早产儿视网膜病变治疗研究新进展

早产儿视网膜病变(retinopathy of prematurity,ROP)是早产儿和低体重儿发生的一种视网膜血管增生性病变,近年来随着早产儿的存活率不断提高,ROP的发生率也明显增加。以往ROP的治疗主要是在阈值期或阈值后期,给予视网膜激光及手术治疗为主,同时给予机体全身应用激素药物,因治疗时机晚,且手术风险大、并发症多,治疗效果很不理想。寻找一种在病变发生早期应用,且操作简单的安全、有效的治疗方法,已成为研究者的共识。我们就目前治疗ROP的新进展进行综述。     

早产儿视网膜病变发病机制及药物治疗的研究进展

早产儿视网膜病变(ROP)是发生于早产儿和低体重儿中的视网膜血管增生性病变,是儿童致盲的主要原因之一。研究ROP发生的危险因素、发病机制及药物干预治疗,对降低ROP的发生率和致盲率有着极其重要意义。近年来随着新生血管研究的深入,新生血管抑制剂用于预防及治疗ROP的研究也越来越多,本文拟对近年来有关ROP上述研究进展作一综述。     

玻璃体腔注射抗VEGF药物治疗早产儿视网膜病变的研究进展

早产儿视网膜病变(ROP)是发生于早产儿的一种未成熟视网膜血管增殖性眼病，是一种严重的儿童致盲性眼病。视网膜激光光凝术是治疗ROP的经典方法，然而激光治疗是破坏性的，尤其是在ROP Ⅰ区病变的情况下，视网膜激光光凝治疗会引起严重的并发症。研究表明，血管内皮细胞生长因子(VEGF)在ROP发生及发展过程中具有关键作用，而玻璃体腔注射抗VEGF药物不仅能有效控制ROP，并且为视网膜继续发育争取了机会。本文就玻璃体腔内注射抗VEGF药物治疗ROP的治疗指征、药物筛选、注射部位、给药剂量、疗效观察以及并发症对其进行综述。     

早产儿视网膜病变发病机制及治疗的研究现状

早产儿视网膜病变(ROP)是早产儿和低体重儿发生的一种视网膜血管增生性病变.近些年来,随着我国医疗条件和水平的提高,早产儿的存活率不断提高,同时ROP的发生率也相应的增加.ROP发展到晚期治疗非常棘手,早期发现及时治疗可能挽救部分患儿的视力.为了降低ROP的发生率和致盲率,故研究ROP发生的危险因素,发病机制及干预治疗,具有极其重要意义.此文拟就有关内容,搜集了国内外有关资料,对其研究现状作一综述.     

早产儿视网膜病变研究进展

早产儿视网膜病变(ROP)是一种增殖性视网膜病变,是世界范围内儿童致盲的主要原因,本文阐述了ROP的发病机制、危险因素、诊断、治疗及近年新进展。     

早产儿视网膜病变的研究进展

早产儿视网膜病变(retinopathy of prematurity,ROP)是早产儿尤其是伴有低体重儿发生的一种视网膜毛细血管发育异常化的双侧性眼病,表现为视网膜缺血,新生血管形成和增生性视网膜病变,重症者可引起视网膜脱离而导致永久性失明。ROP已经成为我国儿童致盲的原因之一。本文着重阐述了早产儿视网膜病变的发病机制、诊断和治疗的最新进展。     

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。     

重视抗血管内皮生长因子药物对早产儿视网膜病变患儿神经发育的影响

早产儿视网膜病变(ROP)是引起儿童视力障碍的主要原因之一。随着人们对ROP发病机制研究的不断深入, 抗血管内皮生长因子(VEGF)药物及临床应用使ROP的治疗模式发生了转变, 因其治疗便捷、疗效明确的优势, 已成为ROP的一种重要治疗方法。由于ROP患儿存在各器官功能发育不全, 玻璃体腔注射抗VEGF药物可进入血液循环一过性地降低血液中VEGF水平, 理论上可能会对ROP患儿各器官(尤其大脑)发育造成不良影响。因此, 应重视抗VEGF药物对ROP患儿神经发育的影响, 严格把握其适应证, 规范其临床应用, 不断提高ROP的总体疗效。     

