Long-term results of lens-sparing vitrectomy for progressive posterior-type stage 4A retinopathy of prematurity

Purpose

To assess the long-term anatomic and visual outcomes and associated complications of lens-sparing vitrectomy (LSV) in infants with progressive posterior-type tractional retinal detachment (TRD) associated with stage 4A retinopathy of prematurity (ROP).

Methods

In a retrospective case series, the medical records of consecutive patients who presented with progressive posterior-type stage 4A ROP and underwent LSV between 1999 and 2007 were reviewed. Retinal attachment status, visual acuity, and development of postoperative complications were assessed.

Results

Eleven eyes of 9 patients were included. The mean follow-up period was 4.6 years. In 8 eyes (73%), plus disease was present at the time of LSV. In 3 eyes (27%), 2 (66%) without plus disease and 1 (13%) with plus disease, the retina remained reattached in the end, while 8 eyes (73%) had TRD on final examination. Two eyes with reattached retinas showed favorable visual acuity. In those eyes with detached retinas, 5 (68%) showed no light perception. When surgery for ROP was unsuccessful, development of cataract, corneal opacity, or glaucoma was common.

Conclusions

The long-term anatomic success rate of LSV for progressive posterior-type stage 4A ROP was low, especially in the presence of plus disease at the time of LSV. Anatomical reattachment is very important for preventing complications and gaining better visual outcomes.     

Functional and anatomical outcomes after primary lens-sparing pars plana vitrectomy for Stage 4 retinopathy of prematurity

Background:

While lens-sacrificing vitrectomy is the standard approach to manage Stage 5 retinopathy of prematurity (ROP), scleral buckling has been used to manage some cases of Stage 4. Lens-sparing vitrectomy was popularized by Maguire and Trese in selected cases of Stage 4 disease.

Purpose:

To assess the functional and visual outcomes after primary lens-sparing pars plana vitrectomy for Stage 4 ROP.

Materials and Methods:

In a retrospective, interventional, consecutive case series, the records of 39 eyes of 31 patients presenting with Stage 4 retinal detachment secondary to ROP who underwent primary two or three-port lens-sparing vitrectomy from January 2000 to October 2006 were evaluated. The outcomes studied at the final follow-up visit were the retinal status, lens and medial clarity and visual acuity. Favorable anatomical outcome was defined as the retinal reattachment of the posterior pole at two months after the surgery; and favorable functional outcome was defined as a central, steady and maintained fixation, with the child following light.

Results:

At mean follow-up of 15 months, 74% of the eyes had a favorable anatomical outcome with single procedure. The visual status was favorable in 63%. The lens remained clear in all the eyes at the last follow-up, and the media clarity was maintained in 87%. Intraoperative complications included vitreous hemorrhage, pre-retinal hemorrhage and retinal break formation.

Conclusions:

Lens-sparing vitrectomy helps to achieve a favorable anatomical and functional outcome in selected cases of Stage 4 ROP.     

保留晶状体的玻璃体切除术治疗4A期早产儿视网膜病变

目的 评价保留晶状体的玻璃体切除术治疗4A期早产儿视网膜病变后视网膜解剖复位情况以及视功能情况.方法 回顾性病例研究.15例20只4A期早产儿视网膜病变患眼经确诊后均在全麻下施行了保留晶状体的玻璃体切除术.术后随访通过间接检眼镜以及RetCamⅡ成像系统检查视网膜解剖复位情况,使用条栅视力(Lea gratingTM)检查来评估视功能的情况.结果 所有20只患眼术后随访中视网膜解剖均完全复位.其中3只患眼伴有黄斑部的变形或牵引(占15％),其余17只患眼术后眼底检查黄斑部结构正常(占85％).共9例患儿12只眼完成了条栅视力的检查,平均条栅视力值为(6.4±.2.5)c/d(2～12 c/d),转换为五分视力值平均为4.29±0.20 (3.82～4.60).其中1只患眼视力为3.82,1只患眼视力为4.0,其眼底检查都发现有黄斑部的变形以及牵引;其余10只患眼视力都优于4.3(4.30～4.60).结论 通过保留晶状体的玻璃体切除术治疗4A期早产儿视网膜病变,能够使视网膜解剖复位成功,并达到良好的视功能预后.     

