【In Press】Effect of anti-VEGF treatment on retinopathy of prematurity in Zone II Stage 3+

AIM: To assess the effect of intravitreal ranibizumab injection for retinopathy of prematurity (ROP) in Zone II Stage 3+. METHODS: Data was collected from ROP patients with Zone II Stage 3+ who had intravitreal ranibizumab injections between October 2014 and January 2017 at the department of Ophthalmology in our hospital. No prior laser or other intravitreal therapy was done. Fundus examination was performed prior to the intervention and at each follow-up visit. Gestational age at birth, birth weight, sex, ROP zone, ROP stage, post menstrual age (PMA) at treatment, and follow-up period were recorded. The final clinical status of the retina was noted for each patient. The primary outcome measures included ROP recurrences requiring re-treatment, complete or incomplete peripheral vascularization RESULTS: Eighty-six eyes of 46 premature infants with Zone II Stage 3+ROP were enrolled in the study. The mean gestational age at birth was 28.18±1.67wk (range: 25 to 33wk) and the mean birth weight was 1070.57±226.85 g (range: 720.00 to 1650.00 g). The mean PMA at treatment was 38.32±2.99wk (range: 32.29 to 46.00wk). Seventy-one eyes (82.56%) were treated successfully with intravitreal ranibizumab as monotherapy. Fifteen eyes (17.44%) developed recurrent disease. The mean interval between the treatment and retreatment was 5.96±3.22wk (range: 1.86 to 11.71wk). All eyes vascularized into zone III at the end of the study and among them 62 eyes (72.1%) achieved complete vascularization. CONCLUSION: Intravitreal ranibizumab injection is an effective treatment in patients with zone II stage 3+ ROP. More patients with longer follow-up duration are mandatory to confirm the safety and efficacy of this treatment.     

Effect of anti-VEGF treatment on retinopathy of prematurity in Zone II Stage 3+

AIM: To evaluate the effect of intravitreal ranibizumab injection for retinopathy of prematurity (ROP) in Zone II Stage 3+. METHODS: Data was collected for ROP patients with Zone II Stage 3+ who received intravitreal ranibizumab injections between October 2014 and Janu-ary 2017 at the Department of Ophthalmology in our hospital. No prior laser or other intravitreal treatment was done. Prior to the intervention and at each follow-up visit, fundus examination was performed. Gestational age at birth, sex, birth weight, ROP zone, ROP stage, post menstrual age (PMA) at treatment, and follow-up pe-riod were recorded. The final clinical status of the retina was evaluated for each patient. The primary outcome mea-sures included ROP recurrences requiring re-treatment, complete or incomplete peripheral vascularization. RESULTS: Eighty-six eyes of 46 premature infants with Zone II Stage 3+ ROP were enrolled in the study. The mean gestational age at birth was 28.18±1.67 (range: 25 to 33)wk and the mean birth weight was 1070.57±226.85 (range: 720.00 to 1650.00) g. The mean PMA at treatment was 38.32±2.99 (range: 32.29 to 46.00)wk. Seventy-one eyes (82.56%) were treated success-fully with intravitreal ranibizumab as monotherapy. Fifteen eyes (17.44%) developed recurrent disease. The mean interval between the treatment and retreatment was 5.96±3.22 (range: 1.86 to 11.71)wk. All eyes vascularized into zone III at the end of the study and among them 62 eyes (72.09%) achieved complete vascu-larization. CONCLUSION: Intravitreal ranibizumab injection is an effective treatment in Zone II Stage 3+ ROP patients. More patients with longer follow-up duration are necessary to confirm the safety and efficacy of this treatment.     

