玻璃体腔注射雷珠单抗联合激光光凝治疗急进性后部型早产儿视网膜病变
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摘要
目的:观察玻璃体腔注射雷珠单抗联合激光光凝治疗急进性后部型早产儿视网膜病变(AP-ROP)的安全性和有效性.方法:对26例确诊为AP-ROP的早产儿视网膜病变患儿的52只眼行玻璃体腔注射雷珠单抗联合激光光凝治疗,观察视网膜病变的改变疗效.结果:玻璃体内注射雷珠单抗后,因附加病变持续不退超过1周接受激光光凝治疗12只眼,因出现新增嵴样病变或纤维增生膜加重接受激光光凝治疗40只眼.二者联合治疗后,42只眼视网膜血管网或嵴消退,其他病变消退,视网膜平坦.仍有6只眼病情未控制,病变处纤维增生明显,再次给予激光光凝治疗.另有4只眼考虑复发,再次行玻璃体腔注射雷珠单抗,后期复查均痊愈.结论:玻璃体腔注射雷珠单抗联合激光光凝术可能是AP-ROP较有效的治疗方式.
Objective: To observe the safety and efficacy of intravitreal injection of ranibizumab combined with laser photocoagulation in the treatment of Aggressive posterior retinopathy of prematurity( AP-ROP). Methods: A total of 52 eyes of 26 children with AP-ROP diagnosed were studied. All patients underwent intravitreal injection of ranibizumab combined with laser photocoagulation to observe the effects of retinopathy. Results: After intravitreal injection of ranibizumab,12 eyes treated with laser photocoagulation due to additional lesions continued for more than 1 week,40 eyes treated with laserphotocoagulation due to the emergence of new sputum-like lesions or fibroproliferative membrane aggravation. With the combination treatment,in 42 eyes the retinal vascular network or sputum and other lesions subsided,and the retina,and they were treated with laser photocoagulation again. There were 4eyes showing recurrence and the intravitreal injection of ranibizumab was performed again,and the eyes were cured later. Conclusion: Intravitreal injection of ranibizumab combined with laser photocoagulation may be a more effective treatment for AP-ROP.
Objective: To observe the safety and efficacy of intravitreal injection of ranibizumab combined with laser photocoagulation in the treatment of Aggressive posterior retinopathy of prematurity( AP-ROP). Methods: A total of 52 eyes of 26 children with AP-ROP diagnosed were studied. All patients underwent intravitreal injection of ranibizumab combined with laser photocoagulation to observe the effects of retinopathy. Results: After intravitreal injection of ranibizumab,12 eyes treated with laser photocoagulation due to additional lesions continued for more than 1 week,40 eyes treated with laserphotocoagulation due to the emergence of new sputum-like lesions or fibroproliferative membrane aggravation. With the combination treatment,in 42 eyes the retinal vascular network or sputum and other lesions subsided,and the retina,and they were treated with laser photocoagulation again. There were 4eyes showing recurrence and the intravitreal injection of ranibizumab was performed again,and the eyes were cured later. Conclusion: Intravitreal injection of ranibizumab combined with laser photocoagulation may be a more effective treatment for AP-ROP.
引文
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[5]李秋平,周细中,章晟,等.2185例早产儿视网膜病变筛查结果及其高危因素[J].中华围产医学杂志,2013,16(2):71-75.LI Q P,ZHOU X Z,ZHANG S,et al.Incidence and risk factors of retinopathy of prematurity---analysis of 2185premature infants[J].Chinese Journal of Perinatal Medicine,2013,16(2):71-75.
[6]林冰纯,连朝辉.小于28周超早产儿的早产儿视网膜病临床特征及疗效分析[J].中华临床医师杂志,2015,9(10):1862-1866.LIN B C,LIAN C H.Analysis on the risk factors and treatment outcomes of retinopathy of prematurity in extremely preterm infants born before 28 weeks of gestation[J].Chinese Journal of Clinicians(Electronic Edition),2015,9(10):1862-1866.
[7]毕明超,李松鹤,陆成伟,等.吉林省早产儿视网膜病变筛查结果分析[J].中国实用眼科杂志,2014,32(7):909-913.BI M C,LI S H,LU C W,et al.Analysis on screening results of prematurity retinopathy of preterm infants in Jilin Province[J].Chinese Journal of Practical Ophthalmology,2014,32(7):909-913.
[8]朱丽,石文静,张淑莲,等.早产儿视网膜病危险因素的前瞻性多中心队列研究[J].中华医学杂志,2011,91(25):1749-1752.ZHU L,SHI W J,ZHANG S L,et al.Evaluation of risk factors for retinopathy of prematurity[J].National Medical Journal of China,2011,91(25):1749-1752.
