未成熟儿视网膜病变危险因素分析

目的分析未成熟儿视网膜病变(retinopathy of     

早产儿视网膜病变的筛查与高危因素分析

目的 研究早产儿视网膜病变(ROP)发病情况及相关的危险因素,探讨其合理的筛查标准.方法 对出生体重≤2500g,胎龄≤37周患儿进行ROP筛查,并行相关因素分析.结果 共筛查275例符合条件的早产儿,发现ROP38例(13.82%);出生体重≤1500g组,～2000g组,～2500g组患病百分比有显著性差异(P<0.05);出生胎龄≤30周组,～32周组,≥33周组间ROP患病百分比有显著性差异(P<0.05);ROP早产儿的吸氧时间明显高于无ROP组(Z=5.292,P=0.000),需要机械辅助呼吸的早产儿发生ROP者较多(x2=30.597,P=0.000),多胎与单胎间发生ROP的差异无统计学意义(x2=0.748,P=0.387),ROP发病与出生胎龄、出生体重、吸氧时间、机械辅助呼口等因素相关.结论 出生体重越低,出生胎龄越小,吸氧时间较长,需要机械辅助呼吸的早产儿,ROP患病率越高.早产儿应及时检查眼底,尽早发现ROP.     

Retinoblastoma in patients with regressed retinopathy of prematurity

Retinopathy of prematurity (ROP) is a well-known clinical entity in premature babies. We report two patients (1 and 2) with regressed ROP who later presented with retinoblastoma (RB). To the best of our knowledge, there is only one such report in the literature so far. Two unrelated patients 1 and 2, born at 32 weeks gestation were screened for ROP at 34 weeks gestation. This showed Zone II Stage II ROP which regressed by 38 weeks of gestation on follow-up. Both patients were lost to follow-up by 40 weeks of gestation. They presented at four years of age with white reflex in the eye. Patient 1 was found to have unilateral and patient 2 bilateral RB. The occurrence of RB in these patients with regressed ROP is probably coincidental.     

严重早产儿视网膜病变危险因素分析

目的分析严重早产儿视网膜病变（ROP）的危险因素，为合理制定ROP筛查标准提供参考依据。方法回顾性分析2002年12月至2004年4月期间我院眼科就诊的168例孕龄<37周的早产儿临床资料。记录其性别、胎数(BC)、孕龄（GA）、出生体重（BW）、氧疗时间以及双眼充分散瞳后双目间接检眼镜检查所见的视网膜血管发育情况。按ROP国际分类法（ICROP）记录检查结果，1、2、3期为轻度ROP，阈值病变、4期和5期为严重ROP。应用多元Logistic回归分析分析ROP与性别、BC、GA、BW、氧疗时间等因素之间的关系。结果168例早产儿336只眼中，严重ROP 47例91只眼，分别占患儿例数和眼数的28.0%、27.1%。其中，阈值病变20只眼，占6.0%；4期病变11只眼，占3.3%。4期病变中，4A期2只眼，占0.6%；4B期9只眼,占2.7%。5期60只眼，占17.8%。各因素中，GA、BW和氧疗时间对严重ROP的发生有影响（P值分别为0.000、0.000和0.015，α=0.05），性别和BC与ROP无关（P值分别为0.640和0.084，α=0.05）。亚变量统计分析显示，当GA≤30周或BW≤1500 或氧疗时间>4d时早产儿患严重ROP的危险性显著增加。结论严重ROP的发生受GA、BW和氧疗时间的影响，而与性别和BC无关。GA≤30周或BW≤1500g或氧疗时间>4d的早产儿患严重ROP的危险性显著增加，建议重点对此类早产儿进行筛查。（中华眼底病杂志，2005，21：271-274）     