两种抗VEGF药物治疗1型早产儿视网膜病变的疗效比较

目的:比较玻璃体腔注射康柏西普和雷珠单抗治疗1型早产儿视网膜病变(ROP)的有效性和安全性。方法:回顾性收集2018-08/2020-01于西京医院眼科确诊为1型ROP,并进行玻璃体腔注射康柏西普(IVC组,46例91眼)或雷珠单抗(IVR组,55例109眼)治疗的患儿临床资料,比较治疗后两组患儿ROP病变消退、复发及再治疗情况,不良预后及眼部和全身并发症情况。结果:纳入患儿101例200眼中急进型后极部ROP(AP-ROP)20眼,阈值期ROP 86眼,阈值前期1型ROP 94眼。两组患儿基线资料及治疗前ROP严重程度均无差异(P>0.05)。IVC组和IVR组一次治愈率无差异(93.4%vs 87.2%,P>0.05)。一次治疗后IVC组复发6眼(6.6%),平均复发时间为11.7±4.13wk,其中2眼再次行IVC治疗,4眼行视网膜激光光凝治疗,治疗后病变均消退;IVR组复发11眼(10.1%),平均复发时间9.82±4.02wk,其中4眼再次行IVR治疗,7眼行视网膜激光光凝治疗,治疗后病变均退行;两组复发率及复发时间均无显著差异(P>0.05)。IVC组一次治疗后未见病变进展;IVR组一次治疗后3眼病情进展,其中2眼视网膜增殖加重伴出血,行视网膜激光光凝治疗,1眼进展为牵拉性视网膜脱离,行玻璃体切除术治疗。两组患儿治疗后均未出现与药物或玻璃体腔注射相关的眼部及全身并发症,IVR组3眼出现颞侧视网膜皱褶,视网膜血管牵拉致血管弓夹角变小等不良预后。结论:IVC和IVR均为1型ROP治疗的有效手段,两者一次治愈率、复发率无显著差异,但IVR治疗的部分病情严重患儿有出现病变进展或不良预后的可能,需长期严密观察随访。     

Efficacy evaluation of intravitreal ranibizumab therapy for three types of retinopathy of prematurity

AIM: To evaluate efficacy of intravitreal ranibizumab (IVR) therapy for aggressive posterior retinopathy of prematurity (ROP), threshold ROP disease and type 1 pre-threshold ROP. METHODS: A retrospective analysis was performed on 40 patients (76 eyes) who had IVR as the primary treatment for ROP from April 2017 to January 2018. According to disease pathogenic features, the 76 eyes were divided into three groups: aggressive posterior ROP (AP-ROP) group (16 eyes), threshold ROP group (28 eyes) and type 1 pre-threshold ROP group (32 eyes). The characteristics of patients and lesions situation before the first intravitreal injection, and posttreatment fundus outcomes determined by wide-angle RetCam fundus imaging were recorded. RESULTS: The birth weight and postmenstrual age of first IVR treatment in AP-ROP, threshold ROP, and type 1 pre-threshold ROP groups were significant difference (1087.50±246.78, 1103.75±168.30, 1257.03±210.82 g, P=0.005; 34.50±1.46, 36.89±2.97, 36.50±2.36wk, P=0.008), while the gestational age was not difference (28.00±2.00, 28.54±1.90, 28.59±1.43wk, P=0.510). The retina hemorrhage ratio (with/without: 14/2, 8/20, 5/27), iris neovascularization or vascular engorgement ratio (with/without: 12/4, 11/17, 6/26), and the zone I (inside/outside: 16/0, 2/26, 5/27) in AP-ROP, threshold ROP, and type 1 pre-threshold ROP group were difference significantly (all P<0.05). The regression rates were 37.5%, 92.86%, and 100%, and the recurrence rates were 62.5%, 7.14%, and 0 in AP-ROP, threshold ROP, and type 1 pre-threshold ROP group, respectively (both P<0.05). The recurrence eyes were cured by secondary IVR or retinal laser photocoagulation. CONCLUSION: IVR is an effective treatment for all types of ROP. The regression of AP-ROP is significantly lower than type 1 pre-threshold and threshold disease. Birth weight, retinal hemorrhage, iris neovascularization or vascular engorgement and lesions located in zone I may be associated with AP-ROP recurrence and retreatment, which should be noted in follow-up.     