4期早产儿视网膜病变巩膜扣带手术与玻璃体视网膜手术治疗疗效评价

目的 评价巩膜扣带手术与玻璃体视网膜手术治疗4期早产儿视网膜病变（ROP）的疗效。 方法回顾性分析接受巩膜扣带手术与玻璃体视网膜手术治疗的39例4期ROP患儿50只眼的临床资料。其中,4a期20只眼,4b期30只眼。患儿年龄2~18个月,平均年龄（6.0±3.4）个月;胎龄26~33周,平均胎龄（30.0±1.6）周;出生体重800~1900 g,平均体重（1404.5±237.6）g。行巩膜扣带手术19只眼,玻璃体视网膜手术31只眼。手术治疗后随访时间6~84个月,平均随访时间（26.0±21.7）个月。观察视网膜复位及屈光情况。 结果 行巩膜扣带手术的19只患眼视网膜全部复位,复位率占接受巩膜扣带手术患眼的100.0%。行玻璃体视网膜手术的31只眼中,27只视网膜复位,占接受玻璃体视网膜手术患眼的87。1%;4只眼手术后视网膜脱离继续进展,占接受玻璃体视网膜手术患眼的12.9%。行巩膜扣带手术的19只患眼中,5只眼随访期间拆除扣带加压物,占26.3%。行玻璃体视网膜手术的患眼屈光度为-1.25~11.00 D,平均屈光度为（-4.46±2.49） D;行巩膜扣带手术患眼屈光度为-1.25~9.25 D,平均(-3.21±1.96) D。两种手术患眼手术后屈光度比较,差 异无统计学意义（F=2.76,P=0.103）。结论玻璃体视网膜手术及外加压手术对4期ROP患儿的视网膜复位均有良好效果。     

‘Stop-and-Slide’ technique for trocar insertion during lens-sparing vitrectomy for retinopathy of prematurity

The modern-day trocar cannula systems meant for adult eyes pose a challenge in infant''s eyes with stage 4 retinopathy of prematurity (ROP) undergoing lens-sparing vitrectomy. This is primarily owing to the length of the trocar, globular lens, smaller axial length, and anteriorly displaced retina. We describe an inexpensive modification of the technique of trocar insertion in such cases wherein the trocar is inserted partially till the cannula impinges the sclera and thereon, the cannula slides over the trocar into the vitreous cavity. This obviates the need for complete insertion of the trocar into the vitreous cavity and hence limits the chances of inadvertent injury to the crystalline lens or the anteriorly lifted retina. We have experience in using this technique in 52 eyes of 44 infants over the past 2 years with no episode of iatrogenic lens touch or retinal break during trocar insertion.     

