保留晶状体的玻璃体切除术治疗4A期早产儿视网膜病变

Lens-sparing vitrectomy for stage 4A retinopathy of prematurity

目的评价保留晶状体的玻璃体切除术治疗4A期早产儿视网膜病变后视网膜解剖复位情况以及视功能情况。方法回顾性病例研究。15例20只4A期早产儿视网膜病变患眼经确诊后均在全麻下施行了保留晶状体的玻璃体切除术。术后随访通过间接检眼镜以及RetCamII成像系统检查视网膜解剖复位情况，使用条栅视力（LeagratingTM）检查来评估视功能的情况。结果所有20只患眼术后随访中视网膜解剖均完全复位。其中3只患眼伴有黄斑部的变形或牵引（占15％），其余17只患眼术后眼底检查黄斑部结构正常（占85％）。共9例患儿12只眼完成了条栅视力的检查，平均条栅视力值为（6．4±2．5）c／d（2～12c／d），转换为五分视力值平均为4．29±0．20（3．82～4．60）。其中1只患眼视力为3．82．1只患眼视力为4．0，其眼底检查都发现有黄斑部的变形以及牵引；其余10只患眼视力都优于4.3（4．30±4．60）。结论通过保留晶状体的玻璃体切除术治疗4A期早产儿视网膜病变，能够使视网膜解剖复位成功．并达到良好的视功能预后。

Objective To assess the anatomical and visual outcomes of stage 4A retinopathy of prematurity （ROP） after lens-sparing vitrectomy. Methods It was a retrospective case series study. Twenty eyes of 15 infants with stage 4A ROP were identified and underwent lens-sparing pars plana vitrectomy under anesthesia. Anatomical outcomes were assessed with an indirect binocular ophthalmoscope and RetCam II imaging system at the follow-up visit. Visual outcomes were measured with a grating acuity test （Lea gratingTM）. Results All twenty eyes had complete retinal reattachment after surgery. Three eyes had distortion or dragging of the macula （15%）. The macula appeared to be normal in the remaining eyes （85%）. Twelve eyes of 9 infants were successfully measured with a grating acuity test. Average grating acuity was 6.4±2.5 cpd （2-12 cpd）, which was 4.29±0.20 （3.8±4.60） when transformed to optotype acuity values. Two eyes had distortion or dragging of the macula. The visual acuity of these 2 eyes was 3.82 and 4.0, respectively. Visual acuity of the remaining eyes was 4.3 or better. Conclusion Patients with stage 4A ROP retinal detachment can be treated successfully with respect to anatomical and visual outcomes utilizing lens-sparing vitrectomy.