The pathogenesis of retinopathy of prematurity as it relates to surgical treatment

Our current surgical treatment for threshold retinopathy of prematurity (ROP) is based upon three concepts which emerged from morphologic and biochemical study of 250 pairs of whole eye donations obtained over a ten year period. 1) Spindle cells normally migrate and canalize to form inner retinal vessels, but when stressed, spindle cells secrete angiogenic factors. The clinical implication is that transretinal cryotherapy to the avascular retina is efficacious because it obliterates spindle cells. The number and timing of cryosessions are determined by the migration and kinetics of spindle cells. 2) Myofibroblasts originate from the shunt, are the major cellular component of extraretinal fibrovascular proliferation (EFP), and contract to produce retinal distortion and detachment. The clinical implication is that a second transretinal cryotherapy session should obliterate the shunt and the EFP, and should eliminate the source of retinal traction. 3) Anterior ocular growth occurs exponentially during the period when ROP develops and is treated. The clinical implication is that a prophylactic scleral buckle supports the fixed surface area of the developing retina while the choroid and sclera enlarge anteriorly. Retinal distortion produces misaligned photoreceptors, and retinal detachment results in rapid retinal death.     

Effect of two different doses of intravitreal bevacizumab with temporal retina-sparing laser photocoagulation for retinopathy of prematurity

This study aims to compare the efficacy and safety between two different doses of intravitreal bevacizumab (IVB) injection with temporal retina-sparing laser (TRSL) photocoagulation for retinopathy of prematurity (ROP). We retrospectively evaluated 22 eyes of ROP infants who underwent IVB combined with partial TRSL for stage 3+ zone I or posterior zone II ROP. Laser photocoagulation was applied on the avascular retina, sparing two-disc-diameter width temporal avascular area anterior to ridge. A half dose (0.625 mg) or minimal dose (0.25 mg) of IVB was conducted. Four eyes in minimal dose group were retreated with IVB and laser photocoagulation on the spared retina. Of those 4 retreated eyes, three developed preretinal hemorrhage around the ridge after the first treatment, resulting in fibrotic macular dragging. A half dose of IVB may be more effective than a minimal dose with partial TRSL for ROP. Preretinal hemorrhage may be a harbinger of poor prognosis.     

Laser photocoagulation (810 nm diode) for threshold retinopathy of prematurity: a prospective randomized pilot study of treatment to ridge and avascular retina versus avascular retina alone

The purpose of this study was to compare the structural outcome of laser treatment to avascular retina and ridge versus laser treatment to avascular retina alone in cases with threshold retinopathy of prematurity (ROP). A prospective, randomized, interventional, comparative study of consecutive cases referred to a single tertiary center was considered here. 50 infants with bilateral symmetrical threshold ROP were recruited into this study over a period of 3 years. Threshold ROP was defined as per CRYO-ROP study. Perinatal history details for all patients including significant maternal history were recorded. One eye of each patient was randomized (Microsoft Excel 2000) to one of the two treatment groups—laser treatment to avascular retina (Group A) or laser treatment to avascular retina and ridge (Group B). Laser treatment was performed with a 810 nm diode laser (Iris Medical Instruments, Inc. Mountain View, CA, USA). Treatment was continued until regression of ROP. Structural outcome was assessed at a minimum follow-up of 6 months and was considered favorable or unfavorable as per the CRYO-ROP study criteria. An unfavorable outcome consisted of either (1) a retinal fold involving the macula; (2) any retinal detachment involving zone 1; or (3) a retrolental mass that obscured visualization of the posterior pole. Secondary outcome measures included the difference in time to regression of ROP and complications of treatment between the two treatment groups. 100 eyes of 50 infants received laser photocoagulation for threshold ROP after randomization (50 eyes in each group). Of these 50 infants, 20 (40%) were female and 30 (60%) were male. A significant proportion of the children (46%) were conceived as twins. The average birth weight was 1360 ± 326 g (range 750−2200 g). The mean gestational age at birth was 30.72 ± 1.6 weeks (range 26−36 weeks). Zone I disease was present in 14 (14%) eyes and zone II in the remaining 86 eyes (86%). Threshold stage retinopathy (CRYO-ROP criteria) extending 360° (12 clock hours) was present in 21 infants (42%), 5 contiguous clock hours of stage 3+ in 14 infants (28%) and intermediate range in the remaining 15 infants (30%). At 6 months follow-up, 3 eyes (6%) in group A and 1 eye (2%) in group B had an adverse structural outcome; however, the time to regression of retinopathy 2.98 ± 1.5 weeks in group A and 3.12 ± 1.1 in group B (P = 0.889) and the rate of complications such as retinal hemorrhage, 3 eyes in group A and 4 eyes in group B, was comparable. Zone I eyes showed equal incidence of favorable anatomical outcome (85.7%) in each group. Laser treatment to ridge was found to be safe and effective in the treatment of threshold ROP in this short-term pilot study; however, it needs to be ascertained whether this treatment has long-term advantages over conventional laser treatment to avascular retina, as well as the long-term benefits of treatment to ridge.     

