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。     

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。     

早产儿视网膜病变治疗新进展

早产儿视网膜病变(retinopathyofprematurity,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发展到晚期治疗相当棘手,早期发现,及时治疗可能挽救部分患儿的视力。治疗方法主要有冷凝治疗,光凝治疗,玻璃体切割手术治疗等方法。     

早产儿视网膜病变的治疗

早产儿视网膜病变(ROP)是一种发生于早产儿和低体质量儿的增生性视网膜病变,是发达国家和发展中国家儿童致盲的重要原因。早期治疗能够有效挽救患儿视功能,随着对ROP发病机制的不断深入研究,治疗方案的选择在不断发生变化。冷冻治疗因其实施的可行性和并发症,目前不作为首选治疗方法。激光治疗仍是黄金手段,但不可避免会出现一些并发症。在与ROP发生相关的众多因子中,抗血管内皮生长因子(VEGF)药物疗效令人满意,药物选择及最佳注射剂量是重点关注问题,对全身不良事件发生情况有待进一步研究。就ROP发病机制及几种治疗方式的优缺点进行综述,为ROP治疗提供参考。     

我国早产儿视网膜病变特点和筛查指南

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 ,是世界发达国家儿童失明的首位原因。随着我国医疗水平的不断提高 ,围产医学也有了极大的发展 ,各种生命支持系统的改进 ,早产儿存活率不断提高。伴随早产儿存活率的提高 ,ROP的发生率也随之上升 ,由此造成的儿童盲目越来越多。对早产儿进行眼底检查 ,发现阈值病变并及时治疗 ,可以有效地降低 ROP的致盲率。1　ROP的流行病学特点我国大陆目前尚缺乏以人群为基础的 ROP发病率的流行病学资料。流行病学调查结果显示 ,80年代 ,在欧美国家的早产儿当中 ,ROP的…     

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。     

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.     

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

早产儿视网膜病变(ROP)是特指发生于早产儿特别是过早产儿的以视网膜血管异常增生为病变特征的视网膜血管疾病,是发达国家儿童失明的主要病因.随着围产医学的不断发展,ROP的发病率也随之上升,而早期发现和及时合理的治疗无疑是现阶段拯救ROP患儿视功能的最重要措施.我们对近年来国内外有关ROP的研究进行综述,内容涵盖了ROP的发病、诊断、筛查、治疗以及随访等诸方面.     

Retinopathy of Prematurity

Retinopathy of prematurity (ROP) is a rapidly evolving area of pediatric ophthalmology. Over the past decade, a new understanding of the pathophysiology of ROP has emerged. Advances in clinical research have lead to modifications in screening criteria and treatment guidelines for ROP. With this knowledge, new treatment modalities such as anti-angiogenic agents are being investigated. This review will highlight some of the current concepts related to ROP.     

Assessment and management of retinopathy of prematurity in the era of anti-vascular endothelial growth factor (VEGF)

The incidence of retinopathy of prematurity (ROP) continues to rise due to the improved survival of very low birth weight infants in developed countries. This epidemic is also fueled by increased survival of preterm babies with variable use of oxygen and a lack of ROP awareness and screening services in resource-limited regions. Improvements in technology and a basic understanding of the disease pathophysiology have changed the way we screen and manage ROP, educate providers and patients, and improve ROP awareness. Advancements in imaging techniques, expansion of telemedicine services, and the potential for artificial intelligence-assisted ROP screening programs have created opportunities to improve ROP care in areas with a shortage of ophthalmologists trained in ROP. To address the gap in provider knowledge regarding ROP, the Global Education Network for Retinopathy of Prematurity (GEN-ROP) created a web-based tele-education training module that can be used to educate all providers involved in ROP, including non-physician ROP screeners. Over the past 50 years, the treatment of severe ROP has evolved from limited treatment modalities to cryotherapy and laser photocoagulation. More recently, there has been growing evidence to support the use of anti-vascular endothelial growth factor (VEGF) agents for the treatment of severe ROP. However, VEGF is known to be important in organogenesis and microvascular maintenance, and given that intravitreal anti-VEGF treatment can result in systemic VEGF suppression over a period of at least 1–12 weeks, there are concerns regarding adverse effects and long-term ocular and systemic developmental consequences of anti-VEGF therapy.Future research in ophthalmology to address the growing burden of ROP should focus on cost-effective fundus imaging devices, implementation of artificial intelligence platforms, updated treatment algorithms with optimal use of anti-VEGF and careful investigation of its long-term effects, and surgical options in advanced ROP. Addressing these unmet needs will aid the global effort against the ROP epidemic and optimize our understanding and treatment of this blinding disease.     