Visual acuity in premature infants

PURPOSE: To measure grating visual acuity in premature infants and compare it with that in full-term infants. METHODS: The visual acuity of 73 premature and 73 full-term infants was tested at 6 months of age by the Teller Acuity Card procedure. All premature infants had undergone indirect funduscopy for the detection of retinopathy of prematurity (ROP). Seven infants had developed ROP. The mean gestational age of the premature infants was 33 +/- 1.4 weeks as compared with 39.9 +/- 0.9 weeks in the full-term infants. The mean birth weights of the 2 groups were 1,906 +/- 412 and 3,244 +/- 420 g, respectively. RESULTS: Impaired binocular visual acuity was found in 53.4% of the premature infants, but in only 11% of the full-term infants (p < 0.0001). Impaired monocular visual acuity was found in 13.7% of the premature infants as compared with 2.7% of the full-term infants. Within the premature infant group, monocular visual acuity was impaired in 42.9% of those with ROP and in 10.6% of those without ROP (p = 0.0497). Pathological refraction was found in 33.3% of the prematures without ROP and in 14.3% of the prematures with ROP. This difference was not statistically significant. Visual acuity of preterm infants was not different from full-term infants when examined at 6 months of postconceptual age. CONCLUSIONS: Both monocular and binocular visual acuities as measured by the Teller Acuity Cards are worse in premature infants than in full-term infants at the same chronological age. Poor visual acuity in premature infants can be attributed mainly to immaturity of the visual system.     

重症早产儿视网膜病变的高危因素分析

目的探讨重症早产儿视网膜病变(ROP)的发生率及高危因素分析对临床筛查的指导意义。方法回顾性分析2013年1月至2015年12月756例早产儿临床资料,记录其孕周、出生体重、吸氧时间、吸氧浓度、APgar评分(1分钟in)、APgar评分(5 min)、败血症、呼吸暂停、机械通气、输血等。应用t检验、卡方检验以及Logistic回归分析分析重症ROP与孕周(GA)、出生体重(BW)、吸氧时间、吸氧浓度、APgar评分(1 min)、APgar评分(5 min)、败血症、呼吸暂停、机械通气、输血等因素之间的关系。结果 756例早产儿,严重ROP发生3.3%。各因素中,孕周较少、低出生体重、长时间吸氧、高浓度吸氧、APgar评分(5 min)<4分,机械通气、输血是重症ROP的高危因素,统计学有显著差异。结论严重ROP的发生受孕周较少、低出生体重、长时间吸氧、高浓度吸氧、APgar评分(5 min)<4分,机械通气、输血影响。特别是GA≤28周或BW≤1000 g早产儿患严重ROP的危险性显著增加,建议重点对此类早产儿进行及时筛查。     

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。     

早产儿出生后早期屈光状态及其影响因素早产儿出生后早期屈光状态及其影响因素

目的：探讨早产儿矫正胎龄32～40周的屈光状态,评估早产儿屈光发育与出生体质量、出生孕龄以及早产儿视网膜病变（ROP）的相关性。方法：选取2016年3-12月在浙江大学医学院附属妇产科医院NICU及温州医科大学附属眼视光医院杭州院区接受ROP筛查的早产儿为研究对象,对早产儿屈光状态以及相关影响因素进行前瞻性研究。在矫正胎龄32～40周时右眼行睫状肌麻痹下检影验光,再进行ROP筛查并记录。记录早产儿的基本信息如出生体质量、出生孕龄、性别、吸氧史等以及接受检查时的矫正胎龄并进行统计分析。采用Pearson相关性分析来研究等效球镜度（SE）分别与出生体质量、出生孕龄、矫正胎龄之间的关系。采用独立样本t检验来比较矫正胎龄40周时有无ROP的SE差异。结果：共333例早产儿纳入研究,其中男175例,女158例。收集屈光记录542份。早产儿出生孕龄为26～36（31.3±2.1）周,出生体质量为740～3 390（1 643±418）g。SE随着早产儿矫正胎龄的增大而增大（r=0.455,P<0.001）。早产儿出生后4～5周,出生孕龄（r=0.373,P<0.001）、出生体质量（r=0.345,P<0.001）均和SE呈正相关。至早产儿矫正胎龄40周时,SE与出生体质量呈正相关（r=0.197,P=0.021）,与出生孕龄无相关性,合并ROP的早产儿相比没有ROP的有较低的SE（t=2.225,P=0.028）。结论：早产儿在出生后早期矫正胎龄32～40周时,屈光状态向远视发展。在出生后4～5周,出生孕龄小或出生体质量低的早产儿更偏向于近视状态。至矫正胎龄40周时,有ROP或者低出生体质量的早产儿有较低的SE,而与出生孕龄无相关性。     