Diode laser photocoagulation to the vascular retina for progressively advancing retinopathy of prematurity.

AIMS--To estimate the effectiveness of diode laser photocoagulation of the retina posterior to the ridge in eyes with retinopathy of prematurity (ROP). METHODS--Diode laser photocoagulation was applied posterior to the fibrovascular ridge in stage 4a ROP in six eyes of four infants and in advancing stage 3+ in two eyes of one infant. Seven eyes had previously been unsuccessfully treated with diode laser photocoagulation anterior to the ridge. RESULTS--Six eyes of four children had total regression, two eyes of two children had flat maculae with residual peripheral tractional detachment and maintained vision. CONCLUSION--These preliminary results indicate that diode laser photocoagulation posterior to the ridge may be a useful treatment in late stage 3 and stage 4A ROP following failed laser treatment to the avascular retina in threshold stage 3 disease.     

An interpretation of retinopathy of prematurity in terms of spindle cells: relationship to vitamin E prophylaxis and cryotherapy

Spindle cells in the hyperoxygenated, avascular, vanguard retina are proposed to be the peripheral inducers of the neovascularization associated with retinopathy of prematurity (ROP). The induction of ROP is conceptualized in terms of three basic events. First, activation of spindle cells results initially in the increase in gap junctions between adjacent spindle cells, secondarily in the increase in cytoplasmic volume of rough endoplasmic reticulum, and ultimately in the synthesis and secretion of angiogenic factors. Second, maturation of spindle cells is associated with a decrease in gap junctions, a diminished cytoplasmic volume of rough endoplasmic reticulum, and a cessation of synthesis and secretion of angiogenic factors. Third, myofibroblasts invade the vitreous concomitantly with spindle cell maturation and provide the tractional force that can produce retinal separation. The extent of interstitial retinol binding protein within the subretinal space explains the gestational-age-dependent efficacy of vitamin E in suppressing the development of severe ROP. The kinetics of both spindle cell activation/maturation and myofibroblast invasion predict the efficacy of appropriately timed and placed transretinal cryotherapy.Presented at the 1984 meeting of the Club Jules Gonin in Lausanne, Switzerland     

【In Press】Effect of two different doses of intravitreal bevacizumab with temporal retina-sparing laser photocoagulation for retinopathy of prematurity

This study aims to compare the efficacy and safety between two different doses of intravitreal bevacizumab injection (IVB) with temporal retina-sparing laser photocoagulation (TRSL) for retinopathy of prematurity (ROP). We retrospectively evaluated 22 eyes of ROP infants who underwent IVB combined with partial TRSL for stage 3+ zone I or posterior zone II ROP. Laser photocoagulation was applied on the avascular retina, sparing two-disc-diameter width temporal avascular area anterior to ridge. A half dose (0.625 mg) or minimal dose (0.25 mg) of IVB was conducted. Four eyes in minimal dose group were retreated with IVB and laser photocoagulation on the spared retina. Of those 4 retreated eyes, three developed preretinal hemorrhage around the ridge after the first treatment, resulting in fibrotic macular dragging. A half dose of IVB may be more effective than a minimal dose with partial TRSL for ROP. Preretinal hemorrhage may be a harbinger of poor prognosis.     

Combined use of cryotherapy and diode laser photocoagulation for the treatment of threshold retinopathy of prematurity.

