早产儿视网膜病变患儿激光光凝术后视功能和屈光状态

Observation of visual function and refractive status after laser coagulation for retinopathy of prematurity

目的研究早产儿视网膜病变(retinopathy of prematurity,ROP)患儿激光光凝术后视功能和屈光状态。方法回顾性队列研究。收集我院行二极管激光光凝术治愈的ROP患儿44例(88眼),远期随访3 a以上,观察其视力、眼位及屈光状态情况。术后最佳矫正视力(best corrected visual acuity,BCVA)<0.3定义为低视力,术后低视力与出生体质量、孕周、治疗时矫正胎龄、病变区域和激光次数的相关性行Logistic多因素回归分析。结果44例(88眼)患儿年龄为(4.2±0.8)岁,BCVA≤0.1者2眼,>0.1~0.3者9眼,>0.3~0.5者14眼,>0.5者63眼。Logistic多因素回归分析显示,术后低视力与出生体质量、孕周、矫正胎龄和激光治疗次数均无相关性(均为P>0.05),与病变区域有关(P=0.049)。近视性屈光不正29眼,近视度数为-0.25^-10.50 D,其中高度近视(SE≥-5.00 D)8眼;合并散光者44眼,散光度-1.00^-5.00 DC,其中高度散光(≥-2.00 DC)20眼;10例患有斜视,1例有眼球震颤。结论ROP激光术后大部分患儿有较好的视力,高度近视和斜视是视力损伤的主要原因。

Objective To investigate the visual function and refractive status of patients who underwent laser photocoagulation for retinopathy of prematurity(ROP).Methods The retrospective cohort study was carried out on 44 ROP children(88 eyes)who underwent diode laser photocoagulation in our hospital and received long-term follow-up for 3 years.Visual acuity,eye position and refractive status were observed.The best corrected visual acuity(BCVA)<0.3 was defined as low vision.Logistic regression analysis was performed to explore the correlation of postoperative low vision with birth weight,gestational age,corrected gestational age during treatment,lesion area and frequency of laser treatment.Results The mean age of child patient was(4.2±0.8)years.There were 2 eyes with BCVA≤0.1,9 eyes with BCVA>0.1 and≤0.3,14 eyes with BCVA>0.3 and≤0.5,and 63 eyes with BCVA>0.5.Logistic regression analysis showed that postoperative low vision had no relation with birth weight,gestational age,corrected gestational age or frequency of laser treatment(all P>0.05),but was related to lesion area(P=0.049).There were 29 eyes with myopic ametropia[with myopia of-0.25 D to-10.50 D],including 8 eyes(9.09%)with high myopia(SE≥-5.00 D);there were 44 eyes with myopia and astigmatism(with astigmatic degree of-1.00 DC to-5.00 DC),including 20 eyes with high astigmatism(with astigmatic degree≥-2.00 DC).There were 10 child patients with strabismus and 1 child patient with nystagmus.Conclusion The majority of child patients who underwent ROP laser therapy have favorable visual outcomes.High myopia and strabismus are the main causes of visual impairment.