Severe retinopathy of prematurity: longitudinal observation of disease and screening implications

PURPOSE: To test the effectiveness of our Canadian retinopathy of prematurity (ROP) screening guidelines as applied to high-risk premature infants. STUDY DESIGN: Retrospective longitudinal cohort study. SUBJECTS: A total of 969 infants were examined longitudinally between 1991 and 2000 and 46 of these infants screened were treated for severe ROP. METHODS: Data from weekly ROP screening examination results were collected from a geographical area and analysed. RESULTS: The average incidence of severe ROP requiring treatment in the population of premature infants eligible for screening was 48.3 per 1000. In all, 46 infants were treated in this cohort. The mean gestational age (GA) was 25.5 weeks of age and the mean birth weight was 750 g. The mean chronological age (CA) and postmenstrual age (PMA) at the time of first screening was 36 days and 30.7 weeks, respectively. The first identification of any ROP in this group was at a mean CA 60 days and PMA of 34.1 weeks. The mean CA and PMA of the first observation of stage 3 were 74 days and 36.3 weeks. The mean CA and PMA at the time of treatment were 86 days and 37.7 week. CONCLUSIONS: Our observations and analysis indicate the following ROP screening recommendations: infants of 28 weeks of GA or less, infants with a GA between 28 weeks and 30 weeks should have a single 'spot examination' at approximately 37 weeks of PMA (or prior to discharge from hospital) to include possible outliers; infants born with a birth weight of 1250 g or less; initial screening examination should be at 31 weeks of PMA or 4 weeks of CA, whichever is later; in the presence of any active ROP, the infant should be followed every 1-2 weeks; and stage 3 should be followed at least every 7 days.     

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.     

Fulminate retinopathy of prematurity - clinical characteristics and laser outcome

PURPOSE: To analyse the clinical characteristics and treatment outcome of zone 1 Fulminate type of Retinopathy of Prematurity (ROP) and compare it to Conventional ROP. METHODS: Preterm infants from two neonatal intensive care units (NICU) born between July 2002 and November 2003 were screened for ROP. Cases with Conventional ROP were classified according to the International Classification of Retinopathy of Prematurity (ICROP) while that of Fulminate ROP according to Shapiro's classification. Threshold disease was kept the cut off for treatment for Conventional ROP and stage 3A for Fulminate ROP. RESULTS: Of the 54 cases that had treatable ROP, 36 (66.67%) had Fulminate type. The mean gestational age and birth weight was higher in Fulminate ROP compared to Conventional disease (31.75 weeks and 1554 gms vs 31 weeks 1387 gms) whereas the mean postnatal age at laser was lower (4.62 weeks vs 6.3 weeks). The average number of laser spots given was 3036.6 for Fulminate disease. CONCLUSION: Fulminate ROP had an atypical morphology which was difficult to classify according to ICROP classification and we would like to lay stress upon the importance of screening of premature infants from the age of 4 weeks and to start treatment immediately once Fulminate ROP has been diagnosed.     

