冷凝治疗早产儿视网膜病变初步报告

The primary reports of cryotherapy for retinopathy of prematurity

目的探讨冷冻治疗阈值或阈值前期(1型)早产儿视网膜病变(retinopathy of pre-maturity,ROP)的治疗效果。方法对筛查过程中发现的25例(50只眼)阈值或阈值前期(1型)ROP进行冷凝手术。全麻后在间接检眼镜直视下冷凝周边视网膜无血管区,术后局部应用皮质类固醇和睫状肌麻痹剂2周。病变继续发展者补充冷凝手术,或进行间接检眼镜直视下光凝治疗,发生视网膜脱离或有玻璃体积血者进行玻璃体手术治疗。结果第一次手术后21例(42只眼)病变控制;4例(8只眼)病变仍继续发展,其中2例(4只眼)第2次冷凝手术后病变控制,最后冷凝治疗成功率为92%。1例(2只眼)第2次冷凝手术后1只眼玻璃体积血,3个月后对侧眼发生视网膜脱离,进行了玻璃体视网膜手术病变控制;另外1例(2只眼)一次冷凝治疗后病变继续发展,遂进行激光治疗、玻璃体手术,最后病变控制。结论冷凝是阻止阈值或阈值前期(1型)ROP发展的有效方法,术后玻璃体出血是冷凝的主要并发症之一。冷凝治疗长期疗效有待进一步随访。

Objective To detect the effect of cryotherapy for threshold or pre-threshold （type 1） retinopathy of prematurity （ROP）. Methods During ROP screening, twenty five infants （50 eyes） were diagnosed threshold or pre-threshold （typel） ROP. All of them underwent cryotherapy. After general anesthesia, avascular areas was frozen under the observation of indirect ophthalmoscope. Postoperatively, local eorticosteroid and mydriasis were used for two weeks. The patients whose diseases continue to progress underwent the second cryotherapy or indirect ophthalmoscopic laser. The cases who occurred retinal detachment or vitreous hemorrhage underwent vitreous surgery. Results After the first cryotherapy, ROP was controlled in 21 cases （42 eyes）. ROP was still developing in 4 cases （8 eyes）, in whom 2 cases recovered after the second cryotherapy, The total success rate of eryotherapy for ROP was 92 %. The other two cases underwent the second cryotherapy and indirect ophthalmoscope laser, but ROP was not controlled and finally underwent vitreous surgery. Conclusions Cryotherapy is an effective method to control ROP. Vitreous hemorrhage is one of the main complications of cryotherapy and might result in retinal detachment. The long-term effect of cryotherapy is in following-up.