CAJ | 학술논문

目的观察4期早产儿视网膜病变(ROP)玻璃体视网膜手术前玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab(商品名Avastin)的安全性和有效性.方法回顾性病例研究.临床确诊为4期ROP并接受玻璃体腔注射bevacizumab治疗的8例患儿16只眼纳入本研究.所有患儿于表面麻醉下给予双眼玻璃体腔注射bevacizumab 0.625 mg.注药后第5天,采用间接检眼镜和二代广角数码视网膜成像系统( RetCamⅡ)观察并记录患眼眼底情况,评估血管活动性；观察有无与玻璃体腔注射bevacizumab 相关的不良反应.所有患儿在全身麻醉状态下行玻璃体切割手术；其中,14只眼行保留晶状体的玻璃体切割手术,2只眼行晶状体切除联合玻璃体切割手术.玻璃体切割手术后3个月,观察所有患眼视网膜复位情况以及行保留晶状体玻璃体切割手术的14只眼的晶状体透明度.结果注药后第5天,所有患眼视网膜动脉纡曲及静脉扩张程度明显减轻,新生血管膜变白并有不同程度萎缩.无1例患儿发生眼内炎、眼内压增高、眼内新鲜出血、胃肠道反应等与玻璃体腔注射bevacizumab相关的不良反应.玻璃体切割手术后3个月,视网膜完全复位15只眼,占93.75％；视网膜部分复位1只眼,占6.25％.所有保留的晶状体都保持透明.结论4期ROP患儿玻璃体视网膜手术前行玻璃体腔注射bevacizumab能安全、有效地减轻ROP血管活动性.
목적 관찰4기조산인시망막병변(ROP)파리체시망막수술전파리체강주사항혈관내피생장인자단극륭항체bevacizumab(상품명Avastin)적안전성화유효성.방법 회고성병례연구.림상학진위4기ROP병접수파리체강주사bevacizumab치료적8례환인16지안납입본연구.소유환인우표면마취하급여쌍안파리체강주사bevacizumab 0.625 mg.주약후제5천,채용간접검안경화이대엄각수마시망막성상계통( RetCamⅡ)관찰병기록환안안저정황,평고혈관활동성；관찰유무여파리체강주사bevacizumab 상관적불량반응.소유환인재전신마취상태하행파리체절할수술；기중,14지안행보류정상체적파리체절할수술,2지안행정상체절제연합파리체절할수술.파리체절할수술후3개월,관찰소유환안시망막복위정황이급행보류정상체파리체절할수술적14지안적정상체투명도.결과 주약후제5천,소유환안시망막동맥우곡급정맥확장정도명현감경,신생혈관막변백병유불동정도위축.무1례환인발생안내염、안내압증고、안내신선출혈、위장도반응등여파리체강주사bevacizumab상관적불량반응.파리체절할수술후3개월,시망막완전복위15지안,점93.75％；시망막부분복위1지안,점6.25％.소유보류적정상체도보지투명.결론4기ROP환인파리체시망막수술전행파리체강주사bevacizumab능안전、유효지감경ROP혈관활동성.
Objective To observe the safety and efficacy of bevacizumab pretreatment in vitrectomy for vascularly active stage 4 retinopathy of prematurity (ROP).Methods A retrospective case series of 16eyes of 8 patients with vascularly active stage 4 ROP who received an intravitreal injection of bevacizumab were studied.An intravitreal injection of 0.625 mg bevacizumab was performed one week prior to planned vitrectomy.Five days after injection,the eyes were examined by indirect ophthalmoscopy and documented with fundus photography using a RetCam Ⅱ to evaluate the vascular activity.Lens-sparing vitrectomy was performed in 14 eyes,while vitrectomy combined with lensectomy was performed in 2 eyes,one week after the injection.Three months after vitrectomy,the retinal status and lens clarity were observed.Results All patients showed remarkable regression of the fibrovascular membrane with clinically absent vascular component 5 days after the injection. No adverse events occurred. Three months after vitrectomy,anatomical attachment was achieved in 15 eyes (93.75 ％ ),1 eye (6.25 ％ ) had partial attachment.The lens remained clear in all the eyes. Conclusion Intravitreal bevacizumab administrated prior to vitrectomy reduced neovascularization safely and effectively for stage 4 ROP.