激光光凝治疗早产儿视网膜病变的疗效分析  

Analysis on outcomes of laser photocoagulation for retinopathy of prematurity

作　　者：李曼红[1] 张自峰[1] 王雨生[1] 王静[1] 王晓婕[1] 樊静[1] 李树志 张志红 

机构地区：[1]第四军医大学西京医院眼科全军眼科研究所,西安710032 [2]麻醉科 [3]儿科

出　　处：《中华眼底病杂志》2014年第1期24-27,共4页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金（8127J014）

摘　　要：目的观察激光光凝治疗早产儿视网膜病变（ROP）的临床效果。方法临床确诊为阈值前I型和阈值期的ROP患儿64例127只眼纳入研究。其中，阈值前I型ROP15例30只眼，占患眼的23．6％；阈值期ROP49例97只眼，占患眼的76．4％。所有患儿均于确诊后72h内在全身麻醉状态下行间接检眼镜引导的532nm或810nm激光光凝治疗。阈值前I型ROP15例30只眼中，行532nm激光光凝治疗6例12只眼，行8i0nm激光光凝治疗9例18只眼。阈值期ROP49例97只眼中，行532nm激光光凝治疗37例73只眼，行810nm激光光凝治疗12例24只眼。治疗后随访时间12～36个月，平均随访时间18．4个月。观察患儿病变退化情况。以1次激光光凝治愈率、重复治疗率、不良预后发生率、全身及局部并发症的发生情况为疗效观察指标，对比分析阈值前I型与阈值ROP，以及532nm与810nm激光光凝治疗的效果差异。结果127只眼中，附加病变消失、嵴消退、病变完全退化125只眼，占98．4％；颞侧周边部残存膜状牵拉、视网膜廊管颞侧牵拉移位2只眼，占1．6％。未出现进展为4期或5期严重不良预后者。经1次激光光凝治疗病变完全退化者118只眼，占92．9％；经2～3次激光光凝治疗病变完全退化者6只眼，占4．7％；因近周边部病变较重，激光光凝反应欠佳，行冷冻治疗者3只眼，占2．4％。64例127只眼中，发生麻醉意外l例，占患儿的1．6％；出现结膜下出血12只跟，占患眼的9．4％；发生白内障1只眼，占患眼的0．8％。经532nm或810nm激光光凝治疗阈值前I型和阈值期ROP的治疗效果相当，差异无统计学意义（P〉0．05）。但需要重复激光光凝治疗、附加冷冻治疗、出现不良预后及严重并发症者主要出现在阈值期532nm激光光凝治疗的患儿中。结论激光光凝可有效治疗阈值前I型和阈值期ROP。Objective To observe clinical outcomes of laser photocoagulation on retinopathy of prematurity （R（）P）. Methods Clinical data of 64 cases of ROP infants （127 eyes） were studied retrospectively. Fifteen infants （30 eyes） were diagnosed of pre-threshold ROP （type I , 23.6~） and 49 cases （97 eyes） of threshold ROP （76.4%o）. All the eyes underwent photocoagulation through binocular indirect ophthalmoscope （532 nm or 810 nm） within 72 hours after the confirmation ROP. In all the 15 cases （30 eyes） of pre-threshold ROP （type I ）, 6 of them （12 eyes） were photocoagulated by laser of 532 nm, and the other 9 ones （18 eyes） were treated with 810 nm. In 49 threshold ROP infants （97 eyes）, 37 cases （73 eyes） and 12 ones （24 eyes） were treated with laser of 532 nm or 810 nm respectively. All the infants were followed up 12 - 36 months （ 18.4 months） since photocoagulation to investigate regression of ROP. All the data of ROP infants photocoagulated, such as recovery rate of one-time photocoagulation, repeat rate, unfavorable outcomes, and complications, were analyzed statistically according to the severity of ROP and wave length of laser employed. Results In all the 127 photocoagulation treated eyes, R（）P regressed completely in 125 eyes （98.40//00）, temporal retinal traction remained in 2 eyes （1.6~）, and no retinal detachment was found. ROP regressed completely in 118 eyes （92.9~） after one-time photocoagulation, recovered totally in 6 eyes （4.7 %） after repeating photocoagulation 2 - 3 times, and resorted to cryotherapy in 3 eyes （2.4%）. Subconjunctiva hemorrhage, found in 12 eyes （9.40/oo）, was the most common complication. During photocoagulation, anesthetic accident occurred in 1 infant （1.6~）, and 1 eye developed cataract （0.8~）. It was suggested from statistical analysis that there was no significant difference on efficiency or safety between pre threshold （type I ） and threshold R（）P photocoagulated by laser of

关 键 词：早产儿视网膜病 治疗 激光凝固术 

分 类 号：R774.1[医药卫生—眼科] R779.7[医药卫生—临床医学]