玻璃体手术治疗晚期早产儿视网膜病变的疗效及影响因素评估

目的 观察玻璃体手术治疗晚期早产儿视网膜病变（ROP）的临床效果,评估5期ROP手术后视网膜解剖复位失败的影响因素。方法 非随机、回顾性病例研究。临床确诊为晚期ROP并行玻璃体手术治疗的40例患儿58只眼纳入研究。其中,4a期16只眼,4b期7只眼,5期35只眼。玻璃体手术前曾接受过激光光凝治疗者18只眼,冷冻治疗者2只眼,玻璃体腔注射抗血管内皮生长因子（VEGF）单克隆抗体bevacizumab（商品名Avastin）（IVB）治疗者11只眼;其余27只眼无既往治疗史。玻璃体手术后平均随访时间17.01个月。随访期间采用双目间接检眼镜和二代广角数码视网膜成像系统(RetCamⅡ)记录各期患儿视网膜解剖复位情况;条栅视力（lea gratingTM）检查记录视功能,并将结果换算为Snellen视力值进行分析,对无法配合检查的患儿,以手动、光感和无光感来记录。分析患儿出生体重、胎龄,手术时年龄,手术前激光光凝、冷冻和IVB治疗史与5期ROP手术后视功能解剖复位失败的相关性。结果 4a期16只眼视网膜解剖复位成功,占100.00%。4b期7只眼中,视网膜解剖复位成功5只眼,占71.43%;复位失败2只眼,占28.57%。5期35只眼中,视网膜解剖复位成功12只眼,占34.29%;部分复位成功10只眼,占28.57%;复位失败13只眼,占37.14%。5期患儿视网膜解剖成功率较4a、4b期明显降低,差异有统计学意义（χ2=22.55,P＜0.05）。4a期16只眼中,在视功能随访过程中失访3只眼。其余13只眼中,完成条栅视力检查6只眼,视力为0.03但＜0.07,占46.15%;手动5只眼,占38.46%;光感2只眼,占15.39%。4b期7只眼中,完成条栅视力检查2只眼,视力分别为0.008和0.017,占28.57%;手动1只眼,占14.29%;光感2只眼,占28.57%;无光感2只眼,占28.57%。5期35只眼中,失访5只眼。其余30只眼中,完成条栅视力检查2只眼,视力均为0.004,占6.67%;手动4只眼,占13.33%;光感12只眼,占40.00%;无光感12只眼,占40.00%。5期患儿手术后视功能较4a、4b期明显降低,差异有统计学意义（χ2=15.734,P＜0.05）。5期患儿出生体重、胎龄,手术时年龄,手术前激光光凝、冷冻和IVB治疗史与手术后视网膜解剖复位失败无明显相关性（F=5.56, P＞0.05）。结论 玻璃体手术能有效控制4a期病变进展,使部分4b、5期病变视网膜复位。5期患儿出生体重、胎龄,手术时年龄,手术前激光光凝、冷冻和IVB治疗史与手术后视网膜解剖复位失败无明显相关性。     

Staged lensectomy and vitrectomy in the management of stage 5C retinopathy of prematurity with corneal opacification: long-term follow up

AIM: To verify the feasibility and safety of staged lensectomy and vitrectomy in stage 5C retinopathy of prematurity (ROP) with corneal opacification. METHODS: This was a retrospective, interventional, consecutive case series. Twenty-two eyes of 18 stage 5C ROP patients with corneal opacification were included. Regular combined lensectomy and vitrectomy were not prescribed due to the invisible fundus. Staged lensectomy and posterior vitrectomy were performed. The anatomical and visual outcomes were reviewed at the final follow-up visit. RESULTS: The mean gestational age of ROP patients was 29.3±1.6wk (range: 27-32wk), comprising 8 males and 10 females. The average birth weight was 1363.0±300.0 g. All the eyes had corneal opacity and flat or disappeared anterior chambers pre-operatively. Two eyes had complicated cataract and 7 eyes had retrolental fibroplasia. Six eyes had posterior pupillary synechiae or membranes. Seven (31.8%) eyes had vascularly active retinas. The average interval between two procedures was 6.8±4.6mo (2.5-18.5mo). After surgeries, all the patients had normal anterior chambers. Fourteen eyes had clear corneas. The intraocular pressure of 3 eyes with glaucoma was controlled by medication. Two eyes had ocular phthisis. The retina was reattached in 3 eyes and partially attached in 11 eyes. Visual acuity ranged from no light perception to hand motion. CONCLUSION: Staged lensectomy and vitrectomy are procedures that can halt progression to further complications and preserve some useful eyesight in stage 5C ROP patients with corneal opacification. The earlier the lensectomy is performed, the better the prognosis is.     