The estimation of selected parameters in antioxidant system in red blood cells in ROP screening of premature infants

PURPOSE: To estimate correlation between concentration of antioxidant system parameters in red blood cells in premature infants and prevalence of ROP MATERIAL AND METHODS: We examined 16 premature infants with the average birth weight of 1071 g and gestational age of 29.1 weeks. Supraoxide dismutase (SOD), reduced glutatione (GSH), and glutathione peroxidase (GSH-Px), were measured at day 1 (cord blood), 7-th and 14-th day after birth. Premature infants had ROP screening. The control group included 12 infants born at term. RESULTS: 8 premature infants had ROP There were higher levels of SOD, GSH and GSH-Px in premature infants with and without ROP than in control group. Premature infants with ROP had lowest levels of GSH. Conclusions: The glutathione status of red blood cells as a oxidative stress index in premature infants might be a reliable parameter, facilitating the early recognition of patients in immediate danger of ROP development.     

计算机辅助间接检眼镜下正常早产儿眼底与早产儿视网膜病变的特征观察

目的 观察计算机辅助的双目间接检眼镜成像系统检查所见的早产儿正常眼底以及早产儿视网膜病变(ROP)图像特征，探讨计算机辅助的双目间接检眼镜成像系统在ROP筛查中 的 临床应用价值。方法 2006年1月至2006年12月期间，通过计算机辅助的 双目间接检眼镜成 像系统对150例早产儿行ROP早期筛查，首次检查的时间为早产儿出生后4~6周或其矫正胎龄 已达32周，并根据首次检查结果决定随诊时间。对检查过程进行录像，并对有意义的图像进 行拍照，以获得正常早产儿和ROP患眼的眼底图像。回顾分析时对各种图像特征进行对比分 析观察。结果 150例早产儿均通过双目间接检眼镜获得正常早产儿眼底 图像或各期典型的R OP图像。其中，正常早产儿眼底视盘色泽为较淡，周边视网膜仍未血管化呈青灰色调；ROP 各期在双目间接检眼镜下均具有不同的典型表现。结论 计算机辅助双 目间接检眼镜成像系 统可清楚地观察到早产儿正常眼底和各期ROP眼底的特征变化,真实客观的保存检查结果，在ROP筛查与治疗随访中具有一定应用价值。     

Semiautomated computer analysis of vessel growth in preterm infants without and with ROP

AIMS: To measure characteristics of the retinal blood vessels close to the optic disc in full term and preterm infants, with and without retinopathy of prematurity (ROP), using digital imaging. To determine whether these measures are indicative of the presence or severity of ROP in the retinal periphery. METHODS: 52 digital fundus images from 42 babies were analysed with a semiautomated analysis program developed at Imperial College London. Analysis was limited to the principal temporal vessels close to the optic disc: recording venular diameter and arteriolar diameter and tortuosity. RESULTS: Each result was categorised by the gestational age of the infant ("very premature" 24-27 weeks, "moderately premature" 28-31 weeks, and "near term" > or =32 weeks) and by the highest stage of ROP present ("no ROP," "mild ROP" stage 1 or 2, and "severe ROP" stage 3). Arteriolar tortuosity was found to vary significantly (Kruskal-Wallis p=0.002) with ROP severity. Although venular and arteriolar diameters increased monotonically with ROP severity the differences were not significant. Venular diameter, arteriolar diameter, and arterial tortuosity did not vary significantly between gestational age groups. CONCLUSIONS: This study confirms it is possible to quantify the size and tortuosity of retinal blood vessels in term and preterm babies using digital image analysis software. This method detected significant increases in arteriolar tortuosity with increasing ROP severity.     

Threshold retinopathy of prematurity in neonates less than 25 weeks' estimated gestational age.

INTRODUCTION: The survival rate of extremely premature infants has increased. No recent study has investigated the characteristics of retinopathy of prematurity (ROP) or the incidence of threshold ROP in the most severely premature infants. We undertook this study to determine the risk of developing ROP and threshold ROP in the growing sub-population of infants <25 weeks' estimated gestational age (EGA). METHODS: A retrospective review of infants born before the 25th week of gestation between the years 1994 and 1997 was performed. Of 49 infants examined (97 eyes), 42 were born in the 24th week of gestation and 7 were born in the 23rd week. Mean follow-up was 6.3 months (range, 2.5-37 months). Ophthalmology screening examinations were initiated at 5 weeks of age and continued until the infants were no longer at risk for serious ROP. RESULTS: ROP developed in all (97) eyes. Thirty-nine of 97 (40%) eyes in 20 of 49 (41%) infants developed threshold ROP, diagnosed at a mean post-conceptional age of 34 weeks. Thirteen (13%) eyes of 7 (14%) patients developed prethreshold disease and regressed without treatment. CONCLUSION: There is an increased incidence of threshold disease in infants 相似文献   

