Effect of Comprehensive Treatment for Aggressive Retinopathy of Prematurity
-
摘要:
目的 观察急进型早产儿视网膜病变的综合治疗效果。 方法 回顾性系列病例研究（Retrospective case study）。 选取2015年7月至2020年5月就诊于昆明市儿童医院眼科经眼底筛查诊断为急进型早产儿视网膜病变（A-ROP）的患儿55例（110眼），女性35例，男性20例，胎龄24～37（29.47±2.30）周，出生体重730～2 250（1322.09±322.75）g，所有患儿均在确诊后48 h内玻璃体腔内注射10 mg/mL雷珠单抗0.025 mL。术后1周，2周，1月，3月，6月，1 a后复查随访6次视网膜情况，随访期间观察患儿眼部情况及全身是否出现不良反应。病情复发或对雷珠单抗治疗无反应者予视网膜激光光凝治疗。注药后到补激光时间为26～48（36.58±5.59）d。并将单次注药有效和注药后补激光分为2组进行比较胎龄、母亲年龄、NICU住院时间、出生体重及吸氧时间作比较，t检验组间差异。 结果 110眼中经过单次注射雷珠单抗治疗有效为26例患儿52只眼，有效率47.3%，病变完全消退，附加病变消失，无新生血管增生，视网膜血管发育至3区。29例患儿57只眼病变未完全消退，部分患儿出现局部视网膜脱离，周边玻璃体轻微增殖，经补充视网膜激光光凝治疗后病变减轻，附加病变消退，无新生血管增生，视网膜血管发育至3区，占比51.8%，1只眼经注药1周后病变复发，新生血管增加，嵴较前增宽，无血管区范围未见明显缩小，血管未向无血管区继续生长，玻璃体腔内大量增殖膜形成，发生白内障合并视网膜部分脱离，行玻璃体切除及晶状体切除术，术后视网膜完全复位，占比0.9%。单次注药及注药后补激光的两组间胎龄、母亲年龄、NICU住院时间、出生体重及吸氧时间无差异（P > 0.05）。所有患儿随访期间未发生眼部及全身不良反应。 结论 急进型早产儿视网膜病变经积极治疗后效果满意。 -
关键词:
- 急进型早产儿视网膜病变 /
- 雷珠单抗 /
- 玻璃体腔内注射 /
- 激光光凝
Abstract:Objective To observe the effect of treatment for aggressive posterior retinopathy of prematurity （A-ROP）. Methods Retrospective case studies were made and 55 premature infants （110 eyes） who were diagnosed as A-ROP were selected from Kunming Children’s Hospital from July 2015 to May 2020, including 35 females and 20 males. The gestational age ranged from 24 to 37 （29.47±2.30） weeks and the birth weight ranged from 730 to 2250 （1322.09±322.75） g.All children received intravitreous injection of ranibizumb 10 mg/ml 0.03 ml （IVR） within 48 hours after the diagnosis. After IVR, the systemic and ocular adverse effects were observed during the follow-up and checked the retina after 1 week, 2 weeks, 1 month, 3 months, 6 months and 1 year for six times. Retinal Laser photocoagulation （LP） therapy was given to those recurrent eyes or not responding to ranibizumb. The time from IVR to LP were 26～48 （36.58±5.59） days. The effectiveness of IVP and the LP after IVR were divided into two groups to compare the gestational age, maternal age, length of NICU hospital stay, birth weight and the duration of oxygen inhalation, and compared the differences by t-test. Results 47.3% of eyes （52 eyes of 110 ） after IVR were effective, the lesions completely subsided, the additional lesions disappeared, and there was no neovascularization. The retinal vessels developed to zone 3. 57 eyes （51.8%） were treated with supplementary retinal LP. After IVR combined with LP, 1 eye （0.9%） had the recurrence, cataract combined with partial retinal detachment, vitrectomy and lensectomy were performed, and the retina was completely restored after the surgery. No ocular or systemic adverse reactions occurred in all pantients during the follow-up. Conclusion The comprehensive treatment of IVR and LP in A-ROP is effective. -
图 1 双眼抗VEGF治疗前眼底图