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.     

早产儿视网膜病变眼底检查方法及眼底图像特征研究进展

早产儿视网膜病变(ROP)是可预防的儿童期失明主要原因,具有筛查难、诊断难及客观评估难等特点。ROP筛查有多种方式,包括各种接触或非接触成像设备、基于智能手机的眼底照相、基于人工智能的眼底图像分析等。ROP诊断是基于对ROP整个视网膜眼底的可视化和记录,也是后续筛查、治疗评估的基础。眼底筛查对早期识别非常关键,有助于早期发现和及时转诊。通过分析总结ROP眼底图像特征,可能发现其潜在的特征规律,及时有针对性地预防和治疗。人工智能可促进ROP筛查的自动化、可量化和客观诊断。本文综述目前临床上常用的ROP眼底检查方法及眼底图像特征规律,总结人工智能用于ROP自动诊断的最新研究进展。     

Treatment of retinopathy of prematurity:a review of conventional and promising new therapeutic options

Retinopathy of prematurity (ROP), a retinal vascular disease of premature infants, continues to be a major cause of preventable childhood blindness all over the world. The incidence of ROP varies among countries, being influenced by the quality of the level of neonatal intensive care. Here, we discuss the potential treatments that are now available or will soon or probably be available for ROP. Although ablation of the avascular retina with laser photocoagulation remains the current gold standard and well established therapy for ROP, some new therapeutic options including angiostatic therapies are being explored based on our knowledge of the pathophysiology of the ROP and complications and efficacy of laser treatment. However, prevention of the development of severe ROP and screening for ROP seem to be the best strategy in avoiding visual impairment caused by ROP in premature infants. New therapeutic interventions including vascular endothelial growth factor antibody administration, gene therapy and supplemental therapies should be supported with evidence-based data for the treatment of ROP.     

Retinopathy of prematurity

Over the last decade major advances have been made in the understanding of the pathogenesis and evolution of retinopathy of prematurity (ROP). The increased survival of very small premature infants in modern neonatal intensive care units has led to the resurgence of this potentially blinding disease. ROP appears to be a multifactorial disease, the prevention of which is probably impossible even now, with the most accurate methods of blood gas monitoring and oxygen restriction. In addition to oxygen, there are a number of significant risk factors, such as birth weight and gestational age, ventilator hours, hyper and hypocarbia, hypoxia and acidosis, xanthine therapy and probably bright light. Current data suggest that the level of antioxidants in the immature retina is relatively low and therefore oxygen radicals which accumulate in the preterm baby's retina may play an important role in the pathogenesis of ROP. The treatment of the disease in both its "active" and "cicatricial" stages emphasizes the need for a new classification which could serve as a common international language through which results may be compared. Vitamin E was suggested in some studies to be helpful in preventing the severe stages of the disease, but its efficacy has yet to be proved. Treatment modalities such as photocoagulation, cryotherapy and vitrectomy are being tried as a means of therapy in the more advanced stages of the disease. Preliminary results of a large multicenter study support the efficacy of cryotherapy.     

Time to consider a new treatment protocol for aggressive posterior retinopathy of prematurity?

Purpose: To discuss treatment modalities for aggressive posterior retinopathy of prematurity (AP‐ROP). Methods: The medical charts of all infants with AP‐ROP at Uppsala University Hospital, Sweden, during a 2‐year period (2009 and 2010) were reviewed. Eight infants (16 eyes) with a mean gestational age of 23.8 weeks and a mean birth weight of 592 g were treated with laser and/or intravitreal injections of bevacizumab (0.4 and 0.625 mg). RetCam photography was used to document the retinal appearance before and after treatment. Results: All infants (16 eyes) had AP‐ROP in zone I. Mean time at initial treatment was 34 weeks postmenstrual age. Two eyes (one infant) were only treated with laser, and six eyes (three infants) were treated with laser therapy or cryopexy and, because of lack of regression, with bevacizumab as salvage therapy. Eight eyes (four infants) were treated with a first‐line bevacizumab injection and four of these eyes (two infants) with additional laser ablation for continued disease progression in zone II. Macular dragging occurred in one eye of one infant primarily treated with laser. Conclusions: Given the high complication rate of the extensive laser treatment for zone I ROP, it is worth considering anti‐vascular endothelial growth factor treatment as an alternative therapy. Further knowledge concerning side effects and long‐term ocular and systemic outcome is warranted before this drug becomes general clinical practice.