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
45-48
,共4页
倪颖勤%黄欣%单海冬%俞笳%薛康%常青%赵培泉
倪穎勤%黃訢%單海鼕%俞笳%薛康%常青%趙培泉
예영근%황흔%단해동%유가%설강%상청%조배천
视网膜病,早产儿/治疗%激光凝固术%冷冻疗法%玻璃体切除术%随访研究
視網膜病,早產兒/治療%激光凝固術%冷凍療法%玻璃體切除術%隨訪研究
시망막병,조산인/치료%격광응고술%냉동요법%파리체절제술%수방연구
Retinopathy of Prematurity/therapy%Laser coagulation%Cryotherapy%Vitrectomy%Follow-up studies
目的 观察遵循我国早产儿视网膜病变(ROP)防治指南进行ROP筛查和及时治疗对ROP预后的影响.方法 2003～2010年7年间筛查确诊的1379例ROP患儿纳入研究.所有患儿均由经验丰富的小儿视网膜专科医生用双目间接检眼镜或二代广角数码视网膜成像系统( RetCamⅡ)检查确诊,并密切随访记录病变发展过程.对于1期病变,2周复查1次,直至病变完全退化、视网膜血管长到锯齿缘.对于2期病变或阈值前病变,1周复查1次,若病变程度下降,改为2周复查一次,直至病变完全退化.对于3期病变或怀疑急进性后部型ROP,1周复查2～3次,如达到阈值病变或阈值前病变1型,在72 h内进行激光光凝治疗.激光光凝治疗后每1～2周复查ROP变化,病变退化者随访处理,病变进展者行视网膜激光光凝或视网膜冷冻治疗,出现视网膜脱离的4、5期患者接受巩膜环扎手术、闭合式玻璃体切割手术治疗.本组患儿随访6个月～2年,平均随访时间为152.3 d.结果 7年间筛查确诊ROP 1379例2758只眼.患儿出生孕周26～35周,平均孕周30.6周.出生体重800～2200 g,平均体重1424.6 g.其中,206例400只眼达阈值病变或阈值前病变1型需进行激光光凝治疗,占患眼数的14.5％.激光光凝治疗后,345只眼病变完全退化,占治疗眼数的86.2％；55只眼进展到视网膜结构不良,占治疗眼数的13.8％.其中,10只眼仅有视盘黄斑牵引,32只眼进展至4期,13只眼进展至5期.未达到需要治疗程度的2358只患眼病变均退化.病变自然退化或干预后退化者共2703只,占98.0％；视网膜结构不良55只眼,占2.0％.其中,4期占1.2％,5期占0.5％.进展至4、5期的45只眼中,6只眼行巩膜外环扎或垫压手术治疗,视网膜均复位,但残留视盘黄斑牵引；39只眼行保留或不保留晶状体的闭合式玻璃体切割手术治疗.17只4a期患眼视网膜均复位,15只4b期患眼中10只眼视网膜复位,5只眼未复位,13只5期患眼中仅4只眼视网膜复位,1只眼视网膜大部复位.结论 及时有效的筛查和早期治疗能够减少导致视网膜结构不良的严重ROP的发生.
目的 觀察遵循我國早產兒視網膜病變(ROP)防治指南進行ROP篩查和及時治療對ROP預後的影響.方法 2003～2010年7年間篩查確診的1379例ROP患兒納入研究.所有患兒均由經驗豐富的小兒視網膜專科醫生用雙目間接檢眼鏡或二代廣角數碼視網膜成像繫統( RetCamⅡ)檢查確診,併密切隨訪記錄病變髮展過程.對于1期病變,2週複查1次,直至病變完全退化、視網膜血管長到鋸齒緣.對于2期病變或閾值前病變,1週複查1次,若病變程度下降,改為2週複查一次,直至病變完全退化.對于3期病變或懷疑急進性後部型ROP,1週複查2～3次,如達到閾值病變或閾值前病變1型,在72 h內進行激光光凝治療.激光光凝治療後每1～2週複查ROP變化,病變退化者隨訪處理,病變進展者行視網膜激光光凝或視網膜冷凍治療,齣現視網膜脫離的4、5期患者接受鞏膜環扎手術、閉閤式玻璃體切割手術治療.本組患兒隨訪6箇月～2年,平均隨訪時間為152.3 d.結果 7年間篩查確診ROP 1379例2758隻眼.患兒齣生孕週26～35週,平均孕週30.6週.齣生體重800～2200 g,平均體重1424.6 g.其中,206例400隻眼達閾值病變或閾值前病變1型需進行激光光凝治療,佔患眼數的14.5％.激光光凝治療後,345隻眼病變完全退化,佔治療眼數的86.2％；55隻眼進展到視網膜結構不良,佔治療眼數的13.8％.其中,10隻眼僅有視盤黃斑牽引,32隻眼進展至4期,13隻眼進展至5期.未達到需要治療程度的2358隻患眼病變均退化.病變自然退化或榦預後退化者共2703隻,佔98.0％；視網膜結構不良55隻眼,佔2.0％.其中,4期佔1.2％,5期佔0.5％.進展至4、5期的45隻眼中,6隻眼行鞏膜外環扎或墊壓手術治療,視網膜均複位,但殘留視盤黃斑牽引；39隻眼行保留或不保留晶狀體的閉閤式玻璃體切割手術治療.17隻4a期患眼視網膜均複位,15隻4b期患眼中10隻眼視網膜複位,5隻眼未複位,13隻5期患眼中僅4隻眼視網膜複位,1隻眼視網膜大部複位.結論 及時有效的篩查和早期治療能夠減少導緻視網膜結構不良的嚴重ROP的髮生.
