玻璃体腔注射雷珠单抗治疗早产儿视网膜病变的临床观察

The clinical observation of intravitreal injection of ranibizumab for retinopathy of prematurity

目的观察玻璃体腔注射雷珠单抗治疗早产儿视网膜病变的疗效。方法收集2015年10月至2016年12月在聊城市人民医院经RetCam 3眼底检查确诊并进行治疗的1型阈值前期病变、阈值期病变及AP-ROP病变患儿23例46只眼,病变均位于Ⅰ-Ⅱ区。其中,男10例20只眼,女13例26只眼,胎龄26~32周,平均(28.1±1.7)周;出生时体重890~1500 g,平均(1120±177)g,治疗时矫正胎龄32~45周,平均(37.8±3.2)周。患儿在吸入麻醉下于角膜缘后1.5mm穿刺玻璃体腔注射雷珠单抗0.25 mg,术后定期随访观察其疗效转归。同时观察有无与治疗相关的其他全身不良反应。结果46只眼在注药1周后病变均出现不同程度缓解,其中16例32只眼(69.6%,32/46)异常血管增生停止,血管继续生长至Ⅲ区;7例14只眼(30.4%,14/46)在注药6~9周(平均7.9周)后病变无继续缓解趋势或复发,需要再次治疗。结论玻璃体腔注射雷珠单抗可以有效控制早产儿视网膜病变的进展,帮助血管发育,但其有一定的复发率,术后需积极随访,以便早发现复发及恶化病例,及时进行再次治疗。

Objective To observe the efficacy of intravitreal injection of ranibizumab for the treatment of Zone Ⅰ and Zone Ⅱ retinopathy of prematurity(ROP).Methods Twenty-three patients(46 eyes)with ROP located in zone Ⅰ and Ⅱ from October 2015 to December 2016 were collected.Among them,10 cases(20 eyes)were male and 13 cases(26 eyes)were female.The mean gestational age was 28.1±1.7 weeks(from26 weeks to 32 weeks),the average birth weight was 1120±177g(from 890g to 1500g),the mean intervention time was(37.8±3.2)corrected gestational weeks(from 32 to 45 weeks).0.25mg ranibizumab was injected through the sclera 1.5mm posterior to thecorneal limbus after anesthesia for all patients.The efficacy outcomes and the systemic adverse reactions related to treatment were observed.Results All the 46 eyes disease released one week after injection.The abnormal vascular proliferation in 16 cases(32 eyes)stopped,and the blood vessel continued to grow to Zone Ⅲ;7.9 weeks after injection(from 6 to 9weeks),the ROP lesions in 7 cases(14 eyes)showed again and needed further anti-VEGF and(or)laser treatment.Conclusions The intravitreal injection of ranibizumab is effective in the treatment of ROP by promoting vascular development.But there is still a recurrence rate.So it is important to emphasis timely follow-up and observe actively to find patients who need to be treated again.