PURPOSE: Cryotherapy and indirect laser retinal photoablation are both effective in the treatment of retinopathy of prematurity (ROP). We describe the safety, efficiency, and effectiveness of combined cryotherapy and diode laser photocoagulation to treat threshold ROP. METHODS: Records of patients developing threshold ROP from January 1, 1996 through December 31, 1998, were retrospectively reviewed to identify those treated with combined cryotherapy and photocoagulation and followed up for at least 45 days postoperatively. Diode laser was used to ablate posterior avascular retina, and cryotherapy was used for anterior retina. Data reviewed included ocular and systemic complication rates, treatment duration, number of laser burns, most recent fundus examination, visual acuity, and refraction. RESULTS: In 13 patients, 23 eyes received combined treatment. No intraoperative complications occurred. Mean duration of anesthesia and treatment was 35 +/- 8 minutes/eye. A mean of 117 +/- 84 laser burns/eye were applied. In 20 of 23 eyes (87.0%), anatomic outcome was favorable at last examination. In 13 of 16 eyes (81.3%), functional (visual acuity) outcome was favorable (visual acuity better than 20/200) at 1 year. At 6 months or later, 14 of 16 eyes (87.5%) measured were myopic, of which 5 (31.3%) were highly myopic (> 6 diopters). CONCLUSIONS: The effectiveness of treating ROP with combined cryotherapy and diode laser photocoagulation compares with that of either modality alone. By decreasing the number of laser applications, combined therapy may be faster and technically easier for eyes with very posterior ROP. This may decrease the number of complications seen when either excessive cryotherapy or laser retinal photoablation is used.     

早产儿视网膜病变注射雷珠单抗后荧光素眼底血管造影表现

目的　了解早产儿视网膜病变（ｒｅｔｉｎｏｐａｔｈｙｏｆｐｒｅｍａｔｕｒｉｔｙ,ＲＯＰ）注射雷珠单抗后的荧光素眼底血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓ-ｃｅｉｎａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）表现。方法　选取２０１４年３月至１１月在深圳市眼科医院确诊为ＲＯＰ的１５例（３０眼）患者纳入研究,其中急进性后部型ＲＯＰ（ａｇｇｒｅｓｓｉｖｅｐｏｓｔｅｒｉｏｒｒｅｔｉｎｏｐａｔｈｙｏｆｐｒｅｍａｔｕｒｉｔｙ,ＡＰ-ＲＯＰ）８眼,阈值期ＲＯＰ１３眼,阈值前期Ⅰ型ＲＯＰ９眼。在表面麻醉下,经颞下方睫状体平坦部进针,向玻璃体内注射雷珠单抗０．０３ｍＬ。在注药术后１～２个月,气管插管全身麻醉下行ＦＦＡ检查,观察附加病变消退情况及视网膜周边血管发育情况。结果　注射雷珠单抗后,所有眼底附加病变消退,但周边视网膜均存在不同程度的无血管区。８眼ＡＰ-ＲＯＰ中６眼Ⅲ区无血管形成,继续随访观察;２眼Ⅱ区大范围无血管形成,血管末梢分支增多呈毛刷样,无荧光素渗漏,１周后再次注射雷珠单抗。１３眼阈值期ＲＯＰ中,１眼可见颞下方牵拉性视网膜脱离,行局部激光光凝;１２眼嵴完全消退,其中２眼视网膜血管基本发育完全;４眼Ⅲ区无血管形成,４眼Ⅲ区及Ⅱ区鼻侧２个钟点无血管形成,均无荧光素渗漏,继续随访观察;２眼Ⅱ区累计４个钟点无血管区伴末梢血管扩张及新生血管荧光素渗漏,行激光光凝。９眼阈值前期Ⅰ型ＲＯＰ中７眼嵴全部消退,２眼嵴变低平;４眼Ⅲ区及Ⅱ区鼻侧２个钟点范围无血管形成,５眼Ⅲ区无血管形成,均见末梢血管扩张,但无荧光素渗漏,继续随访观察。结论　注射雷珠单抗可促使ＲＯＰ病变消退,且不干扰周边视网膜血管化。     

Combined treatment with laser photocoagulation and cryotherapy for threshold retinopathy of prematurity