早产儿视网膜病变的筛查分析

目的 了解早产儿视网膜病变(retinopathy of prematurity,ROP)发病情况.方法 回顾性分析2009年6月至2010年10月间在东莞市人民医院ROP发病率及其特点.结果 接受筛查的早产儿共126例,发生ROP病变的21例,均为双眼发病,发病率16.67%,未到阈值前病变的19例,发病率15.08...     

Management of retinopathy of prematurity

Seventeen patients with symmetrical stage 3 retinopathy of prematurity (ROP) and plus disease as described in the International Classification of ROP had one eye randomized to cryotherapy and the other to control. Seventy-seven percent of the patients were under 1000 grams at birth and females outnumbered males by a 2 to 1 ratio. The average chronologic age at which cryotherapy was performed was three months. Twelve of seventeen treated eyes (71%) showed resolution of the ROP and 10 of 17 untreated eyes (59%) became significantly worse. However, only five patients had improvement in the treated eye and progression in the untreated eye, a number too small to provide statistical significance. Six eyes with Stage IV ROP were operated by encircling scleral buckling techniques because of total retinal detachment secondary to peripheral traction and cicatrization arising from the ridge. In five patients the unoperated eye had already developed a retrolental membrane, and in one patient bilateral detachments were present. Five of the six operated retinas were reattached.     

早产儿视网膜病变的筛查分析

Objective To investigate the incidence of retinopathy of prematurity(ROP)in Dongguan People's Hospital. Methods Records of premature infants who had undergone ROP screening in our hospital between June 2009 and October 2010 were analyzed retrospectively. Results Twenty-one cases out of 126 screened infants had developed ROP. Both eyes suffered from ROP in all the cases. The incidence of ROP was 16.67%. Of 19 cases(15.08%)developed ROP less than prethreshold and 2 cases(1.59%)developed threshold ROP. Among the 126 screened infants, 13(31.71%)out of 41 premature infants with birth weight(BW)<1500g and 8(9.41%)out of 85 with 1500g≤BW<2000g developed ROP, 15(30.61%)out of 49 with gestational age (GA)<32W and 6(7.79%)out of 77 with GA≥ 32W developed ROP. The incidence of ROP either among the groups of BW<1500g andl500g≤BW<2000g(x2=9.899, P <0.01), or among the groups of GA<32W and GA≥32W(x2=11.227, P<0.01)had statistical differences. Conclusions The incidence of ROP is 16.67% in Dongguan People's Hospital in present study. The incidence of severe ROP is low. Birth weight and gestational age are important factors to affect ROP incidence.     

Description and pathogenesis of late stages of retinopathy of prematurity

The retinal and vitreous changes seen in retinopathy of prematurity (ROP) can be explained by proliferation and contraction of tissue originating in the shunt area. Avascular retina is stretchable, and therefore much of it stays attached, while vascular retina is nonstretchable and detaches. When the shunt area forms a circular ring, one of three distinct patterns of retinal detachment develops, according to whether the shunt area is anterior, equatorial, or posterior in location. The detachments of ROP are, typically, traction detachments.     

早产儿视网膜病变筛查结果分析

目的 探索适合成都及周边地区早产儿视网膜病变(retinopathy of prematurity,ROP)的筛查模式.方法 回顾性调查分析研究.对2007年12月至2011年3月在四川省人民医院及成都市妇女儿童中心出生的332例体重2500g以下或孕周小于34周的早产儿,自生后4～6周或矫正胎龄32周开始筛查至周边视网膜血管化.结果 332例早产儿中有41例发生了早产儿视网膜病变,占12.35％.其中严重的4例(7只眼)接受了激光治疗,1例(1只眼)接受视网膜冷凝联合巩膜环扎手术治疗,占1.20％.按照卫生部制定的筛查标准,仅259例受检儿符合标准,ROP检出率为14.29％,有4例ROP患儿漏诊.眼底正常组患儿出生孕周和体重均明显高于ROP组,两组间有吸氧史者所占比例及不同严重程度ROP组与未发生ROP组吸氧时间的差异有统计学意义.结论 出生体重、胎龄、吸氧为早产儿视网膜病变发生的重要危险因素,婴儿出生的成熟度越低,早产儿视网膜病变尤其是严重的早产儿视 网膜病变发病可能性越高.成都及周边地区ROP筛查标准应在卫生部制定的ROP筛查标准的基础上适当扩大范围.     