玻璃体内注射雷珠单抗联合激光光凝治疗早产儿视网膜病变疗效观察

目的　观察激光光凝联合玻璃体内注射雷珠单抗治疗早产儿视网膜病变（retinopathy of prematurity,ROP）的安全性及有效性。方法　对32例（64眼）ROP患儿行玻璃体内注射雷珠单抗治疗,观察附加病变、嵴、嵴上新生血管的消退情况以及周边视网膜,其中12例（24眼）附加病变、嵴及嵴上新生血管不完全消退者进行激光光凝治疗。结果　32例64眼ROP患儿中,经玻璃体内注射雷珠单抗治疗病变完全消退者20例40眼,占62.5%;12例24眼病变复发,经联合激光光凝治疗病情稳定,占37.5%。病变复发的24眼中,包括急进型后极部ROP 14眼,阈值期ROP 6眼,阈值前期ROP 4眼。所有患儿视网膜病变不同程度消退。给予玻璃体内注射雷珠单抗治疗后新生血管及出血吸收,血管继续发育至锯齿缘或病变瘢痕化。12例（24眼）病变复发者联合视网膜光凝治疗后病变完全消退。32例ROP患儿眼部及全身未见不良反应。结论　玻璃体内注射雷珠单抗治疗ROP效果好,不但可以使嵴、嵴上新生血管及附加病变完全消退,而且还可使视网膜血管继续生长,对于病变不能完全消退的患儿联合视网膜激光光凝治疗后也可获得较好疗效。     

激光光凝联合玻璃体腔注射低剂量雷珠单抗治疗急进型后极部ROP的疗效

目的：观察视网膜光凝术联合玻璃体腔注射低剂量雷珠单抗治疗急进型后极部早产儿视网膜病变(ROP)的疗效。

方法：选取2016-03/2018-05在我院新生儿中心住院筛查确诊为双眼急进型后极部ROP的患儿18例36眼,随机分为注药组和联合组,各9例18眼。注药组行玻璃体腔注射雷珠单抗0.4mg,联合组行后极部Ⅰ区及其颞侧2个视乳头直径以外无血管区域激光光凝联合玻璃体腔注射雷珠单抗0.25mg。术后随访12mo以上,观察两组患儿视网膜无血管区血管发育情况,血管嵴、附加病变、虹膜红变消退时间及不良反应发生情况。

结果：术后平均随访18.7±6.3mo,两组患儿视网膜病变和虹膜红变均不同程度消退,视网膜血管继续向周边发育至锯齿缘或病变瘢痕化; 注药组患儿血管嵴、附加病变、虹膜红变消退时间(2.01±0.32、1.92±0.51、1.59±0.07wk)均大于联合组(1.75±0.29、1.75±0.29、1.34±0.18wk)(均P<0.05); 注药组新增视网膜前出血3眼,出血均自行吸收,联合组未出现局部出血及纤维增生。两组患儿术中和术后均未出现严重眼部和全身不良反应。

结论：激光光凝术联合玻璃体腔注射低剂量雷珠单抗治疗急进型后极部ROP安全、有效。     

Effects of ranibizumab on very low birth weight infants with stage 3 retinopathy of prematurity: A preliminary report

Background/PurposeTo report the effects of ranibizumab on very low birth weight (VLBW) infants with retinopathy of prematurity (ROP).MethodsA retrospective, noncomparative, consecutive, interventional case series was conducted. Patients with stage 3 ROP were identified and evaluated from August 2011 to February 2012. All patients with ROP received one intravitreal ranibizumab injection (0.25 mg/0.025 mL) under topical anesthesia as the initial treatment.Main outcome measures: Regression of ROP and the complications associated with the intravitreal ranibizumab injection.ResultsA total of 23 eyes of 12 patients (four boys and eight girls) were included in this study. All of the patients had a history of supplemental oxygen and mechanical ventilation use. The mean gestational age was 26.33 ± 2.06 weeks (range: 24–30 weeks), and the mean birth weight was 821.58 ± 297.63 g (range: 507–1480 g). The mean postmenstrual age during the intravitreal administration of ranibizumab injection was 35.08 ± 2.07 weeks (range: 32–39 weeks), and the mean follow-up period was 5.83 ± 1.64 months (range: 3–8 months). All eyes received one intravitreal ranibizumab injection (0.25 mg/0.025 mL) as the primary therapy. None of the eyes needed conventional laser photocoagulation or cryotherapy as adjuvant therapy and no systemic complications were noted. No cataracts, endophthalmitis, or retinal detachment occurred postoperatively. Preretinal hemorrhages were found in four eyes of three patients (17.39%), but all were absorbed without sequelae.ConclusionIntravitreal ranibizumab injections seem to be effective and well tolerated in VLBW infants with stage 3 ROP. Only self-limited preretinal hemorrhages were noted, and no short-term systemic or major ocular side effects were identified.     

