急进性后部型早产儿视网膜病变的临床特征及治疗

Clinical characteristics and treatment outcomes of aggressive posterior retinopathy of prematurity

目的观察急进性后部型早产儿视网膜病变（AP—ROP）的临床特征和治疗效果。方法回顾分析18例AP—ROP患儿35只眼的临床资料。暗室条件下，采用双目间接检眼镜配合28D透镜、巩膜压迫器、广角数码视网膜成像系统（RetCam）检查所有患儿视网膜并记录病变。所有患儿在确诊后12h内，采用半导体倍频532nm波长激光，应用双目间接检眼镜激光输出系统对病变周边部视网膜无血管区进行激光光凝。其中，因激光光凝治疗后病变继续进展再行玻璃体手术治疗者13只眼，占37．1％；单纯行激光光凝治疗者22只眼，占62．9％。治疗后随访6个月～5年，平均随访时间为23．5个月。观察视网膜病变的转归。结果所有患眼均为后极部病变，位于1区或2区的后部。4个象限的视网膜血管高度扩张纡曲，难以区分视网膜小动静脉，出现视网膜内血管短路、动静脉弓；视网膜无血管区和血管化区域边界不清，新生血管网呈扁平形态，不易识别；无明显的分界线或嵴等典型病变形成。单纯行激光光凝治疗的22只眼，治疗后血管形态及走向趋于正常，病变消退，无血管区光凝斑均匀覆盖。行玻璃体切割手术的13只眼，激光光凝治疗后玻璃体在后极部环形增生收缩引起牵拉性视网膜脱离。手术治疗后视网膜复位8只眼；玻璃体渗出及出血，视网膜未复位5只眼。结论AP-ROP临床表现特殊。及时激光光凝治疗可使大部分患眼病变消退。激光光凝治疗后病变继续进展者行早期玻璃体手术干预，可使大部分患眼视网膜复位。

Objective To observe the clinical characteristics and treatment outcomes of aggressive posterior retinopathy of prematurity （AP ROP）. Methods Thirty five eyes （18 patients） diagnosed with AP-ROP were studied from January 2006 to January 2011. All the patients were examined by 28 D optical lens, sclera compressor and wide angle digital retinal imaging system （RetCam Ⅱ ）. Laser photocoagulation with 532 nm wavelength using binocular indirect ophthalmoscope was used in all the infants within 12 hours after confirmed diagnosis. Thirteen eyes （ 37. 1%） progressed to retinal detachment after laser photocoagulations were surgically treated, while 22 eyes （62.9 %） underwent laser photocoagulation alone. Follow-up ranged from 6 months to 5 years, with a mean of 23.5 months. Results All AP-ROP lesions are located in zone 1 and posterior zone 2, with substantial dilated and tortuous retinal vessels. It is difficult to distinguish between the retinal vein and small arteries. There are shunts from vessel to vessel within the retina and no clear boundary between the vascularized and non-vascularized retina. Neovascularization lesions are flat and hard to be identified. There are no demarcation ridges. After laser treatment, 22 eyes achieved good outcomes. Among 13 eyes who received vitrectomy, 8 eyes achieved retinal reattachment after surgery, while 5 eyes developed total retinal detachment. Conclusion AP ROP has specific clinical manifestations. Timely laser photocoagulation and early surgical treatment is necessary for AP-ROP.