摘要
目的观察早产儿视网膜病变（ROP）激光光凝辅助玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab（商品名Avastin）治疗的临床疗效。方法接受玻璃体腔注射bevacizumab治疗的ROP患儿17例31只眼纳入研究。其中，男性10例18只眼，女性7例13只眼，胎龄24．7～31．0周，平均胎龄（28．2±1．9）周，出生体重750～1600g，平均出生体重（1150±263）g。所有患儿散瞳后行双目间接检眼镜和二代广角数码视网膜成像系统（RetCamⅡ）眼底检查，其中，阈值期ROP3例4只眼；阈值前期1型ROP1例2只眼；急进性后部型早产儿视网膜病变13例25只眼。治疗指征包括瞳孔不能散大或屈光间质混浊不能进行激光光凝和激光光凝治疗后病变不能控制者。31只眼中，激光光凝辅助玻璃体腔注射bevacizumab治疗（联合治疗）者25只眼，单纯玻璃体腔注射bevacizumab者6只眼。治疗后随访1.4～40．8个月，平均随访时间（20．8＋13．2）个月。观察ROP病变是否完全控制和视网膜不良结构的发生以及与治疗相关的并发症。结果31只眼中，治疗后病变完全控制27只眼，占87．%；治疗后新生血管继续发展引起牵引性视网膜脱离2只眼，占6．5％。单纯玻璃体腔注射bevacizumab后病变继续发展，最终发生牵引性视网膜脱离者2只眼，占6．5％。发生牵引性视网膜脱离的2只眼中，经玻璃体视网膜手术治疗后，视网膜复位，后极部视网膜结构恢复正常1只眼；最终形成后极部视网膜局限性牵拉1只眼。治疗中和治疗后所有患儿全身情况良好，未见全身药物不良反应，未发生眼内感染，未出现角膜烧伤、白内障、眼前段缺血等并发症。结论玻璃体腔注射bevacizumab辅助激光光凝治疗ROP，在观察期内表现出较好的临床治疗效果；未发现与治疗相关的并发症。
Objective To observe the application and effectiveness of bevacizumab intravitreal injection as adjunctive treatment for laser coagulation to treat retinopathy of prematurity （ROP）. Methods From March 2008 to October 2010, 17 infants （31 eyes） with ROP received bevacizumab intravitreal injection and were analyzed. Ten infants were male （18 eyes） and 7 were female （13 eyes）. Their gestational age was from 24.7 to 31.0 weeks, with a mean of （28.2±1.9） weeks. Their birth weight was from 750 to 1600 grams, with a mean of （115_± 264） grams. The indications for treatment included poor papillary dilation and refractive media opacity precluding complete laser coagulation and that ROP could not be controlled after complete laser coagulation treatment. The duration of follow-up was 1.4 to 40.8 months, with a mean of （20.8±13.2） months. It was noted whether the diseases were completely controlled or not, unfavourable structural outcome occurred or not and if there were complications regarding treatment. Results During the follow-up of all 31 eyes, ROP of 27 eyes （87.0%） was controlled by bevacizumab intravitreal injection as adjunctive treatment for laser coagulation. Increasing neovascularization and traction retinal detachment occurred in 2 eyes （6.5 % ）. These 2 eyes underwent vitreoretinal surgery. The posterior retinal structure returned to normal in 1 eye and posterior vitreoretinal traction occurred in 1 eye. After bevaeizumab intravitreal injection ROP continued progressing and traction retina detachment occurred in 2 eyes. The overall health of this infant remained good during and after operation. No systemic adverse drug reactions were found. No endophthalmitis occurred. No ocular complications such as corneal burn, cataract, and anterior segmental ischemia were found. Conclusions During the follow-up, the effectiveness of bevacizumab intravitreal injection as adjunctive treatment for laser coagulation to treat ROP was positive. No complications regarding the treatment were found.
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2012年第1期18-21,共4页
Chinese Journal of Ocular Fundus Diseases
基金
基金项目：深圳市科技局项目（200902123）