A：右眼抗VEGF治疗前；B：左眼抗VEGF治疗前。双眼视盘边界清，色正常，后极部网膜血管明显迂曲增粗，伴大量新生血管，右眼颞下方视网膜见小片状出血，周边网膜未见嵴形成，分界线不明显伴大范围无血管区，诊断为双眼A-ROP。予双眼玻璃体腔内注射雷珠单抗各0.025 mL。
Figure 1. The retinal condition of the right and left eye before IVR
图 2 双眼抗VEGF治疗后1个月眼底图
A：右眼抗VEGF治疗后；B：左眼抗VEGF治疗后。双眼抗VEGF治疗后1月复查后极部网膜血管轻度迂曲，新生血管大部分消退，周边网膜未见嵴形成，分界线不明显伴周边颞侧大范围无血管区。
Figure 2. The retinal condition of the right and left eye after IVR 1 month later
图 3 双眼视网膜激光光凝术后2月眼底图
A：右眼抗VEGF治疗后；B：左眼抗VEGF治疗后。术后2月，无血管区激光瘢痕稳定。
Figure 3. The retinal condition of the right and left eye after IVR and LP 2 months later
表 1 单次注药及注药后补激光2组胎龄（周）、母亲年龄（岁）、NICU住院时间（d）、出生体重（g）及吸氧时间（h）组间差异
Table 1. Comparison of Gestational age （weeks），maternal age （years）， NICU （days），birth weight （grams） and duration of oxygen inhalation （hours） in single injection and post-injection laser photocoagulation groups
项目 单次注药有效（n = 52） 注药后激光光凝（n = 57） t P 胎龄（周） 29.46 ± 2.45 29.48 ± 2.45 0.33 0.973 母亲年龄（岁） 28.85 ± 4.71 31.24 ± 5.67 1.692 0.097 NICU（d） 48.04 ± 19.27 40.83 ± 25.11 −1.184 0.424 出生体重（g） 1344.60 ± 388.60 1309.90 ± 308.60 −0.454 0.625 吸氧总时长（h） 28.64 ± 22.80 31.97 ± 29.48 0.464 0.644 
下载: 导出CSV
-
[1] 尹虹,黎晓新,姜燕荣,等. 极低体重早产儿视网膜病变的临床研究[J]. 中华眼底病杂志,2005,21(5):275-277. doi: 10.3760/j.issn:1005-1015.2005.05.002 [2] 尹虹,黎晓新. 与早产儿视网膜病变自然退行有关因素的分析[J]. 中华实验眼科杂志,2006,24(6):643-646. doi: 10.3760/cma.j.issn.2095-0160.2006.06.021 [3] 中华医学会眼科学会分会眼底病组. 中国早产儿视网膜病变筛查指南[J]. 中华眼科杂志,2014,50(12):933-935. doi: 10.3760/cma.j.issn.0412-4081.2014.12.017 [4] None. The international of retinopathy of prematurity revisited[J]. Arch Ophthalmol,2005,123(7):991-999. doi: 10.1001/archopht.123.7.991 [5] 刘文. 早产儿视网膜病变[J]. 临床眼底病,2015,2(1):355. [6] Chiang M F,Quinn G E,Fielder A R,et al. International classification of retinopathy of prematurity,third edition[J]. Ophthalmology,2021,128(10):e51-e68. doi: 10.1016/j.ophtha.2021.05.031 [7] 陈锋,项道满,王建勋,等. 玻璃体注射Bevacizumab治疗阈值期早产儿视网膜病变的疗效分析[J]. 中国斜视与小儿眼科杂志,2016,24(2):25-28. doi: 10.3969/J.ISSN.1005-328X.2016.02.008 [8] 陈锋,项道满,王建勋,等. 不同剂量Bevacizumab治疗阈值前期I型早产儿视网膜病变的疗效分析[J]. 中国斜视与小儿眼科杂志,2018,26(4):25-26. [9] Chan-Ling T,Gock B,Stone J. The effect of oxygen on vasoformative cell division. Evidence that 'physiological hypoxia’ is the stimulus for normal retinal vasculogenesis[J]. Investigative Ophthalmology & Visual Science,1995,36(7):1201-14. [10] Zhang, G , Yang, M , Zeng, J , et al. （2017）. Comparison of intravitreal injection of ranibizumab versus laser therapy for zone ii treatment-requiring retinopathy of prematurity[J]. Retina, 37（4）: 710-717. [11] Zehetner C,Kirchmair R,Huber S,et al. Plasma levels of vascular endothelial growth factor before and after intravitreal injection of bevacizumab,ranibizumab and pegaptanib in patients with age-related macular degeneration,and in patients with diabetic macular odema[J]. Br J Ophthalmol,2013,97(4):454-459. doi: 