[9]ALAJBEGOVIC-HALIMIC J,ZVIZDIC D,ALIMANOVIC-HALILOVIC E,et al.Risk Factors for Retinopathy of Prematurity in Premature Born Children[J].Med Arch,2015,69(6):409-413.
[10]YANG C Y,LIEN R,YANG P H,et al.Analysis of incidence and risk factors of retinopathy of prematurity among very-low-birth-weight infants in North Taiwan[J].Pediatr Neonatol,2011,52(6):321-326.
[11]LIU Q,YIN Z Q,KE N,et al.Incidence of retinopathy of prematurity in southwestern China and analysis of risk factors[J].Med Sci Monit,2014,20(14):1442-1451.
[12]MAINI B,CHELLANI H,ARYA S,et al.Retinopathy of prematurity:risk factors and role of antenatal betamethasone in Indian preterm newborn babies[J].JClin Neonatol,2014,3(1):20-24.
[13]SCHUMANN R F,BARBOSA A D,VALETE C O.Incidence and severity of retinopathy of prematurity and its association with morbidity and treatments instituted at Hospital Antonio Pedro from Universiade Federal Fluminense,between 2003 and 2005.Arq Bras Oflalmol,2010,73(1):47-51.
[14]早产儿视网膜病变多中心调查协作组.中国大陆早产儿视网膜病变临床特点和眼底病变的多中心调查[J].中国循证儿科杂志,2015,10(3):161-165.COLLABORATION GROUP OF RETINOPATHY OFPREMATURE INFANTS.Multicenter survey on the clinical features and fundus lesions of retinopathy in premature infants in mainland China[J].Chinese Journal of Evidence Based Pediatrics,2015,10(3):161-165.
[15]THOMAS K,SHAH P S,CANNING R,et al.Retinopathyof prematurity:Risk factors and variability in Canadian neonatal intensivecare units[J].J Neonatal Perinatal Med,2015,24,8(3):207-214.
[16]王平,罗俊,何容,等.多生子早产儿视网膜病变的临床特点[J].中华临床医师杂志(电子版),2012,6(4):932-934.WANG P,LUO J,HE R,et al.Clinic analysis of retinopathy of prematurity in multiple infants[J].Chinese Journal of Clinicians(Electronic Edition),2012,6(4):932-934.
[17]RAO R,JONSSON N J,VENTURA C,et al.Plus disease in retinopathy of prematurity:diagnostic impact of field of view[J].Retina,2012,32(6):1148-1155.
[18]黄欣,单海冬,常青,等.急进性后部型早产儿视网膜病变的临床特征及治疗[J].中华眼底病杂志,2012,28(1):33-36.HUANG X,SHAN H D,CHANG Q,et al.Clinical characteristics and treatment outcomes of aggressive posterior retinopathy of prematurity[J].Chinese Journal of Ocular Fundus Diseases,2012,28(1):33-36.
[19]李松鹤,高玉先,董宇.急进性后部型早产儿视网膜病变激光光凝治疗疗效观察[J].中华眼底病杂志,2012,28(1):37-40.LI S H,GAO Y X,DONG Y.Clinical characteristics and treatment of aggressive posterior retinopathy of prematurity in 14 patients[J].Chinese Journal of Ocular Fundus Diseases,2012,28(1):37-40.
[20]SHAH P K,RAMAKRISHNAN M,SADAT B,et al.Long term refractive and structural outcome following laser treatment for zone 1 aggressive posterior retinopathy of prematurity[J].Oman J Ophthalmol,2014,7(3):116-119.
[21]胡兰香,项道满,宋生芳.早产儿视网膜病变激光光凝与玻璃体腔注射Bevacizumab治疗后屈光状态的对比观察[J].中国实用眼科杂志,2015,33(7):731-734.HU L X,XIANG D M,SONG S F.Refractive status in retinopathy of prematurity treated with laser photocoagulation and intravitreal bevacizumab injection[J].Chinese Journal of Practical Ophthalmology,2015,33(7):731-734.
[22]HARTNETT M E,PENN J S.Mechanisms and management of retinopathy of prematurity[J].N Engl JMed,2012,367:2515-2526.
[23]田汝银,张国明,唐松,等.玻璃体腔注射雷珠单克隆抗体治疗急进型后极部早产儿视网膜病变的临床疗效观察[J].中华眼科杂志,2015,51(11):822-825.TIAN R Y,ZHANG G M,TANG S,et al.The clinical study on intravitreous injection of ranibizumab for aggressive posterior retinopathy of prematurity[J].Chinese Journal of Ophthalmology,2015,51(11):822-825.
