早产儿视网膜病变的冷冻治疗

Cryo-therapy for retinopathy prematurity

目的：观察早产儿视网膜病变（retinopathy of prematurity,ROP）阈值前病变I型及阈值病变的冷冻治疗疗效,探讨其合理的治疗时机及模式。方法：对胎龄≤35wk,质量≤2000g患儿进行ROP筛查,对阈值前病变I型及阈值病变进行冷冻治疗。结果：（1）共筛查829例符合条件的早产儿,发现早产儿视网膜病变患儿86例（172眼,占10.4%）,如按照中华眼科学会制定的ROP筛查标准（出生胎龄≤35wk,质量≤2000g）则患病率为20.6%;其中4期6眼（3.5%）,3期44眼（25.6%）,发展快的2期14眼（8.1%）,稳定或退行2期56眼（32.6%）,1期52眼（30.2%）;24眼有后部plus现象,58眼周边视网膜出血;50眼2区发病,122眼3区发病;32wk及以内发病的16眼,32-36wk发病的60眼,36wk及以后发病的96眼;（2）行冷冻手术32例（64眼）,其中阈值前病变I型12例,阈值病变20例;24眼有后部plus现象;40眼周边视网膜出血;50眼2区发病,14眼3区发病;32wk及以内发病的16眼,32～36wk发病的36眼,36wk及以后发病的12眼;单生子21例,双生子10例,三生子1例;（3）30例病情控制满意;1例发展为后极部视网膜皱襞,周边视网膜脱离,最后行玻璃体切割手术;2例玻璃体出血,其中1例出血吸收,1例最后牵引性视网膜脱离;（4）3例术后短期角膜水肿,5例眼睑冻伤,2例玻璃体出血。结论：（1）后部plus现象、周边视网膜出血、2区发病、32wk内发病的ROP是高风险病变,病情发展迅速,往往需要行手术治疗;（2）对阈值前病变及阈值病变及时行视网膜冷冻术效果较满意且安全。

AIM： To observe the curative effect of cryotherapy on pre-threshold and threshold ROP, so as to discuss the reasonable treatment opportunity and model of ROP. METHODS： ROP screen was taken under indirect ophthalmoscope in the premature infants （ gestational age ≤5 weeks, the birth weight≤2 000g ）, and cryo-therapy were taken in pre-threshold and threshold ROP. RESULTS： （1）A total of 829 cases were choosen. ROP was found in 86 infants （172 eyes, 10.4%）, of them, 6 eyes with stage 4, 44 eyes with stage3, 14 eyes with developing-stage 2, 56 eyes with regress or stable stage 2, 52 eyes with stage 1. Twenty-four eyes were with plus, 58 eyes with peripheral retina hemorrhage, 52 eyes onset in 2 district, and 122 eye onset in 3 district. Six eyes occurred within 32 weeks, 60 eye in 32 to 36 weeks, and 106 eyes after 36 weeks. （2） Thirty-two cases （64 eyes） of ROP were undertaken cryo-therapy, 12 cases were pre- threshold ROP type I, 20 cases were threshold ROP. Among them, 24 eyes were with plus and 40 eyes with peripheral retina hemorrhage. 50 eyes were onset in 2 district and 4 eyes onset in 3 district. Sixteen eyes occurred within 32 weeks, 36 eyes in 32 to 36 weeks, and 12 eyes after 36 weeks. （3） Thirty cases got good results from controlling the development of ROP. One case developed post pole retinal fold and periphery retinal detachment, and undertook vitrectomy finally. Two cases were with vitreous hemorrhage and was resolved in 1 cases while another case developed with traction retinal detachment. （4） Three cases were with transient corneal edema and 5 cases with eye lid cold injury. CONCLUSION. The ROP with plus phenomenon, peripheral retina hemorrhage, or ROP onset in 2 district, or within 32 weeks are high risks for disease, which will develop rapid and needs for surgery. Cryotherapy on pre-threshold and threshold ROP are with good results and safety .