10.1136/bjophthalmol-2012-302451 [12] Fierson W M,American Academy of Pediatrics Section on Ophthalmology,American Academy of Ophthalmology,et al. Screening examination of premature infants for retinopathy of prematurity[J]. Pediatrics,2013,131(1):189-195. doi: 10.1542/peds.2012-2996 [13] Feng J,Qian J,Jiang Y,et al. Efficacy of primary intravitreal ranibizumab for retinopathy of prematurity in China[J]. Ophthalmology,2017,124(3):408-409. doi: 10.1016/j.ophtha.2016.10.032 [14] Morin J,Luu T M,Superstein R,et al. Neurodevelopmental outcomes following bevacizumab injections for retinopathy of prematurity[J]. Pediatrics,2016,137(4):2015-3218. [15] 赵欢欢,李静,穆歌,等. 玻璃体腔注射雷珠单抗治疗早产儿视网膜病变的临床疗效[J]. 中国斜视与小儿眼科杂志,2018,26(3):22-25. [16] Björn C Harder,Schlichtenbrede F C,Baltz S V,et al. Intravitreal bevacizumab for retinopathy of prematurity:Refractive error results.[J]. American Journal of Ophthalmology,2013,155(6):1119-1124. doi: 10.1016/j.ajo.2013.01.014 [17] Geloneck M M,Chuang A Z,Clark W L,et al. Refractive outcomes following bevacizumab monotherapy compared with conventional laser treatment a randomized clinical trial[J]. Jama Ophthalmology,2014,132(11):1327-1333. doi: 10.1001/jamaophthalmol.2014.2772 [18] Gaurav,Sanghi,Mangat,et al. Aggressive posterior retinopathy of prematurity in Asian Indian babies:Spectrum of disease and outcome after laser treatment.[J]. Retina,2009,29(9):1335-1339. doi: 10.1097/IAE.0b013e3181a68f3a [19] Mintz-Hittner H A,Kennedy K A,Chuang A Z. Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity[J]. New England Journal of Medicine,2011,364(7):603-615. doi: 10.1056/NEJMoa1007374 [20] Mutlu F M,Sarici S U. Treatment of retinopathy of prematurity:A review of conventional and promising new therapeutic options.[J]. International Journal of Ophthalmology,2013,6(2):228-236. [21] Hwang C K,Hubbard G B,Hutchinson A K,et al. Outcomes after intravitreal bevacizumab versus laser photocoagulation for retinopathy of prematurity:A 5-year retrospective analysis[J]. Ophthalmology,2015,122(5):1008-1015. doi: 10.1016/j.ophtha.2014.12.017 [22] Hsieh C J,Liu J W,Huang J S,et al. Refractive outcome of premature infants with or without retinopathy of prematurity at 2 years of age:A prospective controlled cohort study[J]. The Kaohsiung journal of medical ences,2012,28(4):204-211. doi: 10.1016/j.kjms.2011.10.010 [23] 朱苾丹,李绍军. 我国早产儿视网膜病变筛查及治疗现状[J]. 中国斜视与小儿眼科杂志,2019,27(3):44-47. doi: 10.3969/J.ISSN.1005-328X.2019.03.016 [24] 曹贺,罗小玲,李志光,等. 激光光凝联合玻璃体腔注射低剂量雷珠单抗治疗急进型后极部ROP的疗效[J]. 国际眼科杂志,2019,19(11):1978-1981. doi: 10.3980/j.issn.1672-5123.2019.11.38 [25] 张国明,赵金凤. 重视儿童视网膜疾病的规范化治疗,努力提高其治疗水平[J]. 中华眼底病杂志,2020,36(8):583-589. doi: 10.3760/cma.j.cn511434-20200806-00380 -
点击查看大图
图(3) / 表(1)
计量
- 文章访问数: 2327
- HTML全文浏览量: 1640
- PDF下载量: 16
- 被引次数: 0