康柏西普和雷珠单抗治疗早产儿视网膜病变的疗效分析

目的：比较康柏西普和雷珠单抗治疗阈值前期1型早产儿视网膜病变（ROP）的疗效。方法：回顾性病例对照研究。选择2017年1月至2019年6月在解放军总医院第七医学中心儿科医学部住院治疗的阈值前期1型ROP且行抗血管内皮生长因子治疗的患儿107例（208眼），其中行康柏西普治疗（IVC）45例（86眼）作为IVC组，雷珠单抗治疗（IVR）62例（122眼）作为IVR组。IVC组中I区病变16例（32眼），II区病变29例（54眼）；IVR组中I区病变23例（46眼），II区病变39例（76眼）。术后定期随诊观察眼内炎症反应、ROP病变消退情况、ROP病变复发再治疗率和复发再治疗间隔时间。组间数据比较采用t检验和卡方检验。结果：2组间性别、出生胎龄、出生体质量、治疗时矫正胎龄、病变分区、急进型ROP构成差异均无统计学意义。IVR组和IVC组的复发再治疗率分别为45%和35%，其中I区为61%、63%，II区为37%、19%，2组间II区病变复发再治疗率差异有统计学意义（χ2=5.214，P=0.024）。IVR组和IVC组II区复发再治疗时间分别为注药后（8.8±2.5）周和（11.2±3.1）周，差异无统计学意义。结论：玻璃体腔注射雷珠单抗和康柏西普治疗ROP均有效，治疗后复发与病变分区有关，且康柏西普治疗II区病变复发再治疗率低于雷珠单抗的治疗。     

早产儿视网膜病变患儿行玻璃体内注射雷珠单抗后的视功能发育情况

目的　观察早产儿视网膜病变（ROP）患儿行玻璃体内注射雷珠单抗后的早期视网膜发育情况及3年后屈光状态。方法　选取2017年1月至2019年2月于我院诊治的患儿（50例98眼）并收集其临床资料。依照国际ROP分类标准及干预治疗标准分组:ROP患儿病变达到以上标准并在72 h内尽快完成玻璃体内注射雷珠单抗者25例（48眼）作为雷珠单抗组,选取我院同期性别、出生胎龄及出生体重与雷珠单抗组相匹配的ROP自然退行性变者25例（50眼）作为自然退行性变组。所有患儿依据病情变化,调整随访时间,记录患儿ROP发展变化,观察患儿早期视网膜发育变化,比较两组患儿视网膜完全血管化时间,末次随访时最佳矫正视力（BCVA）、眼轴长度及等效球镜度数。结果　两组患儿视网膜完全血管化时间比较,差异有统计学意义（P<0.05）。未次随访时,两组患儿BCVA比较,差异无统计学意义（P>0.05）。未次随访时,两组患儿眼轴长度比较,差异有统计学意义（P<0.05）。末次随访时,两组患儿等效球镜度数比较,自然退行性变组明显高于雷珠单抗组,差异有统计学意义（P<0.05）。结论　ROP患儿玻璃体内注射雷珠单抗后,早期虽然取得了明显疗效,但雷珠单抗组视患儿网膜完全血管化时间晚于自然退行性变组,3年后随访,雷珠单抗组较自然退行性变组更偏向近视化。     

