玻璃体内注射雷珠单抗治疗早产儿视网膜病变疗效观察

Intravitreal injection of ranibizumab for retinopathy of prematurity

目的观察玻璃体内注射抗血管内皮生长因子单克隆抗体ranibizumab（商品名lucentis;雷珠单抗）治疗早产儿视网膜病变（retinopathy of prematurity,ROP）的临床疗效。方法收集2012年10月至2013年7月经检查确诊的ROP患儿8例16眼,病变均位于1-2区。其中,男7例14眼,女1例2眼,胎龄28~32周,平均29.8周;出生体质量955~1900 g,平均1271.9 g。所有患儿散瞳后表面麻醉下于角巩膜缘后1.0 mm处进针向玻璃体内注射ranibizumab 0.25 mg,术后定期随访观察其疗效转归。结果 16眼中13眼（81.25%）注药后病变缓解,异常血管增生停止,血管继续生长,在间隔7.5周（5~9周）后,再次出现ROP阈值前期病变表现,需要进一步激光治疗。2例3眼在注药后1~2周病变继续进展,视网膜结构不良甚至引起牵拉性视网膜脱离。随访期间所有患儿全身情况良好,未见全身药物不良反应,未发生眼内感染、白内障、眼前段缺血等并发症。结论 ROP玻璃体内注射ranibizumab可以有效控制病变的进展。

Objective To observe the efficacy of intravitreal injection of ranibizumab for the treatment of retinopathy of prematurity（ ROP）. Methods Eight patients（ 16 eyes） with ROP located 1- 2 zone from October 2012 to July 2013 were collected. Among them,7 cases（ 14eyes） are males and 1 cases（ 2 eyes） is female. The mean gestational age was 29. 8 weeks（ from28 weeks to 32 weeks）,the average birth mass was 1271. 9 g（ from 955 g to 1900 g）. The intravitreal injection of 0. 25 mg ranibizumab was performed in the limbus at 1. 0 mm from the needle after anesthesia for all patients,the efficacy outcomes were evaluated. Results The disease in 13eyes（ 81. 25%） after injection released,the abnormal vascular proliferation stopped,and the blood vessel continued to growth,after 7. 5 weeks（ from 5 weeks to 9 weeks）,the emergence of pre-threshold ROP lesions showed once again and needed further laser treatment. The diseases in2 cases（ 3 eyes） progressed from 1 week to 2 weeks after injection,retinal dysplasia appeared and even caused the traction retinal detachment. During follow-up,the body in all patients were in good condition,no systemic adverse drug reactions occurred,no intraocular infection,cataract,anterior segment ischemia and other complications appeared. Conclusion The intravitreal injection of ranibizumab is safe and effective in the treatment of ROP.