早产儿视网膜病变的冷凝治疗

目的 评价早产儿视网膜病（retinopathy of prematurity，ROP）冷凝治疗效果，探讨围手术期管理模式。方法 对370例符合筛查指征的早产儿进行眼底筛查，对25例阈值或Ⅰ型阈值前期病变ROP患儿进行冷凝治疗，术前术后在新生儿病房管理，新生儿科医师负责处理围手术期全身并发症，眼科医师术后定期随访检查眼底。结果 ROP的发生率为22％，阈值和Ⅰ型阈值前期病变发生率为6．8％。56例1期、2期病变未治疗，定期随访眼底恢复正常。25例50只眼阈值、Ⅰ型阈值前病变冷凝治疗成功率为92％，2例4只眼冷凝治疗后发生部分视网膜脱离，经玻璃体视网膜手术病变控制。随访9个月病变控制眼底正常的有44只眼（88％），出现视网膜脱离或后极部视网膜皱褶的有6只眼（12％）。6例术后12h内发生呼吸暂停，3例术后第1天出现窦性心动过速。结论 冷凝治疗可以作为治疗ROP阈值病变的选择，近期疗效较好。ROP围手术期处理的重点是呼吸管理。ROP患儿围手术期处理需要眼科医师和新生儿科医师密切合作共同管理。

Screening and cryotherapy for retinopathy of prematurity

Objective To evaluate the effect of cryotherapy on the infants with retinopathy of prematurity (ROP) and investigate the management strategies of perioperation. Methods Three hundreds and seventy premature infants were screened for ROP by the ophthalmologist, and 25 patients with threshold and type I prethreshold ROP were treated with cryotherapy. The patients with general complication during perioperation were treated by neonatologist in neonatology ward. The infants were examined and followed up by the same pediatric ophthalmologist after operation. Results The incidence of ROP was 22%, and that of the threshold and type I prethreshold ROP was 6.8% (25/370). Fifty-six patients with stage 1 or 2 ROP had a good prognosis as complete recovery. The cure rate of cryotherapy in the patients with threshold and type I prethreshold ROP was 92% (46/50 eyes), 2 patients (4 eyes) with partial retina detachment after cryotherapy were treated with vitreous retina surgery. It was found that 44 eyes (22 patients) had normal retinal structure (88%) and 6 eyes (3 patients) had retinal detachments or fold of posterior pole (12%) at the age of 9 months. Six patients had apnea in 12 hours and 3 patients had sinus tachycardia in 24 hours after operation. Conclusions Cryotherapy may be a choice of therapy for threshold and type I prethreshold ROP for its good short-term prognosis. Neonatologist should cooperate closely with ophthalmologist to manage the infants with threshold ROP during perioperation, and pay the intention on respiratory management.