[24]许宇,张琦,季迅达,等.玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab联合激光光凝治疗急进性后部型早产儿视网膜病变的疗效观察[J].中华眼底病杂志,2014,30(1):28-32.XU Y,ZHANG Q,JI X D,et al.Combination of intravitreal injection of ranibizumab and laser photocoagulation for the treatment of aggressive posterior retinopathy of prematurity[J].Chinese Journal of Ocular Fundus Diseases,2014,30(1):28-32.
[25]刘梅.急进性后部型早产儿视网膜病变雷珠单抗疗效观察[J].中华眼外伤职业眼病杂志,2017,39(7):534-537.LIU M.Observation on the efficacy of intravitreal Ranibizumab for the treatment of aggressive posterior retinopathy of prematurity[J].Chinese Journal of Ocular Trauma and Occupational Eye Disease,2017,39(7):534-537.
[26]孙先桃,孙爽,王惠,等.激光光凝、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):14-17.SUN X T,SUN S,WANG H,et al.The efficacy of laser photocoagulation and intravitreal ranibizumab treatment of retinopathy of premature[J].Chinese Journal of Ocular Fundus Diseases,2015,31(1):14-17.
[2]INTERNATIONAL COMMITTEE FOR THECLASSIFICATION OF RETINOPATHY OFPREMATURITY.The international classification of retinopathy of prematurity revisited[J].Arch Ophthalmol,2005,123(7):991-999.
[3]中华医学会眼科学分会眼底病学组.中国早产儿视网膜病变筛查指南(2014年)[J].中华眼科杂志,2014,50(12):933-935.CHINESE MEDICAL ASSOCIATION OPHTHALMOLOGYBRANCH FUNDUS STUDY GROUP.Guidelines for screening retinopathy of premature infants in China(2014)[J].Chin J Ophthalmol,2014,50(12):933-935.
[4]陈宜,冯婧,孟宪芬,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):6-9.CHEN Y,FENG J,MENG X F,et al.Effects of ranibizumab in zoneⅠand zoneⅡretinopathy of prematurity patients[J].Chinese Journal of Ocular Fundus Diseases,2015,31(1):6-9.
[5]李秋平,周细中,章晟,等.2185例早产儿视网膜病变筛查结果及其高危因素[J].中华围产医学杂志,2013,16(2):71-75.LI Q P,ZHOU X Z,ZHANG S,et al.Incidence and risk factors of retinopathy of prematurity---analysis of 2185premature infants[J].Chinese Journal of Perinatal Medicine,2013,16(2):71-75.
[6]林冰纯,连朝辉.小于28周超早产儿的早产儿视网膜病临床特征及疗效分析[J].中华临床医师杂志,2015,9(10):1862-1866.LIN B C,LIAN C H.Analysis on the risk factors and treatment outcomes of retinopathy of prematurity in extremely preterm infants born before 28 weeks of gestation[J].Chinese Journal of Clinicians(Electronic Edition),2015,9(10):1862-1866.
[7]毕明超,李松鹤,陆成伟,等.吉林省早产儿视网膜病变筛查结果分析[J].中国实用眼科杂志,2014,32(7):909-913.BI M C,LI S H,LU C W,et al.Analysis on screening results of prematurity retinopathy of preterm infants in Jilin Province[J].Chinese Journal of Practical Ophthalmology,2014,32(7):909-913.
[8]朱丽,石文静,张淑莲,等.早产儿视网膜病危险因素的前瞻性多中心队列研究[J].中华医学杂志,2011,91(25):1749-1752.ZHU L,SHI W J,ZHANG S L,et al.Evaluation of risk factors for retinopathy of prematurity[J].National Medical Journal of China,2011,91(25):1749-1752.
[9]ALAJBEGOVIC-HALIMIC J,ZVIZDIC D,ALIMANOVIC-HALILOVIC E,et al.Risk Factors for Retinopathy of Prematurity in Premature Born Children[J].Med Arch,2015,69(6):409-413.
[10]YANG C Y,LIEN R,YANG P H,et al.Analysis of incidence and risk factors of retinopathy of prematurity among very-low-birth-weight infants in North Taiwan[J].Pediatr Neonatol,2011,52(6):321-326.
[11]LIU Q,YIN Z Q,KE N,et al.Incidence of retinopathy of prematurity in southwestern China and analysis of risk factors[J].Med Sci Monit,2014,20(14):1442-1451.
[12]MAINI B,CHELLANI H,ARYA S,et al.Retinopathy of prematurity:risk factors and role of antenatal betamethasone in Indian preterm newborn babies[J].JClin Neonatol,2014,3(1):20-24.
