of retinopathy. The mean postnatal age at onset of retinopathy was delayed in E treated infants compared with P treated infants by 1.4 weeks (t = 4.004, p < 0.0001). For both P and E treated infants postnatal age at onset of ROP (which reflects the state of retinal development at which birth insults occur) and postconceptional age at onset of ROP which defines state of maturity) were correlated with gestational age at birth. This suggests that both the event of premature birth and the extent of retinal development are important in determining when ROP will first be observed.     

Mechanism of angiostatin induced reduction of vascular leakage in retina and iris of rats with retinopathy of prematurity

AIM: To study the effect of an intravitreal injection of angiostatin on vascular leakage in the retina and iris of oxygen-induced retinopathy of prematurity (ROP). METHODS: Brown Norway rats at postnatal day 7 (P7) were exposed to hyperoxia (750mL/L O₂) for 5 days (P7-12) and then returned to normoxia to induce retinopathy. Angiostatin was reconstituted in sterile Phosphate Buffered Saline (PBS) and diluted to desired different concentrations. Angiostatin solution was injected into the vitreous of the right eye of the ROP rats at P14 and the age-matched normal rats through pars plana using a glass capillary, and the left eye received the same volume of sterile PBS as the control. Vascular permeability was quantified at 1, 2 and 3 days after the injection by measuring albumin leakage from blood vessels into the retina and iris using the Evans blue method and normalized by total protein concentrations. The expression of vascular endothelial growth factor (VEGF) in retina was evaluated using the Western Blot analysis and immunohis- tochemistry 24 hours following the injection. RESULTS: ROP rats showed significant increases of vascular permeability in the retina and iris (P <0.01). Angiostatin reduces vascular permeability in a dose-dependent manner in the retina of ROP rats. The reduction showed a time course trend. Angiostatin injection reduced retinal vascular permeability by approximately 1.5 and 2-fold at P15 (P <0.05) and P16 (P < 0.01), respectively. Angiostatin injection significantly reduced VEGF levels in the retina of ROP rats but did not affect retinal VEGF levels in normal rats. CONCLUSION: Angiostatin significantly decreases patholog- ical vascular permeability in the retina and iris of ROP rats but not in normal rats. Angiostatin down-regulates VEGF expression in retina of ROP rats. These results suggest that angiostatin may have a therapeutic potential in the treatment of ROP and other diseases with vascular leakage.