目的 观察玻璃体手术治疗晚期早产儿视网膜病变(ROP)的临床效果,评估5期ROP手术后视网膜解剖复位失败的影响因素.方法 非随机、回顾性病例研究.临床确诊为晚期ROP并行玻璃体手术治疗的40例患儿58只眼纳入研究.其中,4a期16只眼,4b期7只眼,5期35只眼.玻璃体手术前曾接受过激光光凝治疗者18只眼,冷冻治疗者2只眼,玻璃体腔注射抗血管内皮生长因子(VEGF)单克隆抗体bevacizumab(商品名Avastin) (IVB)治疗者11只眼；其余27只眼无既往治疗史.玻璃体手术后平均随访时间17.01个月.随访期间采用双目间接检眼镜和二代广角数码视网膜成像系统(RetCamⅡ)记录各期患儿视网膜解剖复位情况；条栅视力(lea gratingTM)检查记录视功能,并将结果换算为Snellen视力值进行分析,对无法配合检查的患儿,以手动、光感和无光感来记录.分析患儿出生体重、胎龄,手术时年龄,手术前激光光凝、冷冻和IVB治疗史与5期ROP手术后视功能解剖复位失败的相关性.结果 4a期16只眼视网膜解剖复位成功,占100.00％.4b期7只眼中,视网膜解剖复位成功5只眼,占71.43％；复位失败2只眼,占28.57％.5期35只眼中,视网膜解剖复位成功12只眼,占34.29％；部分复位成功10只眼,占28.57％；复位失败13只眼,占37.14％.5期患儿视网膜解剖成功率较4a、4b期明显降低,差异有统计学意义(x2 =22.55,P＜0.05).4a期16只眼中,在视功能随访过程中失访3只眼.其余13只眼中,完成条栅视力检查6只眼,视力为0.03但＜0.07,占46.15％；手动5只眼,占38.46％；光感2只眼,占15.39％.4b期7只眼中,完成条栅视力检查2只眼,视力分别为0.008和0.017,占28.57％；手动1只眼,占14.29％；光感2只眼,占28.57％；无光感2只眼,占28.57％.5期35只眼中,失访5只眼.其余30只眼中,完成条栅视力检查2只眼,视力均为0.004,占6.67％；手动4只眼,占13.33％；光感12只眼,占40.00％；无光感12只眼,占40.00％.5期患儿手术后视功能较4a、4b期明显降低,差异有统计学意义(x2=15.734,P＜0.05).5期患儿出生体重、胎龄,手术时年龄,手术前激光光凝、冷冻和IVB治疗史与手术后视网膜解剖复位失败无明显相关性(F=5.56,P＞0.05).结论 玻璃体手术能有效控制4a期病变进展,使部分4b、5期病变视网膜复位.5期患儿出生体重、胎龄,手术时年龄,手术前激光光凝、冷冻和IVB治疗史与手术后视网膜解剖复位失败无明显相关性.
目的 觀察玻璃體手術治療晚期早產兒視網膜病變(ROP)的臨床效果,評估5期ROP手術後視網膜解剖複位失敗的影響因素.方法 非隨機、迴顧性病例研究.臨床確診為晚期ROP併行玻璃體手術治療的40例患兒58隻眼納入研究.其中,4a期16隻眼,4b期7隻眼,5期35隻眼.玻璃體手術前曾接受過激光光凝治療者18隻眼,冷凍治療者2隻眼,玻璃體腔註射抗血管內皮生長因子(VEGF)單剋隆抗體bevacizumab(商品名Avastin) (IVB)治療者11隻眼；其餘27隻眼無既往治療史.玻璃體手術後平均隨訪時間17.01箇月.隨訪期間採用雙目間接檢眼鏡和二代廣角數碼視網膜成像繫統(RetCamⅡ)記錄各期患兒視網膜解剖複位情況；條柵視力(lea gratingTM)檢查記錄視功能,併將結果換算為Snellen視力值進行分析,對無法配閤檢查的患兒,以手動、光感和無光感來記錄.分析患兒齣生體重、胎齡,手術時年齡,手術前激光光凝、冷凍和IVB治療史與5期ROP手術後視功能解剖複位失敗的相關性.結果 4a期16隻眼視網膜解剖複位成功,佔100.00％.4b期7隻眼中,視網膜解剖複位成功5隻眼,佔71.43％；複位失敗2隻眼,佔28.57％.5期35隻眼中,視網膜解剖複位成功12隻眼,佔34.29％；部分複位成功10隻眼,佔28.57％；複位失敗13隻眼,佔37.14％.5期患兒視網膜解剖成功率較4a、4b期明顯降低,差異有統計學意義(x2 =22.55,P＜0.05).4a期16隻眼中,在視功能隨訪過程中失訪3隻眼.其餘13隻眼中,完成條柵視力檢查6隻眼,視力為0.03但＜0.07,佔46.15％；手動5隻眼,佔38.46％；光感2隻眼,佔15.39％.4b期7隻眼中,完成條柵視力檢查2隻眼,視力分彆為0.008和0.017,佔28.57％；手動1隻眼,佔14.29％；光感2隻眼,佔28.57％；無光感2隻眼,佔28.57％.5期35隻眼中,失訪5隻眼.其餘30隻眼中,完成條柵視力檢查2隻眼,視力均為0.004,佔6.67％；手動4隻眼,佔13.33％；光感12隻眼,佔40.00％；無光感12隻眼,佔40.00％.5期患兒手術後視功能較4a、4b期明顯降低,差異有統計學意義(x2=15.734,P＜0.05).5期患兒齣生體重、胎齡,手術時年齡,手術前激光光凝、冷凍和IVB治療史與手術後視網膜解剖複位失敗無明顯相關性(F=5.56,P＞0.05).結論 玻璃體手術能有效控製4a期病變進展,使部分4b、5期病變視網膜複位.5期患兒齣生體重、胎齡,手術時年齡,手術前激光光凝、冷凍和IVB治療史與手術後視網膜解剖複位失敗無明顯相關性.
