进一步完善早产儿视网膜病的筛查制度

早产儿视网膜病(ROP)是儿童致盲的重要原因,已成为发展中国家日益突出的医疗和社会问题。防治ROP的关键是建立科学的筛查制度。文章主要讲述筛查制度中所涉及的筛查对象、筛查时机、随访方案等,以及如何管理该制度,以期对所有符合标准的早产儿做到一个不漏地筛查和全程随访,从而做到早期诊断和及时治疗,以降低致盲率。     

Retinopathy of prematurity: Past,present and future

Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina occurring principally in new born preterm infants. It is an avoidable cause of childhood blindness. With the increase in the survival of preterm babies, ROP has become the leading cause of preventable childhood blindness throughout the world. A simple screening test done within a few weeks after birth by an ophthalmologist can avoid this preventable blindness. Although screening guidelines and protocols are strictly followed in the developed nations, it lacks in developing economies like India and China, which have the highest number of preterm deliveries in the world. The burden of this blindness in these countries is set to increase tremendously in the future, if corrective steps are not taken immediately. ROP first emerged in 1940s and 1950s, when it was called retrolental fibroplasia. Several epidemics of this disease were and are still occurring in different regions of the world and since then a lot of research has been done on this disease. However, till date very few comprehensive review articles covering all the aspects of ROP are published. This review highlights the past, present and future strategies in managing this disease. It would help the pediatricians to update their current knowledge on ROP.     

An Update on Retinopathy of Prematurity (ROP)

Retinopathy of prematurity (ROP) is a proliferative retinal vascular disease affecting the retina of premature infants. The clinical spectrum of ROP varies from spontaneous regression to bilateral retinal detachment and total blindness. Between these two extremes lies the form of ROP, which is amenable to treatment with laser photocoagulation, anti-vascular endothelial growth factor drugs or surgery. Increasing rates of preterm births coupled with better survival rates but lack of uniform quality of neonatal care and delays in diagnosis have led to increasing ROP blindness. Atypical forms of Aggressive Posterior ROP are seen in heavier birth weight babies in developing countries. Prevention of ROP by following stringent protocols for supplemental oxygen, prevention of sepsis, timely screening and laser treatment by a concerted and collaborative effort of neonatologists and ophthalmologists are required to fight the blindness from ROP.     

Screening for retinopathy of prematurity

The CRYO-ROP study confirmed the success of treatment for ROP and made screening mandatory. National based screening has been influenced by the varied incidence of disease in developed and developing countries. Most ophthalmologists in developed countries screen infants born between 1000 and 1500 g and between 28 and 31 weeks gestation post menstrual age. The 1984 classification has been updated to highlight the importance of plus disease. The ETROP study findings have resulted in earlier treatment and elevated the importance of screening. Measures such as nesting may help to reduce infant distress during examination. It is important for neonatal units to have an agreed policy on screening and both neonatologist and neonatal nurses have an invaluable role. Diagnostic retinal imaging and telemedicine may have an increasing role in future screening. Timely and accurate screening is the most important first step as earlier treatment results in improved visual prognosis.     

Educational paper

Retinopathy of prematurity (ROP) is a proliferative retinal vascular disease affecting the premature infant with an incompletely vascularized retina. The spectrum of ophthalmological findings in ROP exists from minimal sequelae, which do not affect vision, to bilateral retinal detachment and total blindness. With the increased survival of very small infants, retinopathy of prematurity has become one of the leading causes of childhood blindness. Over the past two decades, major advances have been made in understanding the pathogenesis of ROP, to a large extent as a result of changes in clinical risk factors (oxygen and non-oxygen related) and characteristics observed in ROP cases. This article provides a literature review on the evolution in clinical characteristics, classification and treatment modalities and indications of ROP. Special attention is hereby paid to the neonatal factors influencing the development of ROP and to the necessity for everyone caring for premature babies to have a well-defined screening and treatment protocol for ROP. Such screening protocol needs to be based on a unit-specific ROP risk profile and, consequently, may vary between different European regions. Conclusion: Retinopathy of prematurity is an important cause of ocular morbidity and blindness in children. With better understanding of the pathogenesis, screening and treatment guidelines have changed over time and are unit specific.     