PURPOSE: To report the structural, functional, and refractive outcome, safety, and effectiveness of combined cryotherapy and diode laser indirect photocoagulation in the treatment of threshold retinopathy of prematurity (ROP). METHODS: Medical records of patients developing threshold ROP between 1995 and 2003 were reviewed to identify those with combined treatment and followed up for at least 4 years postoperatively. A total of 94 patients (172 eyes) received combined treatment. Data consisted of grade of ROP pre- and postoperatively, most recent fundus examination, birthweight, visual acuity, complications, and refraction. Diode laser was used to ablate posterior avascular retina, and cryotherapy was used for anterior retina. RESULTS: A total of 149 (87%) eyes responded to combined treatment and they had favorable anatomic outcome at last examination. In 131 eyes (76%), functional outcome was favorable (visual acuity better than 20/200) at last examination. Perioperative complications included hemorrhages in 26% of eyes, which resorbed spontaneously. Mean duration of treatment was 31 minutes/eye. At final visit (4 to 12 years), 115 eyes (66.8%) refracted were myopic, of which 26 (22.5%) had high myopia over -6 diopters. CONCLUSIONS: Combined cryotherapy and diode laser photocoagulation for ROP in our patients resulted in regression of threshold ROP with relatively successful structural and functional outcomes. Combined therapy may be faster and useful for eyes with very posterior ROP. This may decrease the number of complications occurring when excessive cryotherapy or laser photoablation must be used in zone 1 ROP.     

Zone I retinopathy of prematurity

INTRODUCTION: Patients with zone I retinopathy of prematurity (ROP) have poor outcomes despite treatment. We analyze the clinical characteristics and treatment outcome of patients with zone I disease and compare them with patients with zone II disease. METHODS: Preterm infants weighing less than 1500 g at birth were screened by the authors at age 4 to 6 weeks (group A). Group B was composed of referral patients that had been screened elsewhere. Findings were recorded according to the International Classification of Retinopathy of Prematurity. We classified all patients as either zone I, zone II, or zone III disease. If a retinopathy spanned 2 zones in one eye, it was classified in the most posterior zone as indicated by the International Classification of Retinopathy of Prematurity. Threshold was defined as in the Cryotherapy for Retinopathy of Prematurity study. Indirect diode-laser treatment was used to ablate the avascular retina. At the 3-month follow-up, outcome was judged according to Cryotherapy for Retinopathy of Prematurity criteria. Differences between eyes with zone I or zone II ROP were analyzed. RESULTS: Group A was composed of 222 infants; 2 presented with zone I ROP. Of 63 patients comprising group B, 9 had zone I ROP: a total of 11 infants with zone I ROP, 22 eyes. At 3 months, 8 of 20 eyes with zone I ROP that were included in follow-up had an unfavorable outcome (40%). Mean birth weight and gestational age were similar in zone I and zone II cases, but mean gestational age at treatment was significantly different (35.2 weeks in zone I cases vs 37.2 weeks in zone II cases, P =.006). Unusual signs such as a demarcation vessel between vascular and avascular retina and excessive intraretinal neovascularization were observed in zone I eyes but not observed in eyes with zone II or zone III ROP. DISCUSSION: Zone I ROP appears to be different from zone II ROP. Earlier treatment age suggests either an early start, faster progression, or both. Special attention should be given to atypical morphology present in zone I ROP.     

Diode laser treatment of posterior retinopathy of prematurity

AIMS: To study the efficacy of infrared diode laser for the treatment of posterior retinopathy of prematurity (ROP). METHODS: 48 eyes of 25 premature babies (mean birth weight 779 (SD 127.7) g; mean gestational age 25.5 (SD 1.47) weeks) with threshold ROP in zone I and posterior zone II were treated by the indirect infrared (810 nm) diode laser. Confluent burns were applied to the avascular retina. In 18 eyes, an additional row of laser burns was added posterior to the ridge. RESULTS: Favourable anatomical results were noted in 41 eyes (85.4%). ROP stage 5 developed in two eyes, ROP stage 4A developed in four eyes, and ROP stage 4B in one eye. Three of the eyes with stage 4A eyes were successfully buckled; the fourth was not operated on and remained demarcated by laser scars. No complications were noted. CONCLUSION: In this series, the diode laser was found to be a safe and effective treatment for posterior ROP.     

