玻璃体内注射雷珠单抗联合激光光凝治疗早产儿视网膜病变疗效观察

目的　观察激光光凝联合玻璃体内注射雷珠单抗治疗早产儿视网膜病变（retinopathy of prematurity，ROP）的安全性及有效性。方法　对32例（64眼）ROP患儿行玻璃体内注射雷珠单抗治疗，观察附加病变、嵴、嵴上新生血管的消退情况以及周边视网膜，其中12例（24眼）附加病变、嵴及嵴上新生血管不完全消退者进行激光光凝治疗。结果　32例64眼ROP患儿中，经玻璃体内注射雷珠单抗治疗病变完全消退者20例40眼，占62.5%；12例24眼病变复发，经联合激光光凝治疗病情稳定，占37.5%。病变复发的24眼中，包括急进型后极部ROP 14眼，阈值期ROP 6眼，阈值前期ROP 4眼。所有患儿视网膜病变不同程度消退。给予玻璃体内注射雷珠单抗治疗后新生血管及出血吸收，血管继续发育至锯齿缘或病变瘢痕化。12例（24眼）病变复发者联合视网膜光凝治疗后病变完全消退。32例ROP患儿眼部及全身未见不良反应。结论　玻璃体内注射雷珠单抗治疗ROP效果好，不但可以使嵴、嵴上新生血管及附加病变完全消退，而且还可使视网膜血管继续生长，对于病变不能完全消退的患儿联合视网膜激光光凝治疗后也可获得较好疗效。

Combination of intravitreal injection of ranibizumab and laser photocoagulation for the treatment of retinopathy of prematurity

Objective　To evaluate the efficacy and safety of the treatment of retinopathy of premature (ROP) using laser photocoagulation (LP) and intravitreal injection ranibizumab (IVR).Methods　Totally 32 infants (64 eyes) with ROP underwent IVR，followed by observation of the regression of the plus diseases，ridges，neovascularization on the ridge and the development of peripheral retinal vessels.Besides，12 patients (24 eyes) of 32 infants whose plus diseases，ridges and neovascularization on the ridge did not still improve continued to undergo LP.Results　In the 64 eyes，the lesions completely disappeared by IVR in 40 eyes，accounting for 62.5%，and the recurrence in 24 eyes was recovered by combined laser photocoagulation，accounting for 37.5%.Among the 24 eyes with recurrent lesions，14 eyes were aggressive posterior retinopathy of prematurity (AP-ROP)，6 eyes were ROP at threshold stage，and 4 eyes were pre-threshold ROP.All infants with retinal lesions improved to some degree.Intravitreal injection of ranibizumab could approach neovascular and hemorrhagic absorption，and vascular development to serrate or scar lesions.And 24 eyes of recurrence lesions were improved after photocoagulation；no ocular or the systematic adverse reactions were observed.Conclusion　Intravitreal injection of ranibizumab for the treatment of ROP can achieve satisfied outcomes；as for the infants without satisfied outcomes，retinal laser photocoagulation can be performed.