[13]SCHUMANN R F,BARBOSA A D,VALETE C O.Incidence and severity of retinopathy of prematurity and its association with morbidity and treatments instituted at Hospital Antonio Pedro from Universiade Federal Fluminense,between 2003 and 2005.Arq Bras Oflalmol,2010,73(1):47-51.
[14]早产儿视网膜病变多中心调查协作组.中国大陆早产儿视网膜病变临床特点和眼底病变的多中心调查[J].中国循证儿科杂志,2015,10(3):161-165.COLLABORATION GROUP OF RETINOPATHY OFPREMATURE INFANTS.Multicenter survey on the clinical features and fundus lesions of retinopathy in premature infants in mainland China[J].Chinese Journal of Evidence Based Pediatrics,2015,10(3):161-165.
[15]THOMAS K,SHAH P S,CANNING R,et al.Retinopathyof prematurity:Risk factors and variability in Canadian neonatal intensivecare units[J].J Neonatal Perinatal Med,2015,24,8(3):207-214.
[16]王平,罗俊,何容,等.多生子早产儿视网膜病变的临床特点[J].中华临床医师杂志(电子版),2012,6(4):932-934.WANG P,LUO J,HE R,et al.Clinic analysis of retinopathy of prematurity in multiple infants[J].Chinese Journal of Clinicians(Electronic Edition),2012,6(4):932-934.
[17]RAO R,JONSSON N J,VENTURA C,et al.Plus disease in retinopathy of prematurity:diagnostic impact of field of view[J].Retina,2012,32(6):1148-1155.
[18]黄欣,单海冬,常青,等.急进性后部型早产儿视网膜病变的临床特征及治疗[J].中华眼底病杂志,2012,28(1):33-36.HUANG X,SHAN H D,CHANG Q,et al.Clinical characteristics and treatment outcomes of aggressive posterior retinopathy of prematurity[J].Chinese Journal of Ocular Fundus Diseases,2012,28(1):33-36.
[19]李松鹤,高玉先,董宇.急进性后部型早产儿视网膜病变激光光凝治疗疗效观察[J].中华眼底病杂志,2012,28(1):37-40.LI S H,GAO Y X,DONG Y.Clinical characteristics and treatment of aggressive posterior retinopathy of prematurity in 14 patients[J].Chinese Journal of Ocular Fundus Diseases,2012,28(1):37-40.
[20]SHAH P K,RAMAKRISHNAN M,SADAT B,et al.Long term refractive and structural outcome following laser treatment for zone 1 aggressive posterior retinopathy of prematurity[J].Oman J Ophthalmol,2014,7(3):116-119.
[21]胡兰香,项道满,宋生芳.早产儿视网膜病变激光光凝与玻璃体腔注射Bevacizumab治疗后屈光状态的对比观察[J].中国实用眼科杂志,2015,33(7):731-734.HU L X,XIANG D M,SONG S F.Refractive status in retinopathy of prematurity treated with laser photocoagulation and intravitreal bevacizumab injection[J].Chinese Journal of Practical Ophthalmology,2015,33(7):731-734.
[22]HARTNETT M E,PENN J S.Mechanisms and management of retinopathy of prematurity[J].N Engl JMed,2012,367:2515-2526.
[23]田汝银,张国明,唐松,等.玻璃体腔注射雷珠单克隆抗体治疗急进型后极部早产儿视网膜病变的临床疗效观察[J].中华眼科杂志,2015,51(11):822-825.TIAN R Y,ZHANG G M,TANG S,et al.The clinical study on intravitreous injection of ranibizumab for aggressive posterior retinopathy of prematurity[J].Chinese Journal of Ophthalmology,2015,51(11):822-825.
[24]许宇,张琦,季迅达,等.玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab联合激光光凝治疗急进性后部型早产儿视网膜病变的疗效观察[J].中华眼底病杂志,2014,30(1):28-32.XU Y,ZHANG Q,JI X D,et al.Combination of intravitreal injection of ranibizumab and laser photocoagulation for the treatment of aggressive posterior retinopathy of prematurity[J].Chinese Journal of Ocular Fundus Diseases,2014,30(1):28-32.
[25]刘梅.急进性后部型早产儿视网膜病变雷珠单抗疗效观察[J].中华眼外伤职业眼病杂志,2017,39(7):534-537.LIU M.Observation on the efficacy of intravitreal Ranibizumab for the treatment of aggressive posterior retinopathy of prematurity[J].Chinese Journal of Ocular Trauma and Occupational Eye Disease,2017,39(7):534-537.
[26]孙先桃,孙爽,王惠,等.激光光凝、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):14-17.SUN X T,SUN S,WANG H,et al.The efficacy of laser photocoagulation and intravitreal ranibizumab treatment of retinopathy of premature[J].Chinese Journal of Ocular Fundus Diseases,2015,31(1):14-17.