正确认识婴幼儿视网膜血管性疾病中抗血管内皮生长因子药物与激光光凝的应用

Appropriate understanding the application of anti-vascular endothelial growth factor agents and laser photocoagulation for infants retinal vascular diseases

早产儿视网膜病变、家族性渗出性玻璃体视网膜病变和Coats病是婴幼儿常见的视网膜血管性疾病。其对患儿形成视力威胁的主要原因是新生血管增生牵拉形成的牵拉性视网膜脱离和（或）异常血管渗漏导致的渗出性视网膜脱离。经典的激光光凝治疗通过对视网膜的热凝损伤或者异常血管的破坏达到治疗和稳定病变的目的，然而激光光凝对视网膜广泛损伤带来的视野损害、出血、视网膜裂孔、治疗失败等不良反应导致患儿视力预后并不令人满意。目前，抗血管内皮生长因子药物已在成年人视网膜脉络膜血管性疾病中用以消退视网膜新生血管和减轻血管渗漏，甚至在增生性糖尿病视网膜病变中有替代激光光凝的趋势；但其在婴幼儿视网膜血管性疾病的使用中存在着剂量、时机、再次治疗的选择和全身不良事件风险等问题。因此，合理选择激光光凝与抗血管内皮生长因子药物治疗婴幼儿视网膜血管性疾病是我们需要注意和重视的问题。

Retinopathy ofprematurity, familial exudative vitreoretinopathy and Coats disease are the most common neonates and infants retinal vascular diseases, which may lead to severe visual damage because of either tractional retinal detachment caused by the proliferation of pathogenic neovascularization, or exudative retinal detachment due to the extremely leakage from abnormal retinal vessels. Classic treatment is retinal laser photocoagulation which could destroy these abnormal vessels or reduce non vascular areas to diminish the growth of new vessels, however the side effects induced by laser it self such as visual field damage, hemorrhage, retinal tear, fail to control the progression of the disease make the laser treatment hard to improve the vision of these young patients. Anti-vascular endothelial growth factor （VEGF） agents have been widely applied in various adult retinal and choroidal vascular diseases, they are even possible to replace the pan retinal photocoagulation in proliferative diabetic retinopathy, while there are still many unsolved problems in the applying in neonates and infants retinal vascular diseases, like dosage, timing, retreatment and systemic side effects. We should realize the importance of selecting the laser photocoagulation and anti-VEGF for neonates and infants retinal vascular diseases.