抗血管内皮生长因子药物与激光光凝治疗早产儿视网膜病变长期随访的眼底结构与视功能预后比较  

Comparison of visual function and fundus structure outcomes in long-term follow-up of retinopathy of prematurity undergoing anti-vascular endothelial growth factor agents and laser treatment

作　　者：金恩忠[1] 尹虹[1] 王宗沂 姚璐 赵明威[1] Jin Enzhong;Yin Hong;Wang Zongyi;Yao Lu;Zhao Mingwei(Department of Ophthalmology,Peking University People's Hospital,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases,College of Optometry,Peking University Health Science Center,Beijing 100044,China;Department of Ophthalmology,Air Force Medical University,Air Force Medical Center,Beijing 100142,China)

机构地区：[1]北京大学人民医院眼科,眼病与视光医学研究所,视网膜脉络膜疾病诊治研究北京市重点实验室北京大学医学部眼视光学院,北京100044 [2]空军特色医学中心眼科,北京100142

出　　处：《中华眼底病杂志》2022年第7期546-550,共5页Chinese Journal of Ocular Fundus Diseases

基　　金：国家重点研发计划(2020YFC2008200)。

摘　　要：目的对比观察抗血管内皮生长因子(VEGF)药物和激光光凝治疗早产儿视网膜病变(ROP)长期随访的视功能和眼底结构预后差异。方法回顾性病例对照研究。2010年1月至2021年12月于北京大学人民医院眼科首诊且随访时间≥5年的ROP患儿35例63只眼纳入研究。其中,男性21例36只眼,女性14例27只眼;出生胎龄(GA)(29.30±1.77)周。急进型ROP(A-ROP)12只眼;阈值前1型ROP 51只眼。均未发生视网膜脱离。所有患眼仅接受单一抗VEGF药物或激光光凝治疗,并据此分为抗VEGF治疗组、激光治疗组,分别为20例35只眼、15例28只眼。两组患儿GA、出生体重、首次接受治疗时矫正胎龄比较,差异均无统计学意义(P=0.844、0.859、0.694);A-ROP、阈值前1型ROP眼数比较,差异有统计学意义(P=0.005)。随访期间所有患眼均行最佳矫正视力(BCVA)、屈光状态、视野、光相干断层扫描(OCT)、荧光素眼底血管造影(FFA)检查。BCVA检查采用国际标准小数视力表进行,统计时换算为最小分辨角对数(logMAR)视力。屈光度以等效球镜度(SE)表示。对比观察治疗后5年时两组患眼BCVA、屈光状态、视野缺损情况、黄斑中心凹视网膜厚度(CFT)、中心凹下脉络膜厚度(SFCT)和FFA周边视网膜异常情况。组间计量资料比较采用t检验或非参数检验;计数资料比较采用χ^(2)检验。结果治疗后5年,抗VEGF治疗组患眼周边可见视网膜无血管区,大小为(2.32±1.84)个视盘直径,其中周边无血管区交界处存在荧光素渗漏1只眼;激光治疗组患眼周边视网膜可见陈旧光凝斑,未见荧光素渗漏。抗VEGF治疗组、激光治疗组患眼logMAR BCVA分别为0.15(0.00,0.20)、0.10(0.00,0.16);SE分别为0.50(-1.25,1.31)、0.38(-4.25,1.75)D;视野平均缺损(MD)值分别为2.70(1.20,4.80)、4.25(2.83,6.98)dB;CFT、SFCT分别为(225.00±29.31)、(287.18±68.56)μm和(237.17±32.81)、(279.79±43.61)μm。两组患眼logMAR BCVA、CFT、SFCT比较,差异无统�Objective To investigate the prognosis and differences of visual function and fundus structure in retinopathy of prematurity(ROP)undergoing anti-vascular endothelial growth factor agents(VEGF)or laser photocoagulation treatment with long-term follow-up.Methods Retrospective case control series.From January 2010 to December 2021,A total of 35 children(63 eyes)with ROP who were first diagnosed in Department of Ophthalmology,Peking University People's Hospital and followed up for as long as 5 years were included.Among them,21 males(36 eyes)and 15 females(27 eyes)were enrolled.The average gestational age(GA)of the children at birth was 29.30±1.77 weeks.Among the included 12 aggressive ROP(A-ROP)eyes and 51 pre-threshold type 1 ROP eyes,no retinal detachment occurred.Each eye received only intravitreal injection of anti-VEGF agents or laser monotherapy after diagnosis,and divided into anti-VEGF group or laser group according to the treatment.Thirty-five eyes of 20 infants were included in the anti-VEGF group and 28 eyes of 15 infants were included in the laser group.GA,birth weight(BW)and postmenstrual age receiving first treatment were compared and no significant difference between the two groups was defined(P=0.844,0.859,0.694).The number of A-ROP,pre-threshold type 1 ROP eyes were also compared,and statistically significance can be defined(P=0.005).During the follow-up period,best corrected visual acuity(BCVA),refractive status,visual field,optical coherence tomography(OCT)and fluorescein fundus angiography(FFA)were performed.The BCVA examination was carried out using the international standard decimal visual acuity chart,which was converted into the logarithm of the minimum angle of resolution(logMAR)visual acuity for statistics.Refractive status was calculated as spherical equivalent(SE).Comparative observation of 5-year outcomes including BW,GA,fundus examination at the initial diagnosis,and BCVA,refractive status,visual field defect,central foveal thickness(CFT),subfoveal choroidal thickness(SFCT)and abnormali

关 键 词：早产儿视网膜病变 血管生成抑制剂 激光凝固术 视野 视力预后 

分 类 号：R722.6[医药卫生—儿科] R774.1[医药卫生—临床医学]