早产儿视网膜病变激光术后嵴前无血管区的临床观察

目的:观察早产儿视网膜病变(retinopathy of prematurity,ROP)激光光凝术后嵴前部分无血管化区的临床转归,为ROP的临床治疗提供依据.方法:前瞻性随访观察2014-06/2016-06由我院ROP筛查协作组在门诊以及NICU床旁筛查发现并进行视网膜激光光凝治疗的患儿186例372眼,激光光凝术后嵴前存在部分无血管区的患儿26例32眼,其中男17例18眼,女9例14眼,平均出生胎龄(29.4±0.4)周,平均出生体质量1222.8±70.3g,阈值前1型10例12眼,阈值期12例14眼、急性进展性后极部型4例6眼,分别于激光术后1、3、8、12 wk行Retcam眼底照相复查,观察病变嵴、嵴前无血管区以及附加病变的消退情况.随访中如发现病变嵴或附加病变加重,则给予补充视网膜激光光凝或行玻璃体腔抗VEGF治疗,直至病变嵴和附加病变完全消退,病情稳定.结果:患儿26例均在激光术后1 wk复查时发现病变嵴前无血管区,但附加病变减轻,病变嵴由3期向2期、1期消退,阈值前1型消退最明显;3 wk复查时27眼(84%)病变嵴为1期或不明显、无血管区逐渐缩小,视网膜血管向周边发育;5眼(16%)无血管区缩小不显著,附加病变(+~++),病变嵴3~4期、或伴有出血,其中3眼(9%)为阈值期病变患儿,2眼(6%)为急性进展性后极部型患儿,遂及时给予补充视网膜光凝;8 wk复查,未补充视网膜光凝的27眼嵴前无血管区已血管化,嵴及附加病变消退;补充光凝中3眼(9%)病情得到控制、稳定,其中阈值期2眼、急性进展性后极部型1眼,2眼(6%)嵴上新生血管消退不明显、附加病变依然存在,其中阈值期1眼、急性进展性后极部型1眼,故给予玻璃体腔抗VEGF治疗,12 wk复查时见附加病变、病变嵴消退,视网膜血管向颞侧走形稍僵直.结论:视网膜激光光凝是ROP治疗的有效方法,光凝术后嵴前部分无血管区多可自行发育完善.对于少数激光术后病情活动的阈值期及急性进展性后极部型嵴前部分无血管区需及时补充激光光凝治疗,必要时可联合玻璃体腔抗VEGF治疗.     

Combination of Intravitreal Ranibizumab and Laser Photocoagulation for Aggressive Posterior Retinopathy of Prematurity

Purpose

To report on 2 cases of aggressive posterior retinopathy of prematurity (ROP) treated with intravitreal ranibizumab (Lucentis^®) and laser photocoagulation.

Methods

Two premature females, born at 25 and 26 weeks’ gestation with a birth weight of 530 and 550 g, respectively, with aggressive posterior ROP received combined treatment with laser photocoagulation and intravitreal ranibizumab (0.3 mg [30 µl]) to each eye. Structural outcomes were evaluated by indirect ophthalmoscopy and documented by retinography.

Results

An intravitreal injection was made at 34 weeks of postmenstrual age in the first case, followed by laser photocoagulation 1 week later. There was a partial regression of ROP with treatment. Five weeks later, neovascularization regrowth with bleeding in both eyes (intraretinal and subhyaloid) occurred and retreatment with combined therapy was performed. In the second case, single therapy with laser photocoagulation was made at 34 weeks of postmenstrual age. In spite of the confluent photocoagulation in the avascular area, progression to 4A ROP stage occurred 1 week later. Both eyes were retreated 1 week later with intravitreal ranibizumab and laser photocoagulation. Treatment resulted in ROP regression in both cases. There were no signs of systemic or ocular adverse side effects.

Conclusion

The cases presented show that combination therapy of indirect laser photocoagulation and intravitreal ranibizumab can be effective in the management of aggressive posterior ROP. Further investigation on anti-VEGF safety in premature infants is necessary. Additional studies are needed to define the role of anti-VEGF in ROP treatment.Key Words: Retinopathy of prematurity, Laser photocoagulation, Ranibizumab, Anti-VEGF therapy     