목적 관찰파리체수술치료만기조산인시망막병변(ROP)적림상효과,평고5기ROP수술후시망막해부복위실패적영향인소.방법 비수궤、회고성병례연구.림상학진위만기ROP병행파리체수술치료적40례환인58지안납입연구.기중,4a기16지안,4b기7지안,5기35지안.파리체수술전증접수과격광광응치료자18지안,냉동치료자2지안,파리체강주사항혈관내피생장인자(VEGF)단극륭항체bevacizumab(상품명Avastin) (IVB)치료자11지안；기여27지안무기왕치료사.파리체수술후평균수방시간17.01개월.수방기간채용쌍목간접검안경화이대엄각수마시망막성상계통(RetCamⅡ)기록각기환인시망막해부복위정황；조책시력(lea gratingTM)검사기록시공능,병장결과환산위Snellen시력치진행분석,대무법배합검사적환인,이수동、광감화무광감래기록.분석환인출생체중、태령,수술시년령,수술전격광광응、냉동화IVB치료사여5기ROP수술후시공능해부복위실패적상관성.결과 4a기16지안시망막해부복위성공,점100.00％.4b기7지안중,시망막해부복위성공5지안,점71.43％；복위실패2지안,점28.57％.5기35지안중,시망막해부복위성공12지안,점34.29％；부분복위성공10지안,점28.57％；복위실패13지안,점37.14％.5기환인시망막해부성공솔교4a、4b기명현강저,차이유통계학의의(x2 =22.55,P＜0.05).4a기16지안중,재시공능수방과정중실방3지안.기여13지안중,완성조책시력검사6지안,시력위0.03단＜0.07,점46.15％；수동5지안,점38.46％；광감2지안,점15.39％.4b기7지안중,완성조책시력검사2지안,시력분별위0.008화0.017,점28.57％；수동1지안,점14.29％；광감2지안,점28.57％；무광감2지안,점28.57％.5기35지안중,실방5지안.기여30지안중,완성조책시력검사2지안,시력균위0.004,점6.67％；수동4지안,점13.33％；광감12지안,점40.00％；무광감12지안,점40.00％.5기환인수술후시공능교4a、4b기명현강저,차이유통계학의의(x2=15.734,P＜0.05).5기환인출생체중、태령,수술시년령,수술전격광광응、냉동화IVB치료사여수술후시망막해부복위실패무명현상관성(F=5.56,P＞0.05).결론 파리체수술능유효공제4a기병변진전,사부분4b、5기병변시망막복위.5기환인출생체중、태령,수술시년령,수술전격광광응、냉동화IVB치료사여수술후시망막해부복위실패무명현상관성.
Objective To observe the clinical effects of vitrectomy for advanced retinopathy of prematurity (ROP) and evaluate influence factors of anatomical recovery for stage 5 ROP.Methods Fiftyeight eyes of 40 infants with advanced ROP who underwent vitrectomy were retrospectively analyzed.There were 16 eyes of stage 4a,7 eyes of stage 4b,and 35 eyes of stage 5 ROP.Eighteen eyes received laser photocoagulation,2 eyes received cryotherapy,and 11 eyes received intravitreous injection of Bevacizumab (IVB) before surgery.The average follow-up time was 17.01 months.Anatomical outcome of retina after surgery was recorded by indirect ophthalmoscope and RetCam Ⅱ digital camera system.Visual outcome was measured by grating acuity test(lea gratingTM),and was converted to Snellen acuity values for analysis.For those who cannot cooperate to accomplish the test,we use hand move,light perception and non-light perception to record visual outcome. Results All 16 eyes of stage 4a were anatomically recovered (100.00％).5/7 eyes of stage 4b were anatomically recovered (71.43％) and 2/7 eyes were anatomically failed(28.57％).12/35 eyes of stage 5 were anatomically recovered (34.29％); 10/35 eyes were partial anatomically recovered (28.57％); 13 eyes were anatomically failed (37.14％). Anatomical outcome of stage 4a or 4b was better than stage 5 statistically(x2 =22.55,P＜0.05).Of 16 eyes of stage 4a,3 eyes were absent for visual function test.In the rest 13 eyes of stage 4a,VA of 6 eyes (46.15％) was between 0.03 and 0.07; 5 eyes (38.46％) were hand move; 2 eyes (15.39％) were light perception.Of 7 eyes of stage 4b,2 eyes (28.57％) accomplished grating acuity test with VA of 0.008 and 0.017 respectively; 1 eye (14.29％) was hand move; 2 eyes (28.57％) were light perception; 2 eyes (28.57％) were non-light perception.Of 35 eyes of stage 5,5 eyes were absent for visual function test.In the rest 30 eyes of stage 5,VAof2 eyes (6.67％) was 0.004; 4 eyes (13.33％) were hand move; 12 eyes (40.00％) were light perception; 12 eyes (40.00％) were non-light perception.Visual outcome of stage 5 was worse than stage 4a or 4b statistically(x2=15.734,P＜0.05).There was no statistically significant relationship between anatomical outcome and birth weight,gestational weeks,age at surgery,IVB therapy,laser or cryotherapy before surgery.Conclusions Vitrectomy can effectively control the lesions progress of stage 4a ROP,and achieve partially anatomically recovery of some stage 4b/5 patients.There was no statistically significant relationship between anatomical outcome and birth weight,gestational weeks,age at surgery,IVB,laser or cryotherapy before surgery.
