早产儿视网膜病变间接检眼镜激光治疗及危险因素分析

Retinopathy of prematurity treated by indirect ophthalmoscopic photocoagulation and its risk factors

目的评价早产儿视网膜病变(retinopathy of prematurity,ROP)间接检眼镜激光光凝治疗的临床疗效,并分析影响预后的相关因素。方法回顾分析间接检眼镜光凝治疗的ROP患儿103例(197眼)临床资料,随访37～856d,观察治疗后视网膜血管区与无血管区病变消退或进展情况,记录视网膜血管扩张、迂曲、消退情况及角膜、虹膜、瞳孔、晶状体情况。结果 179眼ROP病变消退,治愈率90.86%。病变消退组的出生胎龄、出生体质量、治疗时矫正胎龄分别为(29.40±2.08)周、(1293.52±311.99)g、(37.12±3.03)周,病变进展组分别为(29.17±1.85)周、(11291.36±290.57)g、(36.67±2.42)周,差异均无统计学意义(均为P>0.05)。Ⅰ区病变74眼,病变消退60眼(81.08%),病变进展14眼(18.92%);Ⅱ区病变123眼,病变消退119眼(96.75%),病变进展4眼(3.25%),Ⅰ区病变进展率明显高于Ⅱ区,差异有显著统计学意义(χ2=11.838,P=0.001)。阈值前病变1型94眼,其中90眼(95.74%)病变消退,4眼(4.26%)病变进展;阈值期病变103眼,其中89眼(86.41%)病变完全消退,14眼(13.59%)病变进展,阈值前病变Ⅰ型病变进展率明显高于阈值期病变,差异有统计学意义(χ2=4.97,P=0.043)。结论双目间接检眼镜激光治疗阈值前期1型和阈值期ROP病变是安全有效的,治疗效果与病变区域、病变程度有关。

Objective To evaluate the efficacy of retinopathy of prematurity （ROP） treated by binocular indirect ophthalmoscopic photocoagulation, and analyze the related factors on its prognosis. Methods The clinical data of 103 preterm infants（ 197 eyes） treated by binocular indirect ophthalmoscopic photocoagulation were retrospec- tively analyzed. The foUow-up time was from 37 days to 855 days, the regression and progression of disease located in area with or without vessels was observed,and the ret- inal vessels,cornea,iris,pupil and lens were recorded. Results ROP in 179 eyes were cured,and the curative rate was 90.85%. The mean birth weight,gestational age and the corrected gestational at the time of operation in the regression group were（ 1293.52 ± 311.99） g, （29.40 ± 2.08 ） weeks and （ 37.12 ± 3.03 ） weeks, respectively, which in pro- gression group were （ 11291.35 ± 290. 57 ） g, （ 29.17 ± 1.85 ） weeks and （ 35.57 ± 2.42 ） weeks, respectively, there was no statistical difference （ all P 〉 0.05 ）. The disease loca- ted in zone 1 in 74 eyes,in which the disease regressed in 50 eyes（81.08% ） and pro- gressed in 14 eyes（ 18.92% ）. The disease located in zone 2 in 123 eyes,in which the dis-ease regressed in 119 eyes（95.75% ） and progressed in 4 eyes（3.25% ） ,there was significant difference （xz = 11. 838,P = 0. 001 ）. The pre-threshold diseases were in 94 eyes ,in which the disease regressed in 90 eyes（95.74% ） and progressed in 4 eyes （4.25%） ;The threshold diseases were in 103 eyes, in which the disease regressed in 89 eyes （85.41%）and progressed in 14 eyes（ 13.59% ）, there was statistical difference（x2 = 4.97 ,P = 0.043 ）. Conelusion Retinal photocoagulation by bin- ocular indirect ophthalmoscope is a Safe and effective procedure for pre-threshold type 1 ROP and threshold ROP, and the outcome of photocoagulation may be influenced by zone and degree of ROP.