积极推动早产儿视网膜病变的防治

早产儿视网膜病变（ROP）是儿童盲的重要致盲原因之一，随着ROP防治指南的颁布以及ROP筛查治疗工作的开展，我国ROP发病率和致盲率有所下降。正确认识和理解ROP分类、筛查标准和治疗指南；建立完善的ROP筛查体系，提高筛查水平；加强ROP临床和基础研究，将有助于进一步降低我国ROP发病率和致盲率。     

深圳早产儿视网膜病变筛查结果分析

目的 了解深圳地区三间医院早产儿视网膜病变（ROP）发病情况。方法 2004年 1月至2007年1月，对深圳市人民医院、深圳市妇幼保健院和深圳市眼科医院三间医院出生体重<2000g的早产儿或根据儿科医生的要求超过以上标准但患有严重疾病的早产儿共1372例2744只眼采用双目间接检眼镜和（或）广角数码儿童视网膜成像系统（RetCamII）进行 ROP筛查，发现阈值或阈值前期Ⅰ型ROP及时进行冷冻或激光 光 凝治疗。所有患儿随访至视网膜完全血管化或病变退化。结果 所有早产儿中218例436只眼发生ROP，发病率15.9％，其中阈值或阈值前期Ⅰ型ROP190只眼，发病率6.9％；4~5期ROP 16只眼，发病率0.6%；未到阈值或阈值前期Ⅰ型ROP 230只眼，发病率8.4 %。出生体重≤1500 g者435例870只眼，占所有筛查对象的31.7％；236只眼发生ROP，发病 率27.1%：其中阈值或阈值前期Ⅰ型ROP 126只眼，发病率14.5％；4~5期ROP10只眼，发病 率1.1%，未到阈值或阈值前期Ⅰ型ROP 100只眼，发病率11.5%。出生体重≤1250 g者274 只眼，占所有筛查对象的10％；108只眼发生ROP，发病率39.4%：其中阈值或阈值前期Ⅰ型 RO P 60只眼，发病率21.9%；4~5期ROP 4只眼，发病率1.4%；未到阈值或阈值前期Ⅰ型ROP 4 4 只眼，发病率16％。所有早产儿、出生体重≤1500g者和出生体重≤1250g者的RO P发病率（χ²=60.43，P<0.001）、阈值或阈 值前期Ⅰ型ROP发病率（χ²=46.82，P<0001）和未到阈值或阈值前期Ⅰ型ROP发病 率 （χ²=10.71，P=0.005）比较，差异均有统计学意义。结论 深圳地区三间医院早产儿ROP的总体发生率较 低，但需要治疗的阈值或阈值前期Ⅰ型重症ROP发病率高。出生体重是影响ROP发病 率的重要因素。     

Exudative retinopathy of adults: a late sequela of retinopathy of prematurity

The cases of 11 patients with a unilateral, retinal detachment associated with hard exudate and other late sequelae of retinopathy of prematurity are described. The abnormality was first noted in the second to fourth decades of life. Ten of the patients were women and one was a man. The source of the hard exudate was thought to be telangiectatic retinal vascular abnormalities. Among the ten treated eyes, four demonstrated an improvement in visual acuity. In two cases a mass lesion was also noted in the fundus.Supported in part by the Retina Research and Development Fund, Philadelphia, and Research to Prevent Blindness, New York     