早产儿视网膜病发病机制的研究进展

早产儿视网膜病(retinopathy of prematurity,ROP)是一种与早产儿相关的眼部疾病,特点是在视网膜发育过程中血管异常的发生,重症者可引起视网膜脱离而失明,是儿童视力障碍和失明的主要原因.ROP是一个复杂的疾病,除了目前发现的吸氧、胎龄小、低出生体重、细胞因子等因素以外,促红细胞生成素、感染等因素均是可能影响本病发生的因素,根据其发病机制,早期发现、早期治疗已愈发重要,现就ROP发病机制的研究现状及进展进行综述.     

AP-ROP in an infant with minimal oxygen exposure

Abstract   Retinopathy of prematurity (ROP) is a multifactorial disease affecting the developing retinal vasculature and remains an important cause of blindness in very preterm infants. Rush disease, or aggressive posterior ROP (AP-ROP), progresses rapidly to stage 5 disease without exhibiting the classical course that includes stages 1–3. We describe an infant with minimal exposure to oxygen who developed AP-ROP that led to bilateral retinal detachments and a poor visual outcome, despite following current recommended screening guidelines.     

Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control

Globally at least 50,000 children are blind from retinopathy of prematurity (ROP) which is now a significant cause of blindness in many middle income countries in Latin American and Eastern Europe. Retinopathy of prematurity is also being reported from the emerging economies of India and China. The characteristics of babies developing severe disease varies, with babies in middle and low income countries having a much wider range of birth weights and gestational ages than is currently the case in industrialized countries. Rates of disease requiring treatment also tend to be higher in middle and low income countries suggesting that babies are being exposed to risk factors which are, to a large extent, being controlled in industrialised countries. The reasons for this "third epidemic" of ROP are discussed as well as strategies for control, including the need for locally relevant, evidence based criteria which ensure that all babies at risk are examined.     

Blindness and Partial Sight Due to Retinopathy of Prematurity in the Netherlands: 1975-1987

ABSTRACT. In 1975–1987 at least 84 children developed blindness or impaired vision due to retinopathy of prematurity (ROP) in the Netherlands. Neonatal data were obtained on 74 (86%). Unexpectedly most children (40 i.e. 54%) had been in level I and II hospitals after birth. Screening for ROP had been either insufficient or not timed according to present recommendations in 33 out of 40 children in level I and II hospitals and 25 out of 34 in level III hospitals. As the number of children with ROP has not changed appreciably over the last 40 years, while birth rates in the Netherlands have steadily decreased, the incidence of blindness/impaired vision due to ROP has probably increased. In the current population at risk of ROP which differs considerably from the one during the first epidemic, the disease may not be completely preventable. We conclude that improvements in screening procedures and timely treatment are crucial in order to improve the present situation.     

Retinopathy of prematurity—promising newer modalities of treatment

Retinopathy of prematurity (ROP) is a disorder of neonatal retinal vascularization. The incidence is increasing in developing countries like India in view of the rising numbers of preterm deliveries and improved neonatal care. Traditional modalities of treatment included cryotherapy and laser therapy, which were laborious and required special training. Hence, research is on way to find novel treatment modalities directed at various levels of pathogenesis for this blinding disease. We reviewed the published and unpublished literature on newer methods of ROP management. The pathogenesis of ROP has been studied with respect to the mediators of angiogenesis. Anti vascular endothelial growth factor (Anti-VEGF) therapy has been extensively studied and the studies have demonstrated its promising role early stages of ROP. The role of Insulin like growth factor (IGF), Granulocyte colony stimulating factor (GCSF), and June kinases (JNK) inhibitors are being studied by various researchers across the world. Gene therapy holds promise in the reversal of ROP changes.     

Retinopathy of prematurity: clinical aspects

There have been many major advances recently that have improved the identification and management of retinopathy of prematurity (ROP). This chapter describes the clinical features of ROP and then considers briefly the incidence and epidemiology of acute phase disease. This is followed by a discussion of the two ROP epidemics and ROP-induced disability in high, low and middle income countries, and how this has been impacted by treatment. The principles and specifics of screening for ROP are considered, focusing on certain topical issues such as whether one screening guideline suits all populations. Treatment has undergone several advances, so that now laser therapy has overtaken cryotherapy as the preferred mode of treatment, and treatment at an earlier stage is now being considered. Finally, the authors attempt to look into the future and wonder how the criteria for treatment will change, and whether innovations in ocular imaging will impact ROP screening in both high and middle income countries.     