玻璃体内注射雷珠单抗治疗早产儿视网膜病变

目的　观察玻璃体内注射雷珠单抗治疗早产儿视网膜病变（ｒｅｔｉｎｏｐａｔｈｙｏｆｐｒｅｍａ-ｔｕｒｉｔｙ,ＲＯＰ）的疗效及其安全性。方法　回顾分析了２０１２年１１月至２０１４年５月于北京同仁医院治疗的１７例（３１眼）ＲＯＰ患儿,在４８ｈ内行玻璃体内注射雷珠单抗,对注射后无反应者,重复玻璃体内注射雷珠单抗或联合激光光凝治疗,术后１ｄ、１个月内每周随访观察复诊。结果　所有治疗眼中,单纯行玻璃体内注射雷珠单抗２７眼,玻璃体内注射雷珠单抗联合激光治疗４眼。２８眼进行了一次治疗,３眼经过了二次注射治疗;４眼进行补充视网膜激光治疗。所有的ＲＯＰ治疗均有效,随访期内未见有复发病例。结论　玻璃体内注射雷珠单抗对ＲＯＰ的治疗效果可靠,尤其对于病情严重、全身情况差不能耐受全身麻醉的患儿,其优势明显。     

玻璃体腔注射贝伐单抗和雷珠单抗治疗1型ROP疗效的Meta分析

目的:评价玻璃体腔注射贝伐单抗(IVB)和雷珠单抗(IVR)治疗1型早产儿视网膜病变(ROP)的疗效。方法:通过检索PubMed、Embase、Web of Science、the Cochrane Library、CQVIP、CBM、OVID、中国知网和万方数据库,检索时间为建库至2020-04-01。纳入所有比较IVB和IVR治疗ROP疗效的研究。由两位研究员进行独立的数据提取和质量评估。使用Review Manager 5.3软件进行统计分析。本研究观察的主要结局指标为再治疗率,次要结局指标包括:完全血管化比例和等效球镜度。结果:共纳入了8篇病例对照研究,共885眼。与IVB治疗组相比,IVR治疗组有更高的再治疗率(OR=0.55,95%CI:0.34~0.88,P<0.05)及更低的等效球镜度数(WMD=-1.44,95%CI:-2.28~-0.00,P<0.05),对于完全血管化比例,两组比较无差异(OR=2.15,95%CI:0.80~0.576,P>0.05)。结论:IVR和IVB治疗1型ROP均可以完成视网膜的完全血管化,但两种治疗方法各有优势,IVR对于儿童屈光的影响较小,但在降低再发率方面其作用较IVB差。     

Recurrence risk factors of intravitreal ranibizumab monotherapy in retinopathy of prematurity: a retrospective study at one center

AIM: To identify risk factors of recurrence of this disorder after intravitreal ranibizumab (IVR) monotherapy. METHODS: Totally 33 eyes of 19 patients who underwent initial IVR treatments for type 1 retinopathy of prematurity (ROP) at our center were retrospectively reviewed between April 1, 2016 and December 31, 2017. Patient demographics, the side of ROP, multiple gestations, Apgar scores, zone, stage, plus disease, postmenstrual age at injection, surfactant therapy, blood transfusion therapy, hemorrhage before IVR, hemorrhage after IVR, gestational diabetes mellitus, pregnancy-induced hypertension, anemia, intraventricular hemorrhage, sepsis, respiratory distress syndrome, carbohemia, and congenital heart defects were recorded. Adjusted hazard ratios (HRs) and 95% confidence intervals were determined after adjusting for potential confounders using multivariate proportional Cox regression. RESULTS: Of the 33 eyes, 12 (36.4%) had ROP recurrences 45.3 (5.1, 50.9)mo after initial IVR treatments. The independent risk factors for ROP recurrences were zone (¢ò vs ¢ñ, HR: 0.056, P=0.003) and gestational diabetes mellitus (no vs yes, HR: 0.095, P<0.001). The mean uncorrected visual acuity for four recurrence eyes was 0.46 logMAR (0.13, 0.70) at 55.0 (51.0, 58.9) mo after the initial IVR treatment. The mean uncorrected visual acuity for 10 eyes without recurrence was 0.46 logMAR (0.19, 0.63) at 48.0 (43.8, 58.4) mo after the initial IVR treatment. CONCLUSION: Two independent risk factors for type 1 ROP recurrence after IVR treatment involving zone¢ñand gestational diabetes mellitus are identified, and the mean uncorrected visual acuity is 0.46 logMAR at 51.0 (44.0, 58.9)mo. The findings of this study are important for follow-up management and for improving the visual function of ROP patients.     

