激光光凝及抗VEGF治疗早产儿视网膜病变阈值前病变1型的疗效对比

Comparison of the efficacy of laser photocoagulation and anti-VEGF in the treatment of type 1 prethreshold retinopathy of prematurity

目的:观察视网膜激光光凝术(laser photocoagulation,LP)及玻璃体腔注射雷珠单抗(intravitreal ranibizumab,IVR)对病变位于II区的阈值前病变1型早产儿视网膜病变(retinopathy of prematurity,ROP)的疗效。方法:收集2015年10月至2019年12月厦门市儿童医院收治的病变位于II区的阈值前病变1型44例(81眼)。根据手术方式分为LP组、IVR组。观察各组术后病变消退、视网膜血管化情况、全身及眼部并发症,分析不同手术方式的效果。结果:LP组20例(37只眼)行视网膜激光光凝治疗,术后未出现复发,首次治愈率100%;术后(3.42±1.57)周病情控制,术后(9.84±4.75)周可观察到周边视网膜血管化。IVR组24例(44只眼)注射雷珠单抗,39只眼行单次手术后病情控制,首次治愈率88.6%,5眼术后病情未控制。术后(2.95±2.58)周病情控制,术后(14.19±4.95)周可观察到周边视网膜血管化。两组手术方式首次治愈率、视网膜血管化时间差异有统计学意义(P<0.05)。结论:视网膜LP及IVR治疗病变位于II区的阈值前病变1型均有较好疗效,IVR复发率较高,手术方式的选择需慎重。

Objective:To observe the efficacy of laser photocoagulation(LP)and intravitreal ranibizumab(IVR)injection in the treatment of type 1 prethreshold retinopathy of prematurity(ROP)with lesions located in zone II.Methods:Forty-four patients(81 eyes)with type 1 prethreshold retinopathy of prematurity with lesions located in zone II staying in our hospital from October 2015 to December 2019 were collected and divided into LP group and IVR group according to the operation method.Through observation of the postoperative disease involution,retinal vascularization,systemic and ocular complications in each group,the effects of different surgical methods were analyzed.Results:In LP group,20 patients(37 eyes)underwent retinal laser photocoagulation treatment,with no recurrence occurred after the operation;the cure rate after the first operation was 100%;the disease was controlled at(3.42±1.57)weeks after the operation;and peripheral retinal vascularization was observed at(9.84±4.75)weeks after the operation.In IVR group,24 patients(44 eyes)were injected with ranibizumab;39 eyes were under control after a single operation;the cure rate after the first operation was 88.6%;and 5 eyes were not under control after surgery.The disease was controlled for an average of(2.95±2.58)weeks after operation;peripheral retinal vascularization was observed at(14.19±4.95)weeks after operation;there were statistically significant differences in the cure rate after the first operation and retinal vascularization time between the two groups.Conclusion:Retinal laser photocoagulation and IVR have good effects in the treatment of type 1 prethreshold retinopathy of prematurity with lesions located in zone II.However,the recurrence rate using IVR is relatively high.Therefore,the surgical method needs to be cautious and still requires clinical observation.