Retinopathy of prematurity: overview of new global problem

Retinopathy of prematurity (ROP) is a disease characterized by abnormal retinal vasculature in preterm infants. It is an important cause of visual disability in premature infants and although the incidence varies among different countries it is increasing as advances in neonatal care result in improved survival. Oxygen, growth factors like vascular endothelial growth factor, and poor postnatal growth play a significant role in the pathogenesis of ROP. Targeting lower oxygen saturation is associated with a reduction in ROP, but with increased mortality. Screening for ROP varies between centres and countries but generally it includes preterm infants (less than 32 weeks’ gestation) and/or those with a birth weight of less than 1500g. ROP has been recently reclassified as type-1-needing treatment and type-2 ROP needing observation, based on the benefits and treatment efficacy. Laser therapy and anti-VEGF are the two main treatments. Recent reports suggest that anti-VEGF therapy may have better visual outcomes (myopia) and a better safety profile. ROP is a global disease of prematurity and understanding the pathogenesis, course of ROP, preventive strategies, treatment options and outcomes are essential for all healthcare professionals caring for preterm babies. This short article describes the evidence for screening, prevention and treatment options and looks ahead to possible advances in the near future.     

Retinopathy of prematurity: the disease process, classifications, screening, treatment, and outcomes

Retinopathy of prematurity (ROP) is the cessation of normal eye development and subsequent abnormal vessel growth that occurs exclusively in premature infants. ROP was first discovered in the 1940s and was for two decades the leading cause of blindness in children. Currently, the disease causes about 500 new cases of blindness per year. The severity of the disease increases with decreasing gestational age. The pathogenesis of ROP involves disruption of normal retinal vascularization. Vessel endothelial growth factor, insulin-like growth factor, and oxygen play important roles in its development. ROP is classified using an international classification system that provides direction for screening and treatment of premature infants. Examinations are performed by ophthalmologists, who identify the scope of vascularization, the degree of abnormal vessel growth, and the amount of the eye that is affected. Treatment modalities include cryosurgery and laser photocoagulation. Long-term outcomes include both structural and functional vision problems.     

早产儿视网膜病的手术治疗

早产儿视网膜病(retinopathy of prematurity,ROP)是儿童重要的可预防的致盲性疾病,需早期发现、及时治疗,对于阈值期及阈值前1型病变首选激光光凝治疗,如果进展为视网膜脱离需进行巩膜扣带术或玻璃体手术,文章对ROP手术治疗的现状及进展进行评述。     

Incidence and severity of retinopathy of prematurity in Vietnam,a developing middle-income country

BACKGROUND: Although retinopathy of prematurity (ROP) is a leading cause of childhood blindness, its impact in lower income countries is not well documented. The World Health Organization has proclaimed that infants at risk for ROP should have screening eye examinations and access to treatment. PATIENTS AND METHODS: A prospective study was conducted from January 1 through December 31, 2001, at Tu Du Hospital in Ho Chi Minh City for premature infants who weighed 1,500 g or less at birth or were 33 gestational weeks or younger. Serial examinations were used to classify ROP, and treatment outcomes were noted. RESULTS: Two hundred twenty-five consecutive infants were included in the data analysis. Birth weights ranged from 900 to 2,000 g (mean, 1,512 g). Gestational ages ranged from 26 to 36 weeks (mean, 31 weeks). ROP was present in 103 (45.8%) of the 225 infants. In infants who weighed 1,250 g or less at birth, the ROP rate was 81.2% (26 of 32 infants). Threshold ROP was present in 9.3% of the 225 infants but in 25% of the 32 infants. Twenty-four eyes received treatment, whereas 16 lacked the family resources. Of the 24 treated eyes, 18 (75%) had a favorable outcome. Of the 16 untreated eyes, only 3 had a favorable outcome. CONCLUSIONS: ROP incidence is high in Vietnam, similar to that in the United States. However, larger, older infants are at risk in Vietnam and the rate of severe ROP seems to be higher. This necessitates an ROP screening paradigm different from that currently used in the United States.     