Fluorescein angiography of retinal vascular involution after intravitreal injection of ranibizumab for retinopathy of prematurity

AIM: To describe the involution patterns of vessel growth of retina through fluorescein angiography (FA) of children, who had been under treatment up to 1y previously intravitreal ranibizumab (IVR) as monotherapy for retinopathy of prematurity (ROP). METHODS: This is a retrospective study. The medical information and FA of 17 children (34 eyes) whose area of avascular retina from the ora serrata was more than two disc diameters (DD) were analyzed. RESULTS: Among 34 eyes, all were the presence of finger-shaped vessels and arteriolar-venular shunts (100%, 34/34 eyes). Popcorn abnormalities were found in most of the eyes (94.1%, 32/34 eyes). Furthermore, in many cases (23.5%, 8/34 eyes), there were leakage persisting in the region of the junction between avascular and vascular retina. In contrast, just 2 eyes (5.9%) showed damage of retinal capillary bed and 3 eyes (8.8%) showed large area of retinal pigment epithelium (RPE) atrophy. CONCLUSION: Although IVR can be very effective in ROP, we should remain cautious as infants may remain avascular peripheral retinas and abnormal vessel. FA allows accurate visualization of vessel abnormalities in eyes with ROP, which will be helpful to affect assessment of disease activity and therapeutic effect.     

早产儿视网膜病变激光光凝辅助玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab治疗临床疗效观察

目的 观察早产儿视网膜病变（ROP）激光光凝辅助玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab（商品名Avastin）治疗的临床疗效。方法 接受玻璃体腔注射bevacizumab治疗的ROP患儿17例31只眼纳入研究。其中,男性10例18只眼,女性7例13只眼,胎龄24.7~31.0周,平均胎龄（28.2±1.9)周,出生体重750~1600 g,平均出生体重（1150±263）g。所有患儿散瞳后行双目间接检眼镜和二代广角数码视网膜成像系统（RetCam Ⅱ）眼底检查,其中,阈值期ROP 3例4只眼;阈值前期1型ROP 1例2只眼;急进性后部型早产儿视网膜病变13例25只眼。治疗指征包括瞳孔不能散大或屈光间质混浊不能进行激光光凝和激光光凝治疗后病变不能控制者。31只眼中,激光光凝辅助玻璃体腔注射bevacizumab治疗（联合治疗）者25只眼,单纯玻璃体腔注射bevacizumab者6只眼。治疗后随访1.4～40.8个月,平均随访时间（20.8±13.2）个月。观察ROP病变是否完全控制和视网膜不良结构的发生以及与治疗相关的并发症。结果31只眼中,治疗后病 变完全控制27只眼,占87.0%;治疗后新生血管继续发展引起牵引性视网膜脱离2只眼,占6.5%。单纯玻璃体腔注射bevacizumab后病变继续发展,最终发生牵引性视网膜脱离者2只眼,占6.5%。发生牵引性视网膜脱离的2只眼中,经玻璃体视网膜手术治疗后,视网膜复位,后极部视网膜结构恢复正常1只眼;最终形成后极部视网膜局限性牵拉1只眼。治疗中和治疗后所有患儿全身情况良好,未见全身药物不良反应,未发生眼内感染,未出现角膜烧伤、白内障、眼前段缺血等并发症。结论 玻璃体腔注射bevacizumab辅助激光光凝治疗ROP,在观察期内表现出较好的临床治疗效果;未发现与治疗相关的并发症。     