早产儿视网膜病变研究进展

早产儿视网膜病变(retinopathy of prematurity,ROP)是早产儿尤其是伴有低体重儿发生的一种视网膜毛细血管发育异常化的双侧性眼病,表现为视网膜缺血、新生血管形成和增生性视网膜病变,重者可以引起视网膜脱离而导致永久性失明。近年来,随着围产医学的进步,早产儿成活率逐渐增加,相应ROP发生率也呈增加趋势。由于其后果严重,对患儿及其家庭造成巨大伤害,ROP也日益引起人们的重视。目前ROP的确切病因仍未明确,真正的发病机制尚不十分清楚,亦缺乏有效的预防措施。本文从ROP的发病因素、发病机制及干预措施三方面对其新近研究进展作一综述。     

雌激素干预早产儿视网膜病变的研究进展

早产儿视网膜病变(ROP)是一种以视网膜新生血管为主要病理改变的疾病,是儿童致盲的主要原因之一。目前主要采取激光或手术治疗,损伤较大且效果不理想,因此寻找有效的药物途径来预防ROP的发生成为研究热点。血管内皮生长因子(VEGF)是一种已知的促新生血管生成物质,在ROP的发病过程中起关键作用,雌激素通过调控VEGF减少新生血管生成,从而防止ROP的发生。本文将围绕早产儿视网膜病变新生血管,VEGF以及雌激素三者之间的关系进行综述。     

早产儿视网膜病变发病基础及抗VEGF药物治疗研究进展

早产儿视网膜病变（ｒｅｔｉｎｏｐａｔｈｙｏｆｐｒｅｍａｔｕｒｉｔｙ,ＲＯＰ）是发展中及发达国家儿童致盲的主要因素。近年来,科研人员的不断努力使得ＲＯＰ发病机理更加清晰地被认知,抗血管内皮生长因子药物治疗为ＲＯＰ患儿带来了越发光明的世界。本文综述了ＲＯＰ的发病机理、相关的血管生成因子、血小板体积、抗ＶＥＧＦ药物治疗等方面的研究进展。     

The results of panphotocoagulation laser treatment in retinopathy of prematurity in the West Pomeranian Region in 2003-2005 years

PURPOSE: ROP--retinopathy of prematurity is a disease of the retina and the vitreous body of premature infants, especially born before 28 weeks of intrauterine life (71%), rare till 33 weeks of pregnancy (7.6%). The pathogenesis is involved with damage of immature vessels of the retina. The disease seems to self-regress in 80%. According to stage of changes of the retina there could be some complications of the organ of vision like: refractive errors, disturbances of eyeball movement, poor vision or even blindness (19.01%). ROP is now second (after atrophy of the optic nerve) cause of blindness in children (3). Aim of our study was the analysis of the results of laser-treatment in ROP in West Pomeranian region in years 2003-2005 and estimation of the risk factors of advanced stages of ROP. MATERIAL AND METHODS: Since January 2003 to June 2005 in Outpatients Clinic for Premature Infants of the Ophthalmology Department of The West Pomeranian Medical University in Szczecin we have examined 708 children. 40 premature infants (78 eyes) were treated with panphotocoagulation of the retina because of advanced ROP We have used the Ocu-Lights SL laser, manufactured by Iris Medical. RESULTS: Laser treatment caused regression of ROP in 88.5% of children. In 11.5% the progression of ROP caused secondary retina detachment. CONCLUSIONS: Respiratory failure, anemia, infections and multi-organ inflammations increase the risk of ROP Good results of laser treatment depend of beginning of the therapy in the right stage of ROP On the final results of treatment could have got the influence both: immaturity of the child and the showed risk of factors.     

Risikofaktoren und Prävention der Retinopathia praematurorum

The history of retinopathy of prematurity (ROP) gives a prime example of how dangerous the uncontrolled introduction of a new medical treatment – particularly in the field of neonatology – may be. The most important risk factors for the development of ROP are the immaturity of premature infants as well as uncontrolled and/or inadequate treatment with oxygen. In comparison to the fetus, the premature infant is exposed to a nonphysiologically high oxygen concentration. This hyperoxia leads to formation of aggressive oxygen radicals on the one hand and, on the other hand, to temporarily reduced production of growth factors such as vascular endothelial growth factor and erythropoietin, which both play an important role in the pathogenesis of ROP. The most important measure to prevent ROP is restrictive and carefully monitored oxygen treatment. Medical treatment to prevent ROP includes injection of D-penicillamine and retinol, but the available data are still limited, particularly with regard to the long-term effects of this treatment. A higher oxygenation in prethreshold ROP does not lead to recovery of ocular findings, but it increases the incidence of pulmonary complications. A reduction of light intensity in neonatal intensive care units proved not to be efficient for preventing ROP. To avoid blindness, standardized screening of the risk group is needed.     