Wide-field digital imaging based telemedicine for screening for acute retinopathy of prematurity (ROP). Six-year results of a multicentre field study

Objective  To report on a 6-year experience with wide-field digital imaging based telemedicine (WFDI telemedicine) to reduce the risk for blindness from retinopathy of prematurity (ROP). Methods  Wide-angle digital fundus cameras (RetCam 120, Massie Lab, Pleasanton, CA, USA) were installed in five neonatal intensive care units (NICUs) in Germany. All prematures at risk were screened with WFDI, and the local ophthalmologists were asked to continue binocular indirect ophthalmoscopy (BIO) according to the German guidelines. Image data were coded and transferred to the Reading Centre in Regensburg. Image evaluation and additional BIO of infants with suspected treatment-requiring ROP (STR-ROP i.e. threshold ROP zone II, prethreshold ROP zone I (type-1 ROP according to ETROP), and ROP possibly requiring treatment but not reliably classifiable from the images) were performed by paediatric ophthalmologists at the Reading Centre. ROP was classified following ICROP, ETROP, and revised ICROP criteria. Outcome measures were incidence of clinically relevant ROP (CR-ROP, i.e. any ROP up to mid-peripheral zone III, ≤ stage 3+), sensitivity to detect STR-ROP, and positive predictive value to detect treatment-requiring ROP (TR-ROP). Results  In total, 1,222 prematures at risk were screened (mean BW 1395 g, SD ±507 g; mean GA 30 wks, SD ±3 wks). The overall incidence of CR-ROP was 27.6% (71.8% mild = stage 1 to 3 without plus disease, 15.7% prethreshold = type-1 ROP according to ETROP, 12.5% threshold according to ICROP). Zone I disease was present in 3.3%, zone II disease in 76.5%, and zone III disease in 20.2%. According to ETROP, 95 infants were type-1 or type-2 ROP; 67.4% type-1 ROP, and 32.6% type-2 ROP. Of all 1,222 infants, 3.5% received treatment. Following ETROP (not applied in the study), 5.3% would have been treated. The sensitivity for detecting STR-ROP was 100%, and the positive predictive value for TR-ROP 82.4% (28/34) at the time of the first referral (28 infants, ≤ stage 3+ in zone I or II). Conclusion  All TR-ROP was detected in time, showing the potential of our telemedical screening program. The overall incidence of CR-ROP was comparable to ROP incidences reported in other West European countries. Support: Bayerische Sparkassenstiftung, München, Germany; Bayerische Landesstiftung, München, Germany; Deutsche Forschungsgemeinschaft (DFG Lo 457/4-1,2), and Iris Medical, Mountain View, CA, USA The authors do not have any financial interest in the RetCam120 or Massie Laboratories, Pleasanton, CA 94588, USA or Clarity Medical Systems Inc, Pleasanton, CA 94588, USA C: (925)-519-6655, Parts of the contents were presented at the Annual Meetings 2003 and 2007 of the Association for Research in Vision and Ophthalmology ARVO, at the Annual Meeting of the European Paediatric Ophthalmological Society EPOS 2003, at the Annual Meeting 2004 of the German Ophthalmological Society DOG, and at the World Ophthalmology Congresses WOC 2006 and 2008     

Ocular dimensions following cryotherapy for active stage of retinopathy of prematurity

In a group of 21 premature children in which 4 to 10 years earlier 26 eyes with stage 4 of active retinopathy of prematurity (ROP) were treated by cryopexy on the avascular retina, and 15 fellow eyes with stage 2 of active ROP were not treated, comparative measurements of the central corneal thickness, anterior chamber depth and eye axial length were performed. Not significant statistical differences of these parameters were found between the cryotreated and untreated eyes. The axial length was correlated with the degree of myopia.     

