中华眼底病杂志

中华眼底病杂志

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

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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 of prematurity, 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.

关键词: 早产儿视网膜病/治疗; 视网膜毛细血管扩张症/治疗; 激光凝固术; 血管生成抑制剂/治疗应用; 述评

Key words: Retinopathy of prematurity/therapy; Retinal telangiectasis/therapy; Laser coagulation; Angiogenesis inhibitors/therapeutic use; Editorial

引用本文: 陆方. 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. 中华眼底病杂志, 2018, 34(5): 429-431. doi: 10.3760/cma.j.issn.1005-1015.2018.05.003 复制

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1. Sun JK, Glassman AR, Beaulieu WT, et al. Rationale and application of the protocol s anti-vascular endothelial growth factor algorithm for proliferative diabetic retinopathy[J/OL]. Ophthalmology, 2018, 2018:E1[2018-08-07] . https://doi.org/10.1016/j.ophtha.2018.08.001.DOI: 10.1016/j.ophtha2018..08.001.[published online ahead of print].
2. 程湧, 梁建宏, 黎晓新. 康柏西普玻璃体腔注射治疗急进性后极部早产儿视网膜病变的疗效观察[J]. 中华眼底病杂志, 2017, 33(2): 144-147. DOI: 10.3760/cma.j.issn.1005-1015.2017.02.008.Cheng Y, Liang JH, Li XX. Intravitreal injection of conbercept for aggressive posterior retinopathy of prematurity[J]. Chin J Ocul Fundus Dis, 2017, 33(2): 144-147. DOI: 10.3760/cma.j.issn.1005-1015.2017.02.008.
3. 易佐慧子, 孙先桃, 陈长征, 等. 玻璃体腔注射雷珠单抗治疗早产儿视网膜病变疗效观察[J]. 中华眼底病杂志, 2015, 31(1): 10-13. DOI: 10.3760/cma.j.issn.1005-1015.2015.01.004.Yi ZHZ, Sun XT, Chen CZ, et al. Effects of intravitreal ranibizumab for the treatment of retinopathy of prematurity[J]. Chin J Ocul Fundus Dis, 2015, 31(1): 10-13. DOI: 10.3760/cma.j.issn.1005-1015.2015.01.004.
4. Mintz-Hittner HA, Kennedy KA, Chuang AZ, et al.Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity[J].N Engl J Med, 2011, 364(7): 603-615. DOI: 10.1056/NEJMoa1007374.
5. Dikci S, Ceylan OM, Demirel S, et al. Which dose of bevacizumab is more effective for the treatment of aggressive posterior retinopathy of prematurity: lower or higher dose?[J]. Arq Bras Oftalmol, 2018, 81(1): 12-17. DOI: 10.5935/0004-2749.20180005.
6. Jin E, Yin H, Li X, et al. Short-term outcomes after intravitreal injections of conbercept versus ranibizumab for the treatment of retinopathy of prematurity[J]. Retina, 2018, 38(8): 1595-1604. DOI: 10.1097/IAE.0000000000001763.
7. Sukgen EA, Söker G, Koçluk Y, et al. Effect of intravitreal aflibercept on central retinal arterial blood flow in type 1 retinopathy of prematurity[J/OL].Eur J Ophthalmol, 2017, 2017:E1[2017-02-08]. https://doi.org/10.5301/ejo.5000938. DOI: 10.5301/ejo.5000938.[published online ahead of print].
8. Quiram PA, Drenser KA, Lai MM, et al. Treatment of vascularly active familial exudative vitreoretinopathy with pegaptanib sodium (Macugen)[J]. Retina, 2008, 28(Suppl 3):S8-12. DOI: 10.1097/IAE.0b013e3181679bf6.
9. Tagami M, Kusuhara S, Honda S, et al. Rapid regression of retinal hemorrhage and neovascularization in a case of familial exudative vitreoretinopathy treated with intravitreal bevacizumab[J].Graefe’s Arch Clin Exp Ophthalmol, 2008, 246(12): 1787-1789. DOI: 10.1007/s00417-008-0949-6.
10. Stahl A, Krohne TU, Eter N, et al. Comparing alternative ranibizumab dosages for safety and efficacy in retinopathy of prematurity: a randomized clinical trial[J]. JAMA Pediatr, 2018, 172(3): 278-286. DOI: 10.1001/jamapediatrics.2017.4838.
11. Lepore D, Quinn GE, Molle F, et al. Intravitreal bevacizumab versus laser treatment in type 1 retinopathy of prematurity: report on fluorescein angiographic findings[J].Ophthalmology, 2014, 121(11): 2212-2219. DOI: 10.1016/j.ophtha.2014.05.015.
12. Lepore D, Quinn GE, Molle F, et al. Follow-up to age 4 years of treatment of type 1 retinopathy of prematurity intravitreal bevacizumab injection versus laser: fluorescein angiographic findings[J]. Ophthalmology, 2018, 125(2): 218-226. DOi: 10.1016/j.ophtha.2017.08.005.
13. Wallace DK, Dean TW, Hartnett ME, et al. A dosing study of bevacizumab for retinopathy of prematurity: late recurrences and additional treatments[J].Ophthalmology, 2018, 2018:E1[2018-06-07] . https://doi.org/10.1016/j.ophtha.2018.05.001.DOI: 10.1016/j.ophtha.2018.05.001.[published online ahead of print].
14. Wong RK, Hubschman S, Tsui I. Reactivation of retinopathy of prematurity after ranibizumab treatment[J]. Retina, 2015, 35(4): 675-680. DOI: 10.1097/IAE.0000000000000578.
15. Zhang L, Ke Y, Wang W, et al.The efficacy of conbercept or ranibizumab intravitreal injection combined with laser therapy for Coats' disease[J]. Graefe’s Arch Clin Exp Ophthalmol, 2018, 256(7): 1339-1346. DOI: 10.1007/s00417-018-3949-1.
16. Fukushima Y, Fujino T, Kusaka S, et al. Favorable outcomes of adequate laser photocoagulation and salvage bevacizumab treatment for aggressive posterior retinopathy of prematurity[J].Am J Ophthalmol Case Rep, 2018, 11: 66-71. DOI: 10.1016/j.ajoc.2018.05.006.
17. Altinsoy HI, Mutlu FM, Güngör R, et al. Combination of laser photocoagulation and intravitreal bevacizumab in aggressive posterior retinopathy of prematurity[J].Ophthalmic Surg Lasers Imaging, 2010, 9: 1-5. DOI: 10.3928/15428877-20100215-03.
18. Lin CJ, Chen SN, Hwang JF, et al. Combination treatment of pediatric coats' disease: a bicenter study in Taiwan[J].J Pediatr Ophthalmol Strabismus, 2013, 50(6): 356-362.