早产儿视网膜病变玻璃体腔注射雷珠单抗治疗后病变复活的临床分析及疗效观察  

Clinical analysis and curative effect of reactivation of retinopathy of prematurity after intravitreous injection of ranibizumab

作　　者：蓝凤霞 张国明[2] 何红辉[2] 田汝银[2] 陈懿[2] 曾宪露 陈妙虹 Lan Fengxia;Zhang Guoming;He Honghui;Tian Ruyin;Chen Yi;Zeng Xianlu;Chen Miaohong(Department of Ophthalmology,Guangxi Maternal and Child Health Hospital,Nanning 530001,China;Shenzhen Eye Hospital Affiliated to Jinan University,Shenzhen 518000,China)

机构地区：[1]广西壮族自治区妇幼保健院眼科,南宁530001 [2]暨南大学附属深圳眼科医院深圳市眼科医院,深圳518000

出　　处：《中华眼底病杂志》2023年第6期471-475,共5页Chinese Journal of Ocular Fundus Diseases

基　　金：广东省高水平临床重点专科项目(SZGSP014);深圳市医学重点学科项目(SZXK038);深港联合资助项目(A类)(SGDX20190920110403741)。

摘　　要：目的观察早产儿视网膜病变(ROP)患眼玻璃体腔注射雷珠单抗(IVR)治疗后病变复活的临床特点及治疗效果。方法回顾性病例系列研究。2019年1月至2021年10月于深圳市眼科医院经IVR治疗后病变复活的ROP患儿11例21只眼纳入研究。其中,男性6例11只眼,女性5例10只眼;出生胎龄(27.6±2.2)周;出生体重(1034.6±306.5)g。首次IVR治疗时,急进型ROP(AROP)者14只眼(63.7%,14/22);阈值病变者8只眼(36.3%,8/22)。病变复活后治疗包括IVR、视网膜激光光凝(LP)或微创玻璃体切割手术(MIVS)。治疗后随访时间12~18个月。记录患儿出生胎龄、出生体重、治疗方式、治疗时矫正胎龄、治疗前后病变分期、病变复活及消退时间。观察和分析其临床特征和疗效。结果首次IVR治疗至出现病变复活的时间为(8.2±3.5)周;患儿矫正胎龄(43.62±4.08)周。21只眼中,复活时病变分期为AROP、阈值病变、阈值前病变、4期病变分别为2、4、12、3只眼。行IVR、LP、IVR+LP、IVR+MIVS治疗分别为2、13、4、2只眼。首次复活治疗后,病变消退且稳定的时间为治疗后(8.4±4.9)周。出现2次病变复活者5只眼,其中病变分期为3期、4a期、5期分别为2、1、2只眼;平均复活时间为上一次治疗后(19.3±6.0)周。其分别行LP、LP+MIVS、IVR治疗,随访期间病变消退稳定。末次随访时,21只眼中,病变完全消退者19只眼,光凝斑稳定,嵴样病变消退,无附加病变,视网膜平伏;视网膜全脱离呈“漏斗状”2只眼。结论AROP经IVR治疗后病变复活较多见;治疗后早期复活率较高;再治疗后存在2次复活可能性。Objective To observe the clinical characteristics and therapeutic effect of reactivation of retinopathy of prematurity(ROP)patients after intravitreal injection of ranibizumab(IVR).Methods A retrospective case series study.Eleven children with ROP(21 eyes)who were reactivated after IVR in Shenzhen Eye Hospital from January 2019 to October 2021 were included in the study.Among them,there were 6 males(11 eyes)and 5 females(10 eyes),with the gestational age of(27.6±2.2)weeks and birth weight of(1034.6±306.5)g.At the first IVR treatment,14 eyes(63.7%,14/22)had acute ROP(AROP),8 eyes(36.3%,8/22)had threshold lesions.Post-reactivation treatments include IVR,retinal laser photocoagulation(LP),or minimally invasive vitrectomy(MIVS).The follow-up time after treatment was 12 to 18 months.Birth gestational age,birth weight,treatment method,corrected gestational age at treatment,lesion stage before and after treatment,lesion reactivation and regression time were recorded.The clinical characteristics and efficacy were observed and analyzed.Results The time from initial IVR treatment to reactivation was(8.2±3.5)weeks.The corrected gestational age of the child was(43.62±4.08)weeks.In 21 eyes,AROP,threshold lesion,prethreshold lesion,and stage 4 lesion were in 2,4,12,and 3 eyes,respectively.The patients were treated with IVR,LP,IVR+LP,IVR+MIVS in 2,13,4 and 2 eyes,respectively.After the first reactivation treatment,the time of regression and stability was(8.4±4.9)weeks after treatment.There were 5 eyes with secondary reactivation of the lesion,and the lesion stages were stage 3,stage 4a and stage 5 in 2,1 and 2 eyes,respectively.The mean reactivation time was(19.3±6.0)weeks after the last treatment.The patients in stage 3,stage 4a and stage 5 were treated with LP,LP+MIVS and IVR,respecitively,and the lesions subsided steadily during follow-up.At the last follow-up,19 out of 21 eyes showed complete regression of the lesions,stable photocoagulation,regression of crista-like lesions,no additional lesions,and retinal leveling.

关 键 词：早产儿视网膜病变 病变复活 血管生成抑制剂 雷珠单抗 

分 类 号：R774.1[医药卫生—眼科]