목적 관찰준순아국조산인시망막병변(ROP)방치지남진행ROP사사화급시치료대ROP예후적영향.방법 2003～2010년7년간사사학진적1379례ROP환인납입연구.소유환인균유경험봉부적소인시망막전과의생용쌍목간접검안경혹이대엄각수마시망막성상계통( RetCamⅡ)검사학진,병밀절수방기록병변발전과정.대우1기병변,2주복사1차,직지병변완전퇴화、시망막혈관장도거치연.대우2기병변혹역치전병변,1주복사1차,약병변정도하강,개위2주복사일차,직지병변완전퇴화.대우3기병변혹부의급진성후부형ROP,1주복사2～3차,여체도역치병변혹역치전병변1형,재72 h내진행격광광응치료.격광광응치료후매1～2주복사ROP변화,병변퇴화자수방처리,병변진전자행시망막격광광응혹시망막냉동치료,출현시망막탈리적4、5기환자접수공막배찰수술、폐합식파리체절할수술치료.본조환인수방6개월～2년,평균수방시간위152.3 d.결과 7년간사사학진ROP 1379례2758지안.환인출생잉주26～35주,평균잉주30.6주.출생체중800～2200 g,평균체중1424.6 g.기중,206례400지안체역치병변혹역치전병변1형수진행격광광응치료,점환안수적14.5％.격광광응치료후,345지안병변완전퇴화,점치료안수적86.2％；55지안진전도시망막결구불량,점치료안수적13.8％.기중,10지안부유시반황반견인,32지안진전지4기,13지안진전지5기.미체도수요치료정도적2358지환안병변균퇴화.병변자연퇴화혹간예후퇴화자공2703지,점98.0％；시망막결구불량55지안,점2.0％.기중,4기점1.2％,5기점0.5％.진전지4、5기적45지안중,6지안행공막외배찰혹점압수술치료,시망막균복위,단잔류시반황반견인；39지안행보류혹불보류정상체적폐합식파리체절할수술치료.17지4a기환안시망막균복위,15지4b기환안중10지안시망막복위,5지안미복위,13지5기환안중부4지안시망막복위,1지안시망막대부복위.결론 급시유효적사사화조기치료능구감소도치시망막결구불량적엄중ROP적발생.
Objective To evaluate the prognosis of retinopathy of prematurity (ROP) following the screening and treatment guidelines of the Chinese Ministry of Public Health.Methods From December 2003 to December 2010,1379 premature infants diagnosed with ROP were followed by binocular indirect ophthalmoscopy or fundus photography using Retcam Ⅱ digital camera.For the stage 1 ROP,eyes were followed every 2 weeks until the ROP regressed.For the stage 2 ROP or pre-threshold disease,eyes were followed weekly.If the ROP decreased,eyes were followed every two weeks until the ROP regressed completely.For the stage 3 ROP or acute progressive ROP (AP-ROP),eyes were followed 2 - 3 times weekly.If the ROP progressed to threshold or type 1 pre-threshold disease,laser therapy was performed within 72 hours.After laser treatment,eyes were followed every 1 - 2 weeks.Laser or cryotherapy was conducted when the ROP progressed after first treatment.Scleral buckle and vitrectomy with closed triple incisions was conducted when the ROP progressed to stage 4 and stage 5.The period the infants were followed ranged from 6 months to 2 years (average 152.3 days).Results A total of 2758 eyes of 1379infants were diagnosed with ROP.The gestational age range was 26 - 35 weeks (average 30.6 weeks) and the birth weight of 800 - 2200 grams (average 1424.6 grams).Four hundred eyes (14.5％) of 206 infants with threshold or type 1 pre-threshold disease were given laser treatment.Three hundred and forty-five eyes (86.2％) completely regressed,and 55 eyes (13.8％) progressed to unfavorable structural outcomes. All 2358 eyes that did not reach threshold or type 1 pre-threshold disease regressed completely.The total regression rate of our study was 98.0％. The incidence of unfavorable structural outcomes was 2.0％including stage 4 in 32 eyes (1.2％) and stage 5 in 13 eyes (0.5％).The retina reattatched in all 6 eyes treated with scleral buckle but macular traction remained at the optic disc.In the 39 eyes treated using vitrectomy with or without lensectomy,the retina reattached completely in 17 eyes at stage 4a.In 15 eyes at stage 4b,the retina reattached completely in 10 and remained detached in 5 eyes.In the 13 eyes at stage 5,the retina reattached completely in 4,and reattached mostly in 1 eye.Conelusion The incidence of severe ROP leading to unfavorable structural outcomes can be effectively reduced by screening and timely treatment.
