激光联合雷珠单抗治疗4a期早产儿视网膜病变

杨秀梅; 张惠敏; 李秋平; 王宗华; 张卯年

doi:10.3969/j.issn.2095-5227.2022.10.009

激光联合雷珠单抗治疗4a期早产儿视网膜病变

Lucentis combined with laser photocoagulation for prematurity with stage 4a plus (+) retinopathy

摘要

摘要:
背景早产儿视网膜病变(retinopathy of prematurity，ROP)是早产儿视网膜血管增生性疾病，是导致儿童盲的主要原因之一。早期多采用激光或药物治疗，发展至晚期则以手术治疗为主。
目的观察玻璃体腔注射抗血管内皮生长因子(anti-vascular endothelial growth factor，抗-VEGF)联合激光治疗4a期伴有附加病变ROP的疗效。
方法收集我中心2014年1月- 2020年12月临床检查确诊为4a期伴有附加病变ROP并首次接受玻璃体腔注射抗-VEGF联合激光治疗的连续性ROP患儿10例(12只眼)。所有患儿均采用间接检眼镜或儿童数字化广域成像系统行眼底检查及眼底摄像。患儿平均出生体质量为(1 015.00 ± 410.59) g，平均孕周为(28.30 ± 1.83)周，治疗时矫正胎龄为(41.67 ± 3.33)周，平均随访时间(868.36 ± 804.85) d。治疗时玻璃体腔注射10 mg/mL的雷珠单抗0.025 mL，1周内行激光治疗。复查周期为1 ~ 3周，直至观察到视网膜继续血管化。若治疗后病情进展行巩膜外加压或玻璃体切割术。随访期主要观察ROP消退以及与治疗相关的眼部和全身不良反应发生情况。
结果首次注药治疗后，附加病变均消退，病变嵴明显缩小，血管大部分消退，激光将无血管区及嵴前包绕后，随访期间9眼病情稳定无进展，3眼接受玻璃体切除手术。
结论抗-VEGF联合激光治疗可有效稳定4a期伴有附加病变ROP病情，为进一步治疗争取时间窗。

Abstract:
Background Retinopathy of prematurity (ROP) is a retinal vasoproliferative disorder that affects exclusively in premature infants and is one of the main reasons for blindness in children worldwide. Laser or drug treatment is often used in the early stage, and surgery is mainly used in the late stage.
Objective To observe the efficacy of intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) combined with laser in treatment of stage 4a plus (+) retinopathy of prematurity (ROP).
Methods Totally 10 consecutive ROP patients (12 eyes) in 4a plus (+) who received initial anti-VEGF combined laser treatment in our hospital from January 2014 to December 2020 were collected in our study. All patients were examined by indirect ophthalmoscopy and documented with fundus photography using a RetCam II to evaluate the vascular activity. The mean birth weight was (1015.00 ± 410.59) g, with the mean gestational age of (28.30 ± 1.83) weeks. The mean post menstrual age at intervention was (41.67 ± 3.33) weeks, and the mean follow-up period was (868.36 ± 804.85) days. All treated eyes received laser photocoagulation within one week after 0.025mL of Ranibizumab (10 mg/mL) was intravitreally injected. Patients were followed up every 1 to 3 weeks until the retinal vascular fully developed. When the disease deteriorated during the follow-up period, surgery was needed. The main outcome observation were the regression of ROP and the local and systemic complications associated with the treatment.
Results After receiving the treatment, all eyes exhibited decreased vascular activity and partial recession of retinal ridge and retinal neovascularization. At the final visit, 9 eyes became stable and 3 eyes deteriorated and further surgery was performed. No local or systemic adverse events associated with the treatment were observed during the following period.
Conclusion Anti-VEGF combined with laser treatment is an effective and well-tolerated method for 4a plus (+) ROP, which can preserve the eyesight for more advanced ROP patients.

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