Comparison of structural outcome between intravitreal bevacizumab and laser treatment for type 1 retinopathy of prematurity after long-term follow-up

Background:To compare the structural outcome of intravitreal bevacizumab(IVB)and laser treatment for type 1 retinopathy of prematurity(ROP).Methods:This is a retrospective comparative study.From December 2002 to April 2009,patients with type 1ROP according to criteria of Early Treatment of Retinopathy of Prematurity(ETROP)study were treated by peripheral retinal diode laser photocoagulation in nearly confluent pattern.From May 2009 to January 2015,we performed IVB for patients with type 1 ROP.The patients were closely followed until disappearance of retinal neovascularization in the laser group and regression of avascular zone in the bevacizumab group.The demographical data,postmenstrual age(PMA)for treatment,and fundus findings were recorded by chart review.The difference between laser and bevacizumab groups was compared by Student t-test and Fisher exact test.Results:We collected 43 patients(86 eyes)with type 1 ROP,including 30 male and 13 female infants.Their mean gestation age and birth body weight(BBW)were 27.5 weeks and 1,034 gm.Zone I and zone II disease were found in 8 and 35 patients.The mean PMA for treatment was 37.3 weeks.The mean follow-up period was54.4 months.Laser treatment was administered in 26 patients,and bevacizumab injection for 17 infants.Single session of laser was performed in all patients of laser group without recurrence of retinal neovascularization.Complete regression of ROP was found in 15 infants of bevacizumab group following the first IVB.Four eyes in two patients(2/17,11.7%)had recurrence of ROP and received additional injections and adjuvant laser treatment.There was no unfavorable anatomical results such as retinal detachment or macular ectopia or complications such as cataract or endophthalmitis in either bevacizumab or laser management.Conclusions:Laser therapy and IVB were both effective treatments for type 1 ROP to cause favorable anatomical outcomes.Single session of laser ablation in nearly confluent pattern was sufficient for complete regression of ROP in laser group.Single IVB was appropriate for managing most of cases with ROP in bevacizumab group,but a small proportion(nearly one tenth)of them had recurrent episodes requiring adjuvant therapies.

巴西南部第三中心早产儿视网膜病变(英文)

目的:评估2002-10/2006-10在巴西de Clinicasde Porto Alegre医院出生的所有早产儿的早产儿视网膜病变(ROP)的发生率,其治疗和预后的比率。方法:对323例出生体质量低于或等于1500g或者出生时孕龄等于或者少于32wk的早产儿进行前瞻性队列研究。所有的新生儿都在出生后6wk内进行开睑器开睑,瞳孔散大,间接检眼镜及28D透镜眼底检查,根据疾病的分类进行复查。结果由均数表示,发病率为于95%的可信区间,主要的临床结果为任何分期的ROP发生。结果:新生儿82例发生了ROP,发生率为25.7%。患者中只有17例((5.3%)发生了阈病变,他们的病变都累及后部第II区,需要激光治疗。除了3例经治疗的患儿需要两次激光治疗外,没有一个经过治疗的患儿有I区病变或者严重的后部病变。重复治疗组的1例患儿因发展成为4期ROP而需要行赤道部硅胶带巩膜环扎术。结论:ROP的发生率和阈病变同国际其它的研究结果类似。本研究显示了孕期28wk以内或出生后体重1000g的新生儿高生存率(70.1%)、高视网膜病变发病率和激光治疗的高度必要性。这组患儿需要眼科专家和新生儿专家为发现ROP进行仔细筛查和随访。本组患儿中没有确诊1例有I区后部病变,此点是本研究值得引起注意之处。

云浮地区早产儿视网膜病变防治现状调查

目的：了解基层医院尤其是经济欠发达地区ROP防治现状。方法采取调查表形式调查当地6家医院NICU病区ROP筛查和治疗情况及医护人员、患儿家属对ROP的了解和认识情况，并进行汇总分析。结果2011年6月～2013年10月，在6家医院平均每年收治早产儿300多例。其中极低出生体重儿50多例。6家医院只有氧疗的监测及对患儿家属告知氧疗的可能出现情况，无一例随访，无一例进行ROP筛查，患儿发生ROP的情况不清楚。结论 ROP防治在大医院及三甲医院筛查治疗率高，但在偏远山区及经济欠发达地区医护人员及患儿家属对ROP的整体认识不够，从而导致患儿即使失明也不知原因的情况，这需要政府的大力扶持和大医院的多加指导。

早产儿视网膜病变多中心临床试验介绍-LIGHT—ROP、STOP—ROP和BEAT—ROP

循证医学证据对于临床防治早产儿视网膜病变（ROP）具有重要意义。已证实视网膜消融术（冷冻和激光）治疗ROP有效，但对周边视网膜具有一定的破坏性，因而需要寻找更安全的治疗方法。继“冷冻治疗ROP（CRYO．ROP）”和“早期治疗ROP（ET—ROP）”临床试验之后，美国又先后发起了“减少光照对ROP的效应（LIGHT—ROP）”、“阈值前ROP补充氧疗（STOP—ROP）”和“贝伐单抗消除ROP的血管生成威胁（BEAT—ROP）”等多项重要的多中心临床试验，旨在探索新的治疗途径。本文综述了ROP多中心临床试验LIGHT—ROP、STOP-ROP和BEAT—ROP的目的、试验设计、主要结果和结论。（国际眼科纵览，2012，36：21—25）

早产儿视网膜病防治与健康教育

早产儿视网膜病(ROP)是目前导致儿童失明的重要原因之一。根据ROP冷凝协作组统计,出生体重≤1250g的新生儿中各期ROP发生率为65·8%,阈值期病变的发生率为6%。早期发现和早期治疗是防治ROP的关键,西方发达国家已建立常规ROP筛查和随访制度,健康教育在预防ROP中起重要作用。