The discovery of retrolental fibroplasia and the role of oxygen: a historical review, 1942-1956

Nearly 50 years after it was thought to be conquered, retinopathy of prematurity (ROP) continues to cause vision disturbances and blindness among prematurely born infants. During the 1940s and early 1950s, researchers and caregivers first identified and struggled to eliminate this problem, which seemed to come from nowhere and was concentrated among the most advanced premature nurseries in the U.S. Research studies initially identified many potential causes, none of which could be proved conclusively. By the mid 1950s, oxygen was identified as the culprit, and its use was immediately restricted. The rate of blindness among premature infants decreased significantly. ROP was not cured, however. By the 1960s, it had reappeared. The history of ROP serves to remind us that, despite our best intentions, the care and treatment of premature newborns will always carry with it the possibility of iatrogenic disease. This caution is worth remembering as we work to expand the quality and quantity of clinical research.     

急进型后极部早产儿视网膜病的研究进展

急进型后极部早产儿视网膜病（AP-ROP）是一种特殊类型的早产儿视网膜病,其眼底特征表现为视网膜后极部血管扩张迂曲严重,并累及所有象限,而且病情进展非常迅猛。随着越来越多的AP-ROP 病例被发现,并且治疗效果相对差,使AP-ROP 问题日益受到关注。哪些早产儿更易患病？如何做到早期诊断？是否有更好的治疗技术？国内外对此进行了一定的研究探索。该文对AP-ROP 的危险因素、筛查、临床诊断、治疗的临床研究最新进展做一综述。     

Retinopathy of prematurity: Recommendations for screening

Retinopathy of prematurity (ROP) is a disorder of the developing retinal blood vessels of the preterm infant. New recommendations for screening and treatment of ROP have been published in the past few years. Current evidence suggests that screening infants with gestational ages of 30 6/7 weeks or less (regardless of birth weight) and birth weights of 1250 g or less is a strategy with a very small likelihood that an unscreened baby would have treatable ROP. Individual centres may choose to extend birth weight screening criteria to 1500 g. Initial screening should be performed at 31 weeks' postmenstrual age in infants with gestational ages of 26 6/7 weeks or less at birth, and at four weeks' chronological age in infants with gestational ages of 27 weeks or more at birth by an ophthalmologist skilled in the detection of ROP. Follow-up examinations are conducted according to the ophthalmologist's recommendation. Infants with high-risk prethreshold ROP and threshold ROP are referred for retinal ablative therapy. Developing processes for ROP screening, documenting results and communicating results to parents as well as health professionals involved in the infant's care are important responsibilities for all nurseries providing care for preterm infants.     

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??Abstract??Objective??To evaluate the clinical features of retinopathy of prematurity ??ROP?? and the long-term therapeutic effect. Methods??The clinical data ?? ROP stage ?? the therapy and long-term prognosis of 107 preterm infants with ROP were retrospectively analyzed??who were admitted to Children’s Hospital of Fudan University between January 1?? 2004 to July 31?? 2009. Results??Among 64 preterm infants with Stage 1 or 2 ROP?? 6 infants with Stage 2 ROP developed to type I threshold ROP and received the laser therapy. All the follow-up infants except the death did not need special treatment without the vision affected later and the lesions of ROP were self-limiting. Fifteen infants were detected with Stage 3 ROP?? of whom 14 infants had threshold ROP and received the laser therapy. Another one infant who did not develop to the threshold ROP had no treatment. Eleven follow-up infants had no blindness ?? but three infants’ vision was affected severely after the treatment and 8 infants had the normal vision. There were 28 Stage 4 or 5 ROP infants??but 18 infants were followed up completely. In follow-up infants ?? there was only one infant with the normal post-operative vision??5.6%???? 12 ones had blindness after treatment ??66.7%???? and the remaining five ones had poor eyesight and were light-sensitive ??27.7%??. Conclusion??It’s a key step to screening and intervention in time at the early stage of ROP. Otherwise the outcome is very poor when developed to the late stage with retinal detachment.