经双目间接检眼镜激光光凝治疗严重早产儿视网膜病变

Binocular indirect ophthalmosope photocoagulation for severe retinopathy of prematurity

目的评价经双目间接检眼镜激光光凝治疗的严重早产儿视网膜病变（ROP）的疗效和安全性。方法回顾分析激光光凝治疗的ROP阈值病变、阈值前病变患儿126例241只眼的临床资料。所有患儿均于确诊后3d内在眼表面麻醉下采用半导体倍频YAG激光经双目间接检眼镜输出进行视网膜激光光凝，治疗后平均随访129．4d。结果所有接受治疗的患儿中，ROP退化203只眼，占84．2％；视网膜结构不良预后38只眼，占15．8％。后者包括黄斑牵引增生条索16只眼，占不良预后的42．1％；进展至4A期（未累及黄斑的局限视网膜脱离）4只眼，占10．5％；4B期（累及黄斑的局限视网膜脱离）7只眼，占18、4％；5期（完全视网膜脱离）11只眼，占28．9％。最常见的治疗后眼部并发症包括结膜下出血（38只眼，占15．8％）和感染性结膜炎（22只眼，占9．1％），呼吸暂停等全身并发症少见（1例，占0．8％）。结论经双目间接检眼镜激光光凝治疗ROP阈值病变和阈值前病变有效、安全。

Objective To evaluate the safety and efficiency of binocular indirect ophthalmoscope photocoagulation on severe retinopathy of prematurity （ROP）. Methods The clinical data of 241 eyes of 126 infants with threshold and prethreshold ROP from July 2003 to Auguest 2007 were retrospectively analyzed. All eyes underwent YAG photocoagulation by binocular indirect ophthalmoscope 3 days after the confirmation of the disease. The mean follow-up duration was 129.4 days. Results In the 241 eyes, ROP regressed completely in 203 （84. 2%）, unfavorable structural outcomes were observed in 38 （15.8%）, including macular dragged strips in 16 （42. 1%）2 ROP stage 4A （partial retinal detachment without macular involvement） was found in 4 （10. 5%）; stage 4B （partial retinal detachment involving macula） was found in 7 （18.4%）; stage 5 （total retinal detachment） was found in 11 （28. 9%）. Subconjunctiva hemorrhage and bacterial conjunctivitis were the most common post-photocoagulation complications （38 and 22 eyes, 15.8% and 9.1%, respectively）. System complications such as apnea were rare （1 case, 0.8%）. Conclusion Binocular indirect ophthalmoscope photocoagulation is effective and safe for threshold and prethreshold ROP.