早产儿视网膜病变的临床分析

目的 观察早产儿视网膜病变(ROP)发生发展特点、危险因素及冷冻治疗疗效，探讨其合 理的筛查时机及治疗模式。方法 采用间接检眼镜合并巩膜压迫器加压 的方法对829例胎龄 ≤35周，体重≤2000g的早产、低体重儿进行ROP筛查；对32例阈值前病变Ⅰ型及阈值 病变患 儿行视网膜冷冻手术治疗。手术后随访3~16个月，以附加(plus)病变消退，血管嵴消退，冷冻斑形成，玻璃体视网膜出血吸收及无视网膜不良结构出现作为病情控制指标；若有病变遗漏区、血管嵴发展或附加病变不消退甚至加剧者则再次冷冻；若玻璃体积血不吸收，病情仍进展，发展 为视网膜皱 襞或脱离者则行玻璃体切割手术。结果 发现ROP86例172只眼。ROP各组与未发生ROP组吸氧时 间有显著性差异；出生体重≤1000 g、1001~1500 g、1501~2000 g的早产儿ROP发病比例 分别为69.56%、16.38%、4.14%；出生胎龄≤30周、31~32周、33~35周的早产儿ROP发病 比例分别为37.14%、10.43%、2.91%；单生子早产儿中ROP患病率为7.52%，双生子及 多生子早产儿中ROP患病率为20.22%。32例接受视网膜冷冻手术治疗的患儿，30例病情控制 满意, 2例病情发展为视网膜脱离，伴有后部附加病变，周边视网膜出血。32周内发病患儿 冷冻手术成功机 率高。 结论吸氧时间长、出生体重≤1000 g，胎龄≤30周ROP发病 风险显著增高，建议加强筛查。32周内发病或伴后部附加病变、周边视网膜出血的ROP患儿要严密随访；阈值前病变Ⅰ型及阈值病变行视网膜冷冻手术效果满意且安全。

Clinical analysis of retinopathy of prematurity

Objectives To observe the characteristics of occurrence a nd progres s of retinopathy of prematurity (ROP) in premature infants and search the reason able ROP screening time and therapeutic methods.〓〖WTHZ〗Methods〓〖WTBZ〗ROP s creening was perf ormed on 829 infants, with the gestational age≤35 weeks and the birth weight≤ 2000 g, by indirect ophthalmoscopy combined with scleral pressurizing implement. Thirty two infants with pre threshold type I and threshold ROP underwent cryot he rapy. The follow up duration after the operation was 3 16 months, and the crit er ia of the control of the diseases included: alleviation of the plus disease, all eviation of the vascular ridge, formation of the cryo spots, absorption of vitr e oretinal hemorrhage, and non bad retinal structure. If the disease was not contr olled, re cryotherapy or vitrectomy would be carried out.〓〖WTHZ〗Results〓〖W TBZ〗ROP was fou nd in 86 infants (172 eyes). The difference of oxygen duration time among ROP g roups and non ROP group was significant; the occurrence rate of ROP in the infa n ts with the birth weight≤1000 g, 1001 1500 g and 1501 2000 g was 6956%, 16 38% , and 414%, respectively; the occurrence rate of ROP in the infants with the g estat ional age≤30 weeks, 31 32 weeks, and 33 35 weeks was 37.14%, 10.43%, and 2.91 %, respectively; the occurrence rate of ROP in single embryo infants group and mul t iple embryo infants group was 7.52% and 20.22%, respectively. Favorable outcom e was observed in 30 out of 32 infants who had undergone cryotherapy; 2 infants d eveloped retinal detachment with plus disease and peripheral retinal hemorrhage. The sccess rate of cryotherapy is high in the infants with the gestational age <32 weeks.〓〖WTHZ〗Conclusions〓〖WTBZ〗The ROP incidence rate is higher in the infants with lo ng oxygen breathing duration, birth weigh≤1000 g, and gestational age ≤ 32 we ek infants, which should be screened carefully. The infants having ROP onset within 32 weeks, with plus disease, and peripheral retinal hemorrhage should be follow ed up closely. The prognosis of cryotherapy for type I pre threshold and thresh old ROP is good and the operation is safe.