抗血管内皮生长因子玻璃体内注射治疗不同区域早产儿视网膜病变的疗效观察

目的 观察抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗不同区域早产儿视网膜病变的临床效果.方法 回顾性分析2013年4月至2014年4月在郑州儿童医院行玻璃体内注射抗VEGF药物的早产儿视网膜病变患儿24例(46眼),分为Ⅰ区病变组15例(28眼),Ⅱ区病变组9例(18眼).所有患者均在全身麻醉下行玻璃体内注射抗VEGF药物雷珠单抗,对患儿术后眼底进展情况进行观察,分析两组首次注射治愈和进展情况以及并发症发生情况.结果 两组间的出生孕周、出生体质量相比,差异均无统计学意义(均为P ＞0.05);手术矫正孕周相比,差异有统计学意义(P=0.001).24例(46眼)中,首次注射治愈21眼,病情继续发展25眼,治愈率为45.65％,治疗到治愈的时间间隔为2～12个月.Ⅰ区病变组首次注射治愈9眼,治愈率为32.14％,进展率为67.86％;Ⅱ区病变18眼中12眼首次注射治愈,6眼病情继续进展,治愈率为66.67％,进展率为33.34％.两组首次注射治愈率相比,差异有统计学意义(x2=5.263,P=0.022),Ⅰ区病变的首次注射治愈率明显低于Ⅱ区病变.两组进展率相比,差异有统计学意义(x2=-2.269,P=0.023),Ⅰ区病变的进展率明显高于Ⅱ区病变.随访中未发现与玻璃体内注射有关的白内障、眼内炎、视网膜裂孔等出现,仅有2例出现角膜水肿,4例出现结膜下出血,均未做特殊处理自愈.结论 玻璃体内注射抗VEGF药物对于Ⅰ区、Ⅱ区病变均有效,Ⅰ区病变手术成功率低,再次手术的几率大,但可为再次手术创造时间和条件.     

玻璃体内注射雷珠单抗治疗早产儿视网膜病变疗效观察

目的 观察玻璃体内注射雷珠单抗治疗早产儿视网膜病变(retinopathy of prematurity,ROP)的疗效及安全性.方法 将2014年6月至2015年8月在我院确诊并首次进行抗VEGF治疗的连续性Ⅰ、Ⅱ区ROP患儿49例95眼纳入研究.将患儿依据病变分区分为Ⅰ区组和Ⅱ区组,主要比较2组患儿出生体质量、孕周、治疗时矫正胎龄、治疗好转、复发及再治疗时间之间的差异.用30G 1 mL注射器抽取10 mg·mL-1的雷珠单抗0.025 mL(含雷珠单抗0.25 mg)于患儿角膜缘后1.5 mm穿刺注射.注射结束时妥布霉素地塞米松眼膏包眼.注药后3d运用手持裂隙灯及眼压计观察患眼有无眼压增高、眼内新鲜出血及眼内炎情况,治疗后1周间接检眼镜观察视网膜血管迂曲扩张及病变嵴消退情况.同时观察有无与治疗相关的其他全身不良反应.结果 本研究病例首次治疗后血管迂曲、扩张消失或程度减轻,新生血管及嵴消退93眼,占95.9％.其中,Ⅰ区组58眼,Ⅱ区组35眼.两组ROP好转率比较,差异无统计学意义(P＞0.05).随访期间复发22眼.其中,Ⅰ区组17眼,占Ⅰ区ROP消退患眼的29.3％;Ⅱ区组5眼,占Ⅱ区ROP消退患眼的14.3％.两组复发率比较,差异有统计学意义(P＜0.05).复发后再次行雷珠单抗或激光光凝治疗.复发至再次治疗时间为(6.50±2.54)周.Ⅰ区组和Ⅱ区组复发至再次治疗时间分别为(6.44±2.74)周、(6.67±2.31)周,两组差异无统计学意义(P＞0.05).末次随访时,可观察到继续血管化.随访期间和末次随访时,未见与治疗方式和药物相关的其他眼部并发症和全身不良反应发生.结论 雷珠单抗治疗Ⅰ、Ⅱ区ROP疗效较好,但ROP复发率较高.未见明确与药物有关的局部和全身并发症.     

Repeated intravitreal ranibizumab for reactivated retinopathy of prematurity after intravitreal ranibizumab monotherapy: vascular development analysis

Graefe's Archive for Clinical and Experimental Ophthalmology - To evaluate the retinal vascularization of repeated intravitreal ranibizumab (IVR) for reactivated retinopathy of prematurity...