摘要
目的 观察玻璃体腔注射雷珠单抗治疗早产儿视网膜病变（ROP）的疗效及安全性.方法 回顾性病例研究.临床检查确诊为阈值前1型和阈值病变并首次接受玻璃体腔注射雷珠单抗（IVR）治疗的连续性ROP患儿85例1 51只眼纳入研究.所有患儿均采用间接检眼镜或儿童数字化广域成像系统行眼底检查及眼底摄像.视网膜病变均位于Ⅰ、Ⅱ区,同时伴有附加病变.151只眼中,Ⅰ区病变67只眼,占44.4％;Ⅱ区病变84只眼,占55.6％.Ⅰ、Ⅱ区病变患儿平均出生体重分别为（1438.6±334.5）、（1465.3±340.2）g,孕周分别为（30.1±2.2）、（30.0±2.3）周,治疗时矫正胎龄分别为（37.0±2.4）、（37.7±2.6）周,差异均无统计学意义（P＞0.05）.首次IVR治疗时玻璃体腔注射10 mg/ml的雷珠单抗0.025 ml（含雷珠单抗0.25 mg）.治疗后平均随访时间（4.9±3.3）个月.复查周期为1～3周,直至观察到视网膜继续血管化.若治疗后2周ROP无好转或恶化,行视网膜激光光凝治疗;进展至ROP 4期则行玻璃体切割手术.观察ROP消退以及与IVR治疗相关的眼部和全身不良反应发生情况.ROP未消退与出生体重、孕周、治疗时矫正胎龄的相关性行logistic回归分析.结果 首次IVR治疗后,ROP消退120只眼,占79.5％.其中Ⅰ、Ⅱ区病变者分别为55、65只眼.末消退或恶化31只眼,占20.5％.其中Ⅰ、Ⅱ区病变者分别为12、1 9只眼.31只眼中,行视网膜激光光凝治疗26只眼,玻璃体切割手术5只眼.首次IVR治疗后ROP消退的120只眼中,随访期间ROP复发50只眼,占41.7％.再次IVR治疗14只眼,视网膜激光光凝36只眼.Logistic回归分析结果显示,ROP未消退与出生体重、孕周,ROP分区无关（P＞0.05）.IVR治疗后出现玻璃体积血和视网膜前出血3只眼,未干预自行吸收.随访期间和末次随访时,未见与治疗方式和药物相关的其他眼部并发症和全身不良反应发生.结论 IVR治疗Ⅰ、Ⅱ区ROP疗效较好,但ROP复发率较高.未见明确与药物有关的局部和全身并发症.
Objective To evaluate the effectiveness and complications associated with the use of ranibizumab in the treatment of Zone Ⅰ and Zone Ⅱ retinopathy of prematurity （ROP）.Methods Data from patients of ROP who had received intravitreal ranibizumab （IVR） injections in Peking University People＇s Hospital for the treatment of ROP from July 2012 to December 2013 were collected.In total,151 eyes from 85 patients （56 male and 29 female） were analyzed.The mean birth weight was （1438.6±334.5） g （range：790-2280 g）,mean gestational age was （30.1±2.0） weeks （range：25-37 weeks）,mean age at the time of intervention was （37.0 ±6.2） gestational weeks （range：32-45 weeks）,mean follow-up was （4.9±3.3） months （range：1.4-20.8 months）.The main outcome measures were the regression of ROP and the complications that were associated with the IVR injections.Results After receiving IVR injections,120 eyes （79.5％） exhibited ROP regression after single injection.Twenty-six eyes （17.2％） required additional laser treatment for ROP regression after the absence of a positive response to the IVR injections.Five eyes （3％） progressed to stage 4 ROP and required vitrectomy to reattach the retinas.Fifty of 120 eyes which were regressed after single IVR had recurrence of ROP and need additional laser or additional IVR.All of the eyes （100.0％） had attached retinas after the various treatments that they received.No notable systemic complications related to the IVR injections were observed.Conclusions IVR an effective and well tolerated method to treat Zone Ⅰ and Zone Ⅱ ROP.Recurrence of ROP is common and long-term follow up may be needed.
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2015年第1期6-9,共4页
Chinese Journal of Ocular Fundus Diseases
