CAJ | 학술논문

目的观察激光光凝、玻璃体腔注射雷珠单抗(IVR)治疗早产儿视网膜病变(ROP)的临床效果.方法临床确诊为ROP的49例患儿96只眼纳入研究.其中,阈值前病变1型7例14只眼,阈值期病变38例74只眼,急进性后部型ROP(AP-ROP)4例8只眼.屈光间质清楚,以纤维增生为主的Ⅱ区3期病变者接受激光光凝治疗(激光治疗组),共40例78只眼;屈光间质欠情楚,Ⅰ区病变、AP-ROP及全身情况较差者接受IVR治疗(IVR治疗组),共9例18只眼.对比分析不同治疗组及不同分期患儿的首次治疗治愈率.对比分析阈值前病变1型、阈值期病变及AP-ROP患儿的首次治疗治愈率差异.结果激光治疗组78只眼中,首次治疗成功75只眼,治愈率为96.15％;病情继续进展至4A期3只眼,占3.85％,转外院行玻璃体切割手术后病情稳定.IVR治疗组18只眼中,首次治疗成功8只眼,治愈率为44.44％;病情继续进展10只眼,占55.56％,经补充激光光凝治疗或重复IVR治疗后病情均稳定.激光治疗组与IVR治疗组首次治愈率比较,差异有统计学意义(Z=-5.749,P＜0.05).阈值前病变1型、阈值期病变及AP-ROP患儿的治愈率分别为57.14％、95.95％、50.00％;3者之间首次治疗治愈率比较,差异有统计学意义(x2 =24.787,P＜0.05).结论激光光凝治疗以纤维增生为主的Ⅱ区3期病变有较好疗效.IVR治疗1区病变、AP-ROP和全身情况较差者也可获得较好疗效.
목적 관찰격광광응、파리체강주사뢰주단항(IVR)치료조산인시망막병변(ROP)적림상효과.방법 림상학진위ROP적49례환인96지안납입연구.기중,역치전병변1형7례14지안,역치기병변38례74지안,급진성후부형ROP(AP-ROP)4례8지안.굴광간질청초,이섬유증생위주적Ⅱ구3기병변자접수격광광응치료(격광치료조),공40례78지안;굴광간질흠정초,Ⅰ구병변、AP-ROP급전신정황교차자접수IVR치료(IVR치료조),공9례18지안.대비분석불동치료조급불동분기환인적수차치료치유솔.대비분석역치전병변1형、역치기병변급AP-ROP환인적수차치료치유솔차이.결과 격광치료조78지안중,수차치료성공75지안,치유솔위96.15％;병정계속진전지4A기3지안,점3.85％,전외원행파리체절할수술후병정은정.IVR치료조18지안중,수차치료성공8지안,치유솔위44.44％;병정계속진전10지안,점55.56％,경보충격광광응치료혹중복IVR치료후병정균은정.격광치료조여IVR치료조수차치유솔비교,차이유통계학의의(Z=-5.749,P＜0.05).역치전병변1형、역치기병변급AP-ROP환인적치유솔분별위57.14％、95.95％、50.00％;3자지간수차치료치유솔비교,차이유통계학의의(x2 =24.787,P＜0.05).결론 격광광응치료이섬유증생위주적Ⅱ구3기병변유교호료효.IVR치료1구병변、AP-ROP화전신정황교차자야가획득교호료효.
Objective To investigate the efficacy of laser photocoagulation and intravitreal ranibizumab treatment of retinopathy of premature(ROP).Methods This study included 49 ROP infants (96 eyes),including type 1 pre-threshold ROP (7 infants,14 eyes),threshold ROP (38 infants,44 eyes) and aggressive posterior ROP (AP-ROP,4 infants,8 eyes).According to the treatments received,all patients were divided into laser photocoagulation (LP) group (40 infants,78 eyes) and intravitreal ranibizumab (IVR) treatment group (9 infants,18 eyes).Generally,zone Ⅱ and stage 3 ROP with clear refractive media received laser photocoagulation,zone Ⅰ ROP and AP-ROP,or eyes with unclear refractive media or infants with poor general condition received IVR.The infant gestational age,birth weight,corrected gestational age at first treatment and the cure rate of the first treatment were analyzed between the two groups,and between three disease types (type 1 pre-threshold,threshold and AP-ROP).Results The gestational age and birth weight was no difference between the LP group and IVR group (t=0.827,1.911; P＞0.05).The corrected gestational age at first treatment of LP group was significantly smaller than that in the IVR group (t=3.041,P＜0.05).In the LP group,75 of 78 eyes (96.15％) was cured by the first treatment,3 of 78 eyes (3.85％) progressed to stage 4A after the first treatment and was controlled by vitrectomy.In the IVR group,8 of 18 eyes (44.44％) was cured by the first treatment,10 of 18 eyes (55.56％) progressed to next stage after the first treatment and was controlled by additional laser photocoagulation or repeated IVR.The gestational age and birth weight was no difference between type 1 pre-threshold,threshold and AP-ROP infants (t=2.071,0.664; P＞0.05).The corrected gestational age at first treatment of type 1 pre-threshold infants was the same of the threshold lesion infants (t=2.054,P＞0.05).The corrected gestational age at first treatment of AP-ROP infants was significantly smaller than that of type 1 pre-threshold and threshold lesion infants (t =3.250,P ＜0.05).The cure rate was statistically significant (x2=24.787,P ＜ 0.05) between there three ROP lesions.Conclusion IVR treatment is suitable for zone Ⅰ lesions,AP-ROP and Plus lesions,while laser photocoagulation is appropriate for zone Ⅱ lesions with fibrosis and less vascular proliferation.