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.

Efficacy of intravitreal injection of anti-vascular endothelial growth factor agent for retinopathy of prematurity in different zones

Objective To observe the clinical effects of anti-vascular endothelial growth factor (VEGF) agent for retinopathy of prematurity (ROP) in different zones.Methods Retrospective analysis was performed on 24 ROP patients (46 eyes) who received intravitreal injection of anti-VEGF agent in our hospital from April 2013 to April 2014,including 15 patients (28 eyes) with Zone Ⅰ ROP and 9 patients (18 eyes) with Zone Ⅱ ROP.All the patients receive intravitreal injection of anti-VEGF agent Ranibizumab.The patients were observed for postoperative progression of fundus conditions,and the recovery rate and progression rate following initial injection were compared statistically between two groups.Results There was no statistically significant difference between the two groups in gestational age at birth or birth weight (both P ＞0.05);And statistically significant difference was found between two groups in gestational age at surgical correction (P =0.001).Following initial injection,the recovery rates were 32.14％ and 66.67％,and the progression rates were 67.86％ and 33.34％ in Zone Ⅰ ROP group and Zone Ⅱ ROP group,respectively,there was statistically significant difference between the two groups in recovery rate (x2 =5.263,P =0.022).The progression rate in Zone Ⅰ ROP group was higher than that in Zone Ⅱ ROP group,there was statistically significant difference (x2 =-2.269,P =0.023).During follow-up,no complications of intravitreal injection as cataract,endophthalmitis or retinal tears was observed;Only 2 patients experienced corneal edema,and 4 patients experienced subconjunctival hemorrhage.Conclusion Intravitreal injection of anti-VEGF agent is effective for both Zone Ⅰ and Zone Ⅱ ROP.While for Zone Ⅰ ROP,the surgery success rate is low and the reoperation rate is high,such treatment can provide favorable time and conditions for reoperation.