徐州地区早产儿视网膜病变相关因素分析

目的：了解徐州地区早产儿视网膜病变发病情况并分析相关影响因素。方法 ROP筛查患儿520例,收集整理相关资料并对其进行Logistic回归分析。结果完成筛查520例,检出74例（14.3%）,ROP的发生与母亲分娩年龄,婴儿性别,婴儿是否罹患HIE及母亲孕期吸氧史无关,胎龄和出生体重是保护因素,婴儿吸氧史,母亲孕期使用激素是危险因素。结论徐州地区ROP检出率14.3%,出生体重低,胎龄小,有吸氧史,及母亲孕期有激素使用史的早产儿ROP发病率较高。因此必须加强对此类患儿的ROP筛查。     

Analysis of risk factors for retinopathy of prematurity

AIM: To analyze the incidence and risk factors for retinopathy of prematurity (ROP). METHODS: A retrospective analysis was conducted on 568 premature infants from September 2005 to December 2010 with birth weight(BW) equal to or less than 2 500g or a gestational age(GA) at birth of 34 weeks or less. All of the members were examined by indirect binocular ophthalmoscopy. RESULTS: ROP occurred with an incidence rate of 10.7% among 568 premature infants, and stages 3 and above ROP occurred with an incidence rate of 2.5%. This study showed the infants were more prone to develop ROP with short geststional age, low BW, long time of oxygen inhalation, and severe infants diseases. Twins had a significantly higher rate of ROP(18.3%) than singleton babies(9.8%), ROP were severer in twins than singleton babies . CONCLUSION: Short GA, low BW, long time of oxygen inhalation, severe infants diseases, and non-singleton babies were the most significant risk factors associated with ROP.     

早产儿视网膜病变和宫外生长发育状况的关系研究

目的:观察苏州地区早产儿视网膜病变(retinopathy ofprematurity,ROP)的发病情况和宫外生长发育状况的关系。方法:对2010-01/10在苏州市立医院出生的胎龄<34wk,体质量<1500g的早产、低体重儿进行ROP筛查,记录符合筛查标准的各早产儿出生后第1～5wk的体质量值,按照出生后5wk体质量偏离百分比将早产儿分组,计算每组ROP阳性率。运用卡方检验对数据进行统计学分析。结果:出生后5wk内的体质量偏离百分比越大,ROP阳性率越大。结论:早产儿出生后生长发育状况和ROP发病密切相关,对早产儿出生后生长发育指标的测量,尤其是体质量的增长,或许可成为我国一个新的经济、简单的早期筛查方法,并可能对疾病的早期干预提供理论依据。     

规范氧疗后早产儿视网膜病变的临床分析

目的:分析规范氧疗后早产儿视网膜病(retinopathy of prematurity,ROP)发生状况的特点。方法:回顾性分析2005-01/2007-12住院并符合筛选条件的早产儿277例的临床资料以及ROP筛查随访资料。结果:ROP发生率为5.4%,均为Ⅰ,Ⅱ期ROP,无Ⅲ期或以上的ROP;出生胎龄≤32wk的早产儿和出生体质量≤1499g的早产儿占93.3%;首次诊断ROP时患者32～37(34.7±1.4)wk;出生胎龄、出生体质量和氧疗时间是致ROP发生的高危因素(P<0.01)。结论:规范氧疗可降低ROP发生率,筛查主要对象是出生胎龄≤32wk且出生体质量<1500g的早产儿。     

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.