中华眼底病杂志

中华眼底病杂志

视网膜出血对早产儿视网膜病变激光光凝治疗后疗效的影响

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目的观察视网膜出血对早产儿视网膜病变(ROP)激光光凝治疗效果的影响。方法回顾性病例分析。筛查并诊断为Ⅱ区阈值期的ROP患儿67例134只眼纳入研究。其中,男性32例64只眼;女性35例70只眼。平均出生胎龄(27.80±2.55)周;平均出生体重(1060±320)g。所有患儿均采用双目间接检眼镜和第三代儿童广角数码视网膜成像系统进行检查。134只眼中,伴有视网膜前、嵴上出血或玻璃体积血38只眼(A组),占28%;未伴出血96只眼(B组),占72%。确诊后72 h内在静脉注射镇静剂联合眼表面麻醉下采用810 nm激光经双目间接检眼镜输出进行视网膜无血管区光凝治疗。治疗后1、4、8、12周进行随访,其后每6个月复查1次。采用治疗前相同设备和方法检查并记录ROP嵴、附加病变的消退及进展情况。两组患眼光凝治疗后病变进展眼数比较采用χ2检验;出生胎龄、出生体重比较采用t检验。结果134只眼中,病变完全消退125只眼,占93.3%;病变进展9只眼,占6.7%。A组病变进展者7只眼,占18.4%;B组病变进展者2只眼,占2.1%。A、B组患儿光凝治疗后病变进展眼数比较,差异有统计学意义(χ2=9.14,P=0.00);出生胎龄、出生体重比较,差异无统计学意义(t=0.85、0.25,P=0.40、0.80)。结论ROP激光光凝治疗安全、有效;视网膜前、嵴上或玻璃体积血与激光光凝治疗后病变进展有关。

ObjectiveTo observe the effect of retinal hemorrhage on the treatment of retinopathy of prematurity (ROP) by laser photocoagulation.MethodsRetrospective case analysis. Screening and diagnosis of 134 eyes in 67 patients with ROP in Zone Ⅱ Stage 3+ were included in the study. Among them, 32 patients were male and 35 patients were female. The average birth gestational age was 27.80±2.55 weeks. The average birth weight was 1060±320 g. All children underwent binocular indirect ophthalmoscopy and RetCam Ⅲ. Of the 134 eyes, 38 eyes (28%) with anterior, ridge or vitreous hemorrhage (group A); 96 eyes (72%) without hemorrhage. Retinal avascular photocoagulation was performed within 72 hours after diagnosis by intravenous sedative combined with ocular surface anesthesia with 810 nm laser. Follow-up was performed at 1, 4, 8 and 12 weeks after treatment, and then every 6 months thereafter. The same equipment and methods before treatment were used to examine and document the regression and progression of ROP. The number of eyes with lesions after photocoagulation in the two groups was compared by χ2 test. The t-test was used to compare the gestational age and birth weight.ResultsAmong 134 eyes, lesions completely resolved in 125 eyes (93.3%), progressed in 9 eyes (6.7%). In group A, 7 eyes were progressive (18.4%). In group B, 2 eyes were progressive (2.1%). There was a statistically significant difference in the number of eyes with lesions after laser treatment in group A and B (χ2=9.14, P=0.003). There was no significant difference in birth gestational age and birth weight (t=0.85, 0.25; P=0.40, 0.80).ConclusionThe laser photocoagulation is safe and effective in the treatment of ROP. The preretinal, ridge or vitreous hemorrhage is related to the progression of the lesion after laser photocoagulation.

关键词: 早产儿视网膜病/治疗; 视网膜出血; 激光凝固术

Key words: Retinopathy of prematurity/therapy; Retinal hemorrhage; Laser coagulation

引用本文: 田汝银, 张国明, 何红辉, 吴桢泉, 赵金凤. 视网膜出血对早产儿视网膜病变激光光凝治疗后疗效的影响. 中华眼底病杂志, 2018, 34(5): 467-470. doi: 10.3760/cma.j.issn.1005-1015.2018.05.011 复制

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