超未成熟儿视网膜病变术后屈光状态分析

目的　研究出生体质量＜１０００ｇ的早产儿视网膜病变患儿经过抗血管内皮生长因子玻璃体内注射后矫正胎龄６个月大时的眼位、注视功能及屈光状态情况。方法　横断面研究，回顾性队列研究。出生体质量＜１０００ｇ、因早产儿视网膜病变接受抗血管内皮生长因子玻璃体内注射的３２例（６４眼）患儿，于矫正胎龄６个月大时检查其注视功能、眼位，并散瞳验光。按治疗前眼底有无纤维增殖进行分组，观察两组屈光性弱视发生风险有无统计学差异。结果　矫正胎龄６个月大时，３２例６４眼中近视眼者２９眼（４５．３％），近视度数为－０．７５～－４．００（－２．０３±０．７１）ＤＳ；远视眼３２眼（５０．０％），远视度数为＋１．００～＋４．００（＋１．７８±０．７６）ＤＳ；存在或合并散光者２８眼（４３．８％），散光度数为１．００～６．００（２．３９±１．１３）ＤＣ。所有患儿均为正位眼且中心注视，无注视抑制；治疗前眼底纤维增殖组中，有屈光性弱视风险的比例为７５．０％（１２／１６）；无纤维增殖组中，有屈光性弱视风险的比例为２５．０％（４／１６），两者相比差异具有统计学意义（Ｐ＝０．０３２）。结论　出生体质量＜１０００ｇ早产儿接受抗血管内皮生长因子玻璃体内注射术后矫正胎龄６个月大时，表现出中心注视及正位眼，无注视抑制。治疗前眼底纤维增殖组发生屈光性弱视的风险大于无纤维增殖组。

Refractive outcome of retinopathy of prematurity in extremely low birth weight infants after intravitreal injection of bevacizumab

Objective To observe ocular position , fixation ability , and refractive error of retinopathy of prematurity ( ROP) in infants with birth mass < 1000 g at 6 months ( corrected age) , who had received intravitreal injection of bevacizumab. Methods This is a cross-sectional and retrospective cohort study from a single center. Thirty-two extremely low birth weight infants with ROP got intravitreal injection of bevacizumab. At 6 months ( corrected age) , ocular position, fixation ability were measured. Meanwhile refractive data from retinoscopy under ciliary muscles paralyzed were recorded. These infants were classified int0 2 groups by the fact that the extraretinal fibrovascular proliferation was occurred or not before surgery. Results In 64 eyes of 32 infants,29 eyes (45. 3% ) were myopia,the myopic degree was from - 0. 75 DS to -4. 00 DS , mean ( - 2. 03 +0. 71 ) DS ; 32 eyes ( 50. 0% ) were hyperopia , the hyperopic degree was from + 1. 00 DS to +4. 00 DS.mean ( + 1. 78 +0. 76) DS ;28 eyes (43. 8% ) presented astigmatism , the astigmatism degree was from l. 00 DC t0 6. 00 DC , mean ( 2. 39 + 1. 13 ) DC. All patients showed orthophoria and central steady maintain fixation. There was no fixation suppression. The incidence of amblyopia due to severe refractive error in infants with extraretinal fibrovascular proliferation ( 75. 0% . 12/16) was higher than that in infants without extraretinal fibrovascular proliferation ( 25. 0% . 4/16 ) . Conclusion Infants with birth mass < 1000 g with ROP can develop orthophoria and quality fixation at 6 months ( corrected age) and there is no fixation suppression in these infants. Extraretinal fibrovascular proliferation before surgery may be a risk for severe refractive error.