早产儿视网膜病变激光光凝治疗效果及预后影响因素分析

目的:观察激光光凝术治疗阈值前Ⅰ型和阈值期早产儿视网膜病变(ROP)的临床效果,分析光凝术后病变进展的影响因素。方法:回顾分析激光光凝治疗ROP患者46例89眼,其中阈值前Ⅰ型57眼,阈值期32眼。采用810nm激光对周边视网膜无血管区进行光凝治疗。根据光凝术后结果分为病变消退组和进展组。随访视网膜解剖结构和ROP病变的变化,分析ROP病变部位、病变程度、光凝点数量、机械辅助呼吸、败血症、新生儿肺炎等因素与光凝术后病变进展的相关性。结果:ROP89眼经激光光凝治疗后病变完全消退79眼(89%),病变进展10眼(11%)。光凝治疗ROP病变消退组与进展组比较,出生胎龄、出生体重、首次光凝校正胎龄差异无统计学意义(P=0.668,0.495,0.143)。病变进展组的Ⅰ区病变、阈值病变、急性进展性后极部早产儿视网膜病变(AP-ROP)、光凝点数量均较病变消退组明显增加,差异有统计学意义(P=0.035,0.017,0.000,0.031)。Logistic回归分析结果显示,AP-ROP与光凝术后病变进展有关(P=0.001)。AP-ROP患眼光凝术后病变进展的可能性是非AP-ROP患眼的12.167倍(95%CI:2.733～54.154)。结论:激光光凝术能有效控制早期ROP的病变进展,使大部分阈值前Ⅰ型和阈值期ROP病变完全消退。急性进展性后极部早产儿视网膜病变光凝术后容易发生视网膜脱离,是影响光凝术后疗效的最主要因素。

Analysis on effects and prognostic factors of laser photocoagulation for retinopathy of prematurity

AIM: To observe the clinical effects of laser photocoagulation for retinopathy of prematurity(ROP)and to identify the potential risk factors for the unfavorable outcomes.

METHODS: Forty-six ROP infants(89 eyes)underwent laser photocoagulation were analyzed retrospectively. Among the 89 eyes, 57 eyes were type I pre-threshold and 32 eyes were threshold disease. Laser photocoagulation with 810nm wavelength using binocular indirect ophthalmoscope was performed in all the infants. While changes of ROP and retinal structural outcome after laser treatment were to be followed up. The results were divided into regressed group and progressed group. The relationships between anatomical outcome changes and localization of lesions, occurring in course of ROP, number of laser spots, ventilation need, sepsis, pneumonia of newborn et al were analyzed.

RESULTS: In the 89 eyes, ROP regressed completely in 79(89%), unfavorable structural outcomes were observed in 10(11%). The difference in birth weight(P=0.495), gestational weeks(P=0.668), age at laser photocoagulation(P=0.143)were not statistically significant between the two groups. Zone I disease(P=0.035), threshold disease(P=0.017), aggressive posterior ROP(P=0.000)and number of laser spots(P=0.031)in progression group were more than regressed group, the difference were statistically significant. Logistic regressive analysis indicated that aggressive posterior ROP(OR=12.167, 95% CI: 2.733-54.154, P=0.001)emerged as primary risk factors for anatomical outcome after laser treatment.

CONCLUSION: Laser photocoagulation is an effective approach to treat type I pre-threshold and threshold ROP. Aggressive posterior ROP is closely related to prognosis after laser treatment, which is easier to reach retinal detachment than other ROP.