中华眼底病杂志
中華眼底病雜誌
중화안저병잡지
CHINESE JOURNAL OF OCULAR FUNDUS DISEASES
2012年
1期
33-36
,共4页
黄欣%单海冬%常青%赵培泉
黃訢%單海鼕%常青%趙培泉
황흔%단해동%상청%조배천
视网膜病,早产儿/治疗%激光凝固术%玻璃体切除术
視網膜病,早產兒/治療%激光凝固術%玻璃體切除術
시망막병,조산인/치료%격광응고술%파리체절제술
Retinopathy of prematurity/therapy%Laser coagulation%Vitrectomy
目的 观察急进性后部型早产儿视网膜病变(AP-ROP)的临床特征和治疗效果.方法 回顾分析18例AP-ROP患儿35只眼的临床资料.暗室条件下,采用双目间接检眼镜配合28 D透镜、巩膜压迫器、广角数码视网膜成像系统(RetCam)检查所有患儿视网膜并记录病变.所有患儿在确诊后12 h内,采用半导体倍频532 nm波长激光,应用双目间接检眼镜激光输出系统对病变周边部视网膜无血管区进行激光光凝.其中,因激光光凝治疗后病变继续进展再行玻璃体手术治疗者13只眼,占37.1％；单纯行激光光凝治疗者22只眼,占62.9％.治疗后随访6个月～5年,平均随访时间为23.5个月.观察视网膜病变的转归.结果 所有患眼均为后极部病变,位于1区或2区的后部.4个象限的视网膜血管高度扩张纡曲,难以区分视网膜小动静脉,出现视网膜内血管短路、动静脉弓；视网膜无血管区和血管化区域边界不清,新生血管网呈扁平形态,不易识别；无明显的分界线或嵴等典型病变形成.单纯行激光光凝治疗的22只眼,治疗后血管形态及走向趋于正常,病变消退,无血管区光凝斑均匀覆盖.行玻璃体切割手术的13只眼,激光光凝治疗后玻璃体在后极部环形增生收缩引起牵拉性视网膜脱离.手术治疗后视网膜复位8只眼；玻璃体渗出及出血,视网膜未复位5只眼.结论 AP-ROP临床表现特殊.及时激光光凝治疗可使大部分患眼病变消退.激光光凝治疗后病变继续进展者行早期玻璃体手术干预,可使大部分患眼视网膜复位.
目的 觀察急進性後部型早產兒視網膜病變(AP-ROP)的臨床特徵和治療效果.方法 迴顧分析18例AP-ROP患兒35隻眼的臨床資料.暗室條件下,採用雙目間接檢眼鏡配閤28 D透鏡、鞏膜壓迫器、廣角數碼視網膜成像繫統(RetCam)檢查所有患兒視網膜併記錄病變.所有患兒在確診後12 h內,採用半導體倍頻532 nm波長激光,應用雙目間接檢眼鏡激光輸齣繫統對病變週邊部視網膜無血管區進行激光光凝.其中,因激光光凝治療後病變繼續進展再行玻璃體手術治療者13隻眼,佔37.1％；單純行激光光凝治療者22隻眼,佔62.9％.治療後隨訪6箇月～5年,平均隨訪時間為23.5箇月.觀察視網膜病變的轉歸.結果 所有患眼均為後極部病變,位于1區或2區的後部.4箇象限的視網膜血管高度擴張紆麯,難以區分視網膜小動靜脈,齣現視網膜內血管短路、動靜脈弓；視網膜無血管區和血管化區域邊界不清,新生血管網呈扁平形態,不易識彆；無明顯的分界線或嵴等典型病變形成.單純行激光光凝治療的22隻眼,治療後血管形態及走嚮趨于正常,病變消退,無血管區光凝斑均勻覆蓋.行玻璃體切割手術的13隻眼,激光光凝治療後玻璃體在後極部環形增生收縮引起牽拉性視網膜脫離.手術治療後視網膜複位8隻眼；玻璃體滲齣及齣血,視網膜未複位5隻眼.結論 AP-ROP臨床錶現特殊.及時激光光凝治療可使大部分患眼病變消退.激光光凝治療後病變繼續進展者行早期玻璃體手術榦預,可使大部分患眼視網膜複位.
목적 관찰급진성후부형조산인시망막병변(AP-ROP)적림상특정화치료효과.방법 회고분석18례AP-ROP환인35지안적림상자료.암실조건하,채용쌍목간접검안경배합28 D투경、공막압박기、엄각수마시망막성상계통(RetCam)검사소유환인시망막병기록병변.소유환인재학진후12 h내,채용반도체배빈532 nm파장격광,응용쌍목간접검안경격광수출계통대병변주변부시망막무혈관구진행격광광응.기중,인격광광응치료후병변계속진전재행파리체수술치료자13지안,점37.1％；단순행격광광응치료자22지안,점62.9％.치료후수방6개월～5년,평균수방시간위23.5개월.관찰시망막병변적전귀.결과 소유환안균위후겁부병변,위우1구혹2구적후부.4개상한적시망막혈관고도확장우곡,난이구분시망막소동정맥,출현시망막내혈관단로、동정맥궁；시망막무혈관구화혈관화구역변계불청,신생혈관망정편평형태,불역식별；무명현적분계선혹척등전형병변형성.단순행격광광응치료적22지안,치료후혈관형태급주향추우정상,병변소퇴,무혈관구광응반균균복개.행파리체절할수술적13지안,격광광응치료후파리체재후겁부배형증생수축인기견랍성시망막탈리.수술치료후시망막복위8지안；파리체삼출급출혈,시망막미복위5지안.결론 AP-ROP림상표현특수.급시격광광응치료가사대부분환안병변소퇴.격광광응치료후병변계속진전자행조기파리체수술간예,가사대부분환안시망막복위.
Objective To observe the clinical characteristics and treatment outcomes of aggressive posterior retinopathy of prematurity(AP-ROP).Methods Thirty-five eyes (18 patients) diagnosed with AP-ROP were studied from January 2006 to January 2011.All the patients were examined by 28 D optical lens,sclera compressor and wide-angle digital retinal imaging system (RetCam Ⅱ ).Laser photocoagulation with 532 nm wavelength using binocular indirect ophthalmoscope was used in all the infants within 12 hours after confirmed diagnosis. Thirteen eyes (37.1％) progressed to retinal detachment after laser photocoagulations were surgically treated,while 22 eyes (62.9 ％) underwent laser photocoagulation alone.Follow-up ranged from 6 months to 5 years,with a mean of 23.5 months.Results All AP-ROP lesions are located in zone 1 and posterior zone 2,with substantial dilated and tortuous retinal vessels.It is difficult to distinguish between the retinal vein and small arteries.There are shunts from vessel to vessel within the retina and no clear boundary between the vascularized and non-vascularized retina.Neovascularization lesions are flat and hard to be identified.There are no demarcation ridges.After laser treatment,22 eyes achieved good outcomes.Among 13 eyes who received vitrectomy,8 eyes achieved retinal reattachment after surgery,while 5 eyes developed total retinal detachment.Conclusion AP-ROP has specific clinical manifestations.Timely laser photocoagulation and early surgical treatment is necessary for AP-ROP.
