急进性后极部早产儿视网膜病变的临床进程及疗效观察

A clinical study on the clinical progress and treatment efficacy of aggressive posterior retinopathy of prematurity

目的描述急进性后极部早产儿视网膜病变（AP—ROP）的临床进程及特征，评价视网膜光凝及冷凝对急进性后极部早产儿视网膜病变的治疗效果。方法前瞻性、非对比性、连续性病例。2006年1月至2008年6月经检查确诊为急进性后极部ROP的患儿8例16只眼。确诊后24h内行间接眼底镜下行视网膜光凝治疗联合或不联合直视下冷凝治疗。结果急进性后极部早产儿视网膜病变以病变大部分位于后极部1区，所有象限视网膜血管扩张迂曲，病程进展快，若不及时治疗，迅速发生视网膜漏斗状全脱离为临床特征。本组8例16只眼视网膜光凝和（或）冷凝治疗后，9只眼病变完全退化或控制，占56．2％。7只眼病情未能控制，最终发展为4b至5期视网膜病变。结论AP—ROP进展快，预后小良，部分患儿虽经严密观察和治疗，病情仍进展。视网膜光凝和（或）冷凝治疗能控制大部分AP-ROP患儿视网膜病变的发展，挽救患儿视功能。临床上需要加强观察和随访，早发现、早诊断、早治疗是减低该病致盲率的惟一方法。

Objective To describe the clinical progress and characteristics of aggressive posterior retinopathy of prematurity（AP-ROP, and to access the efficacy of retinal photocoagnlation and cryotherapy for AP-ROP to stop progression of retinal detachment. Methods Prospective, non-comparative, consecutive case series. Sixteen eyes （ 8 patients ） with AP-ROP were included in this study. Each patient underwent retinal pho-tocoagulation with or without cryotherapy within 24 hours after identification.Results AP-ROP, an unusual form of ROP, often rapidly progresses to a closed funnel of tractional retinal detachment within several weeks if left untreated. It is characterized by substantial dilation and tortuosity of the vessels of the posterior pole in Zone 1. Nine out of 16 （56.2%） eyes were stopped to progress to advanced ROP in our series. However, retinal detachment developed in 7/16 （43.8%） eyes. Conclusions These results suggest that early intervention with photocoagulation or cryotherapy is necessary and effective to stop ROP progression to Stage 5 in most cases; however, the prognosis is poor in parts of patients despite retreatment of peripheral retinal photocoagulation and cryotherapy. Clinicians looking for preterm infants must be vigilant in screening and providing appropriate intervention to avoid missing the ＂time window＂ of treatment.