Comparison of structural outcome between intravitreal bevacizumab and laser treatment for type 1 retinopathy of prematurity after long-term follow-up

Background:To compare the structural outcome of intravitreal bevacizumab (IVB) and laser treatment for type 1 retinopathy of prematurity (ROP). Methods: This is a retrospective comparative study. From December 2002 to April 2009, patients with type 1 ROP according to criteria of Early Treatment of Retinopathy of Prematurity (ETROP) study were treated by peripheral retinal diode laser photocoagulation in nearly confluent pattern. From May 2009 to January 2015, we performed IVB for patients with type 1 ROP. The patients were closely followed until disappearance of retinal neovascularization in the laser group and regression of avascular zone in the bevacizumab group. The demographical data, postmenstrual age (PMA) for treatment, and fundus ifndings were recorded by chart review. The difference between laser and bevacizumab groups was compared by Studentt-test and Fisher exact test. Results: We collected 43 patients (86 eyes) with type 1 ROP, including 30 male and 13 female infants. Their mean gestation age and birth body weight (BBW) were 27.5 weeks and 1,034 gm. Zone I and zone II disease were found in 8 and 35 patients. The mean PMA for treatment was 37.3 weeks. The mean follow-up period was 54.4 months. Laser treatment was administered in 26 patients, and bevacizumab injection for 17 infants. Single session of laser was performed in all patients of laser group without recurrence of retinal neovascularization. Complete regression of ROP was found in 15 infants of bevacizumab group following the ifrst IVB. Four eyes in two patients (2/17, 11.7%) had recurrence of ROP and received additional injections and adjuvant laser treatment. There was no unfavorable anatomical results such as retinal detachment or macular ectopia or complications such as cataract or endophthalmitis in either bevacizumab or laser management. Conclusions: Laser therapy and IVB were both effective treatments for type 1 ROP to cause favorable anatomical outcomes. Single session of laser ablation in nearly conlfuent pattern was sufifcient for complete regression of ROP in laser group. Single IVB was appropriate for managing most of cases with ROP in bevacizumab group, but a small proportion (nearly one tenth) of them had recurrent episodes requiring adjuvant therapies.     

Cryotherapy for treatment of active retinopathy of prematurity: experience in London, Ontario.

Between January 1985 and May 1990, 49 infants (97 eyes) with stage 3 "plus" retinopathy of prematurity (ROP) were treated with cryopexy. The mean gestational age at birth was 29.6 weeks and the mean birth weight 753 g. At the time of treatment the mean chronologic age was 8.7 weeks and the mean weight 1629 g. Noncutting cryopexy was applied to the entire avascular peripheral retina, anterior to the mesenchymal ridge. Confluent treatment was done anteriorly to the posterior border of the pars plana. Favourable results, defined as a normal-appearing fundus (apart from the cryopexy scars) with no retinal folds or traction, were observed in 70% of the eyes an average of 13.8 (range 2 to 60) months after treatment. Our results emphasize the importance of early detection of ROP and diligent monitoring and treatment of affected infants.     

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.     

影响1区早产儿视网膜病变激光治疗结果的因素分析

目的　观察影响1区早产儿视网膜病变（ROP）激光治疗效果的相关因素。方法　回顾性分析35例1区ROP患儿 69只眼的临床资料。所有患儿均经过间接检眼镜检查确诊,根据病变在视网膜的位置分为前部1区和后部1区,分别为49、20只眼。69只眼中急进性ROP（AP-ROP）12只眼,前部1区4只眼,后部1区8只眼。在+20 D透镜辅助以及巩膜压迫器压迫下,采用二极管间接检眼镜激光对嵴前周边视网膜无血管区进行激光光凝,随访观察时间2～48个月,平均观察时间（10.85±11.35）个月。嵴消退,病情稳定为治愈;视网膜病变进展为4期或5期为视网膜病变进展。结果　69只眼中,治愈42只眼,占60.87%;视网膜病变进展27只眼,占39.13%。前部1区49只眼中,治愈34只眼,占69.38%;进展15只眼,占30.62%。后部1区20只眼中,治愈8只眼,占40.00%;进展12只眼,占60.00%。前部1区和后部1区视网膜病变进展率比较,差异有统计学意义（χ2=5.15,P＜0.05)。AP-ROP 12只眼中激光光凝后视网膜脱离9只眼。发现视网膜病变进展的时间在激光光凝治疗后2～18周。Logistic回归分析表明,激光光凝治疗后ROP的进展与治疗前视网膜纤维血管网的范围有关（回归系数0.235,P=0.00）,与早产儿的出生体重（回归系数0.000,P=0.091）、胎龄（回归系数-0.037,P=0.359）、激光治疗时矫正胎龄（回归系数0.013,P=0.651）及激光光凝点数量（回归系数-5.7E-0.05,P=0.800）的多少无关。结论　1区ROP激光光凝治疗有效,前部1区的激光光凝治疗预后较后部1区好;激光光凝治疗后的视网膜病变进展与治疗前视网膜纤维血管网范围有关。     