泰州市早产儿视网膜病变筛查结果分析

目的了解泰州市早产儿视网膜病变（ROP）的患病情况并分析与ROP相关的高危因素。方法收集泰州市2008年3月至2011年3月286例（572只眼）早产儿和低体重儿ROP筛查资料进行回顾性分析。结果 286例（572只眼）早产儿和低体重儿中,共筛查出36例（72只眼）患有不同程度的ROP,ROP检出率约为12.6%,所有患儿均为双眼患病,其中包括ROP 1期12例（24只眼）,ROP 2期14例（28只眼）,ROP 3期4例（8只眼）,ROP4期2例（4只眼）,AP-ROP 1例（2只眼）,ROP 5期3例（6只眼）,提示早产、低出生体重、缺血和缺氧性脑病、胎盘早剥等影响胎儿发育的相对缺氧因素与ROP的发生密切相关。结论早产、低出生体重及相对缺氧因素是ROP发生的高危因素,早筛查、早发现、早治疗是预防ROP致盲的关键。     

西安地区早产儿视网膜病变筛查的初步结果

目的 探讨适合西安地区早产儿视网膜病变(ROP)的筛查标准并分析与ROP相关的高危因素.方法 回顾性系列病例研究.收集西安地区2008年6月至2009年6月134例(268只眼)早产儿和低体重儿ROP筛查资料进行回顾性分析.参照我国卫生部制定的ROP筛查标准,结合本地具体情况,适度扩大筛查范围,将出生体重≤2000 g或矫正胎龄≤34周的早产儿和低体重儿确定为本地区ROP筛查标准,并比较分析两个筛查标准所获结果.检查同时对受检儿全身情况进行评估与记录,分析ROP发生的全身高危因素.ROP患儿组与眼底正常儿组的出生孕周和出生体重比较,采用组间比较t检验;两组受检儿中有持续吸氧史者所占比例的比较,采用四格表资料的χ~2检验;ROP与全身相关因素的分析,采用Fisher精确检验.以P<0.05作为差异有统计学意义.结果 西安地区134例(268只眼)早产儿和低体重儿中,共筛查出18例(36只眼)患有不同程度的ROP,ROP检出率约为13.43%.其中男、女性各9例;出生孕周28～34周,平均(30.58±1.97)周;出生体重880～1950 g,平均(1388.89±268.39)g.18例ROP患儿均为双眼患病,其中ROP 1期4例(8只眼);ROP 2期5例(10只眼),其中1例病变侵及Ⅱ区且伴附加病变;ROP 3期伴附加病变5例(10只眼);ROP 4 A期1例(2只眼);ROP 5期1例(2只眼);退行性病变2例(4只眼).按照卫生部制定的ROP筛查标准,西安地区134例早产儿和低体重儿中,仅108例需要筛查,可以涵盖所有ROP患儿,ROP检出率约为16.67%(18/108).在接受筛查的134例早产儿和低体重儿中,眼底正常儿组的平均出生孕周为(32.56±2.00)周,平均出生体重为(1773.91±349.73)g,均明显高于ROP患儿组,差异有统计学意义(孕周t=3.90,P<0.01;体重t=4.45,P<0.01);眼底正常儿组与ROP患儿组有持续吸氧史者所占比例分别为59.48%和61.11%,差异无统计学意义(χ~2=0.017,P>0.05);缺血和缺氧性脑病及胎盘早剥在眼底正常儿组与ROP患儿组的比例分别为12.07%与33.33%(P=0.030)和0.86%与11.11%(P=0.047),差异有统计学意义;结果表明早产、低出生体重、缺血和缺氧性脑病、胎盘早剥等影响胎儿发育的相对缺氧因素与ROP的发生密切相关.结论 西安地区ROP检出率与国内其他地区报道的数据相近.我国卫生部制定的ROP筛查标准适合西安地区的ROP筛查工作.早产、低出生体重及相对缺氧因素是ROP发生的高危因素.     

