高危阈值前和阈值病变早产儿视网膜病变激光光凝治疗疗效分析

目的 观察激光光凝治疗高危阈值前和阈值病变早产儿视网膜病变（ROP）的临床疗效和安全性。方法 临床检查确诊的97例ROP患儿186只眼纳入研究。其中，高危阈值病变88只眼，阈值病变98只眼。186只眼中，1区病变70只眼，2区病变116只眼。所有患儿均在全身麻醉下采用波长为810 nm的Iridis激光机经双目间接检眼镜输出进行激光光凝治疗。治疗后随访35～852 d，平均随访时间(316±274) d。观察病变完全消退和病变进展情况。结果 186只眼中，病变完全消退168只眼，占90.3%；出现局部纤维增生10只眼，占5.4%；进展为局限性视网膜脱离8只眼，占4.3%。高危阈值病变组88只眼中，病变完全消退84只眼，占95.5%；病变进展4只眼，占4.5%。阈值病变组98只眼中，病变完全消退84只眼，占85.7%；病变进展14只眼，占14.3%。两组病变完全消退率比较，差异有统计学意义（χ2=3.98，P＜0.05）。1区病变70只眼中，病变消退56只眼，占80.0%；病变进展14只眼，占20.0%。2区病变116只眼中，病变消退112只眼，占96.6%；病变进展4只眼，占3.4%。1区病变进展眼数明显高于2区病变进展眼数，差异有统计学意义（χ2=11.86，P＜0.01）。未观察到与治疗相关的并发症。结论激光光凝治疗高危阈值前和阈值病变ROP均有较好疗效，提前干预能减少其不良预后；无与治疗相关的并发症发生。

Comparing the outcome between the prethreshold and threshold retinopathy of prematurity after laser photocoagulation

Objective To observe the efficacy and safety of laser photocoagulation on high risk prethreshold versus threshold retinopathy of prematurity (ROP). Methods Ninety-seven ROP infants (186 eyes)， which included 88 high-risk prethreshold ROP eyes and 98 threshold ROP eyes, were enrolled in this study. Among the 186 eyes, 70 eyes were zone one and 116 eyes were zone two. Laser photocoagulation with 810 nm wavelength using binocular indirect ophthalmoscopy was used in all the infants under general anesthesia. Follow-up ranged from 35 to 852 days with a mean of (316±274) days. The degree of retinopathy alleviation and progress were observed. ResultsAmong the 186 eyes, complete abatement of retinopathy was found in 168 eyes (90.3%), local retinal detachment was found in eight eyes (4.3%). The complete abatement of retinopathy was found in 84 eyes both in high-risk prethreshold group (95.5%) and threshold group (85.7%), while progressive retinopathy was found in four eyes in the high-risk prethreshold group (4.5%) and 14 eyes in threshold group (14.3%). The difference in recovery rate was statistically significant between two groups (χ2=3.98,P＜0.05). The abatement of retinopathy was found in 56 eyes in zone one group (80.0%) and in 112 eyes in zone two group (96.6%), while progression of retinopathy was found in 14 eyes in zone one group (20.0%), and 14 eyes in zone two group (3.4%). The number of eyes with progressive retinopathy in zone one group was obviously higher than that in zone two group. The difference was statistically significant (χ2=11.86，P＜0.01). No treatment related complications were observed during the follow-up period. ConclusionsLaser photocoagulation is effective in treating high-risk prethreshold and threshold ROP. Early intervention could improve prognosis. There was no treatment-related complication during the follow-up duration.