冷凝治疗早产儿视网膜病变初步报告

目的探讨冷冻治疗阈值或阈值前期(1型)早产儿视网膜病变(retinopathy of pre-maturity,ROP)的治疗效果。方法对筛查过程中发现的25例(50只眼)阈值或阈值前期(1型)ROP进行冷凝手术。全麻后在间接检眼镜直视下冷凝周边视网膜无血管区,术后局部应用皮质类固醇和睫状肌麻痹剂2周。病变继续发展者补充冷凝手术,或进行间接检眼镜直视下光凝治疗,发生视网膜脱离或有玻璃体积血者进行玻璃体手术治疗。结果第一次手术后21例(42只眼)病变控制;4例(8只眼)病变仍继续发展,其中2例(4只眼)第2次冷凝手术后病变控制,最后冷凝治疗成功率为92%。1例(2只眼)第2次冷凝手术后1只眼玻璃体积血,3个月后对侧眼发生视网膜脱离,进行了玻璃体视网膜手术病变控制;另外1例(2只眼)一次冷凝治疗后病变继续发展,遂进行激光治疗、玻璃体手术,最后病变控制。结论冷凝是阻止阈值或阈值前期(1型)ROP发展的有效方法,术后玻璃体出血是冷凝的主要并发症之一。冷凝治疗长期疗效有待进一步随访。     

早产儿视网膜病变的冷冻治疗

目的:观察早产儿视网膜病变(retinopathy of prematurity,ROP)阈值前病变I型及阈值病变的冷冻治疗疗效,探讨其合理的治疗时机及模式。方法:对胎龄≤35wk,质量≤2000g患儿进行ROP筛查,对阈值前病变I型及阈值病变进行冷冻治疗。结果:(1)共筛查829例符合条件的早产儿,发现早产儿视网膜病变患儿86例(172眼,占10.4%),如按照中华眼科学会制定的ROP筛查标准(出生胎龄≤35wk,质量≤2000g)则患病率为20.6%;其中4期6眼(3.5%),3期44眼(25.6%),发展快的2期14眼(8.1%),稳定或退行2期56眼(32.6%),1期52眼(30.2%);24眼有后部plus现象,58眼周边视网膜出血;50眼2区发病,122眼3区发病;32wk及以内发病的16眼,32~36wk发病的60眼,36wk及以后发病的96眼;(2)行冷冻手术32例(64眼),其中阈值前病变I型12例,阈值病变20例;24眼有后部plus现象;40眼周边视网膜出血;50眼2区发病,14眼3区发病;32wk及以内发病的16眼,32~36wk发病的36眼,36wk及以后发病的12眼;单生子21例,双生子10例,三生子1例;(3)30例病情控制满意;1例发展为后极部视网膜皱襞,周边视网膜脱离,最后行玻璃体切割手术;2例玻璃体出血,其中1例出血吸收,1例最后牵引性视网膜脱离;(4)3例术后短期角膜水肿,5例眼睑冻伤,2例玻璃体出血。结论:(1)后部plus现象、周边视网膜出血、2区发病、32wk内发病的ROP是高风险病变,病情发展迅速,往往需要行手术治疗;(2)对阈值前病变及阈值病变及时行视网膜冷冻术效果较满意且安全。     

重度早产儿视网膜病变早期治疗后眼屈光状态研究进展

临床上发现在早产儿视网膜病变阈值期、阈值前期I型以及急进性后部型的患儿行早期治疗,如冷凝治疗、激光光凝治疗、玻璃体内注射抗血管内皮生长因子药物后,对眼部结构、眼球发育和眼屈光状态有影响,不同治疗方法间也有差异.本文旨在对近年来重度早产儿视网膜病变早期治疗术后眼的屈光状态研究进行综述.