远程医疗用于早产儿视网膜病变防治的意义

早产儿视网膜病变（ROP）是目前世界范围内儿童致盲的主要原因之一,虽然防治策略已取得了很大进步,但其管理体系方面尚存在许多限制.作为一种新兴技术,远程医疗对于提高ROP防治效率和管理质量具有较大潜力,但同时也面临着许多挑战.本综述对远程医疗用于ROP防治的必要性、可行性、优势及目前尚存在的问题进行了总结,特别强调了远程医疗用于ROP防治具有准确性高、可靠性高、效率高、性价比高的优势,具有广泛应用的前景.     

早产儿视网膜病变的临床分析

目的 观察早产儿视网膜病变(ROP)发生发展特点、危险因素及冷冻治疗疗效，探讨其合 理的筛查时机及治疗模式。方法 采用间接检眼镜合并巩膜压迫器加压 的方法对829例胎龄 ≤35周，体重≤2000g的早产、低体重儿进行ROP筛查；对32例阈值前病变Ⅰ型及阈值 病变患 儿行视网膜冷冻手术治疗。手术后随访3~16个月，以附加(plus)病变消退，血管嵴消退，冷冻斑形成，玻璃体视网膜出血吸收及无视网膜不良结构出现作为病情控制指标；若有病变遗漏区、血管嵴发展或附加病变不消退甚至加剧者则再次冷冻；若玻璃体积血不吸收，病情仍进展，发展 为视网膜皱 襞或脱离者则行玻璃体切割手术。结果 发现ROP86例172只眼。ROP各组与未发生ROP组吸氧时 间有显著性差异；出生体重≤1000 g、1001~1500 g、1501~2000 g的早产儿ROP发病比例 分别为69.56%、16.38%、4.14%；出生胎龄≤30周、31~32周、33~35周的早产儿ROP发病 比例分别为37.14%、10.43%、2.91%；单生子早产儿中ROP患病率为7.52%，双生子及 多生子早产儿中ROP患病率为20.22%。32例接受视网膜冷冻手术治疗的患儿，30例病情控制 满意, 2例病情发展为视网膜脱离，伴有后部附加病变，周边视网膜出血。32周内发病患儿 冷冻手术成功机 率高。 结论吸氧时间长、出生体重≤1000 g，胎龄≤30周ROP发病 风险显著增高，建议加强筛查。32周内发病或伴后部附加病变、周边视网膜出血的ROP患儿要严密随访；阈值前病变Ⅰ型及阈值病变行视网膜冷冻手术效果满意且安全。     

早产儿视网膜病变全视网膜脱离的玻璃体视网膜手术治疗预后

目的：评价玻璃体视网膜手术治疗早产儿视网膜病变(ROP)视网膜全脱离的临床效果。方法:回顾分析接受玻璃体视网膜手术治疗的56例5期（视网膜全脱离）ROP患儿73只眼的临床资料。手术时患儿年龄为3～84个月，平均年龄(13.02±14.64)个月，出生胎龄为25～36周，平均胎龄(29.5±2.22)周；出生体重为900～2500 g，平均体重(1400.19 ±300.05) g；吸氧时间为2～90 d，平均吸氧时间为(20.53±18.91) d。手术包括开放玻璃体切割手术和闭合晶状体切除、玻璃体切割手术。视网膜解剖复位的标准以黄斑复位为视网膜复位成功，视网膜复位黄斑脱离为部分成功，视网膜未复位为手术失败。结果:手术后10只眼视网膜复位成功，占13.69%；20只眼视网膜复位部分成功，占27.39%；43只眼视网膜复位失败 ，占58.9%。手术后视力为手动者9只眼，占12.33%；条栅视力＞0.004者6只眼,占8.21% 。结论:ROP 视网膜全脱离的玻璃体视网膜手术治疗手术难度较大，手术后仅少数患儿视网膜复位成功 ，部分患儿视功能有一定恢复。