早产儿视网膜病变模型研究进展

目前,早产儿视网膜病变(retinopathy of prematurity,ROP)已经成为世界范围内儿童致盲的重要原因,约占儿童致盲原因的6%～18%。防治ROP以改善早产儿的生存质量已成为全球关注的焦点。因此,建立合适的视网膜新生血管动物模型已成为探讨视网膜新生血管的发生机制并评估其药物治疗效果的重要手段。本文对用各种模型模拟ROP的发生过程进行综述。     

The pathophysiology of retinopathy of prematurity: an update of previous and recent knowledge

Retinopathy of prematurity (ROP) is a disease that can cause blindness in very low birthweight infants. The incidence of ROP is closely correlated with the weight and the gestational age at birth. Despite current therapies, ROP continues to be a highly debilitating disease. Our advancing knowledge of the pathogenesis of ROP has encouraged investigations into new antivasculogenic therapies. The purpose of this article is to review the findings on the pathophysiological mechanisms that contribute to the transition between the first and second phases of ROP and to investigate new potential therapies. Oxygen has been well characterized for the key role that it plays in retinal neoangiogenesis. Low or high levels of pO₂ regulate the normal or abnormal production of hypoxia‐inducible factor 1 and vascular endothelial growth factors (VEGF), which are the predominant regulators of retinal angiogenesis. Although low oxygen saturation appears to reduce the risk of severe ROP when carefully controlled within the first few weeks of life, the optimal level of saturation still remains uncertain. IGF‐1 and Epo are fundamentally required during both phases of ROP, as alterations in their protein levels can modulate disease progression. Therefore, rhIGF‐1 and rhEpo were tested for their abilities to prevent the loss of vasculature during the first phase of ROP, whereas anti‐VEGF drugs were tested during the second phase. At present, previous hypotheses concerning ROP should be amended with new pathogenetic theories. Studies on the role of genetic components, nitric oxide, adenosine, apelin and β‐adrenergic receptor have revealed new possibilities for the treatment of ROP. The genetic hypothesis that single‐nucleotide polymorphisms within the β‐ARs play an active role in the pathogenesis of ROP suggests the concept of disease prevention using β‐blockers. In conclusion, all factors that can mediate the progression from the avascular to the proliferative phase might have significant implications for the further understanding and treatment of ROP.     

亟待新型早产儿视网膜病变动物模型的问世

早产儿视网膜病变（ROP）病因和发病机制尚不完全清楚,制约了其有效防治和相关研究的深入开展。尽管氧诱导视网膜病变动物模型为探索ROP复杂的病因和发病机制发挥了重要作用,但特异性较差,与人类ROP临床本质存在一定差异。因此,有必要对现有动物模型进行改良或建立新动物模型。通过更新观念、在多学科交叉中寻求突破,融合更多ROP危险因素,并结合新兴的转基因技术以及完善模型评价系统,建立科学的实验研究平台,为更好地开展ROP防治研究奠定基础。     

Ophthalmological follow up of preterm infants: a population based, prospective study of visual acuity and strabismus

BACKGROUND/AIMS: Prematurely born infants are known to have an increased rate of ophthalmological morbidity. The aim of the present study was to investigate visual acuity and ocular alignment in a population of preterm infants in a geographical area, in infants with and without retinopathy of prematurity (ROP). METHODS: A prospective population based study of ophthalmological status of preterm infants with a birth weight of 1500 g or less was performed during 3.5 years, with examinations at 6, 18, 30, and 42 months of corrected age. Visual acuity was tested using linear optotypes. Multiple regression analyses were used to analyse independent risk factors for poor vision and strabismus. RESULTS: Poor vision (< 0.3) was detected in 2.5% (6/237) of the children. Of these, only two (0.8%) had a severe visual impairment (< 0.1). Strabismus occurred in 13.5% (31/229). Children with cryotreated ROP and neurological complications ran the highest risk of poor vision and strabismus, according to multiple regression analysis. Among children without a history of ROP or neurological complications, 34% had a visual acuity < 0.7 and 5.9% had strabismus, compared with 61% and 22%, respectively, among the children with ROP or neurological complications. CONCLUSIONS: The overall incidence of subnormal vision and strabismus in children born prematurely was higher than in a full term population of the same age. On the basis of this study, follow up of all preterm infants screened for ROP is recommended and general guidelines are suggested.