玻璃体内注射雷珠单抗联合激光光凝治疗早产儿视网膜病变疗效观察
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摘要
目的观察激光光凝联合玻璃体内注射雷珠单抗治疗早产儿视网膜病变(retinopathy of prematurity,ROP)的安全性及有效性。方法对32例(64眼)ROP患儿行玻璃体内注射雷珠单抗治疗,观察附加病变、嵴、嵴上新生血管的消退情况以及周边视网膜,其中12例(24眼)附加病变、嵴及嵴上新生血管不完全消退者进行激光光凝治疗。结果 32例64眼ROP患儿中,经玻璃体内注射雷珠单抗治疗病变完全消退者20例40眼,占62.5%;12例24眼病变复发,经联合激光光凝治疗病情稳定,占37.5%。病变复发的24眼中,包括急进型后极部ROP 14眼,阈值期ROP 6眼,阈值前期ROP 4眼。所有患儿视网膜病变不同程度消退。给予玻璃体内注射雷珠单抗治疗后新生血管及出血吸收,血管继续发育至锯齿缘或病变瘢痕化。12例(24眼)病变复发者联合视网膜光凝治疗后病变完全消退。32例ROP患儿眼部及全身未见不良反应。结论玻璃体内注射雷珠单抗治疗ROP效果好,不但可以使嵴、嵴上新生血管及附加病变完全消退,而且还可使视网膜血管继续生长,对于病变不能完全消退的患儿联合视网膜激光光凝治疗后也可获得较好疗效。
Objective To evaluate the efficacy and safety of the treatment of retinopathy of premature( ROP) using laser photocoagulation( LP) and intravitreal injection ranibizumab( IVR). Methods Totally 32 infants( 64 eyes) with ROP underwent IVR,followed by observation of the regression of the plus diseases,ridges,neovascularization on the ridge and the development of peripheral retinal vessels. Besides,12 patients( 24 eyes) of 32 infants whose plus diseases,ridges and neovascularization on the ridge did not still improve continued to undergo LP. Results In the 64 eyes,the lesions completely disappeared by IVR in 40 eyes,accounting for 62.5%,and the recurrence in 24 eyes was recovered by combined laser photocoagulation,accounting for 37. 5%. Among the 24 eyes with recurrent lesions,14 eyes were aggressive posterior retinopathy of prematurity( AP-ROP),6 eyes were ROP at threshold stage,and 4 eyes were pre-threshold ROP. All infants with retinal lesions improved to some degree. Intravitreal injection of ranibizumab could approach neovascular and hemorrhagic absorption,and vascular development to serrate or scar lesions. And 24 eyes of recurrence lesions were improved after photocoagulation; no ocular or the systematic adverse reactions were observed. Conclusion Intravitreal injection of ranibizumab for the treatment of ROP can achieve satisfied outcomes; as for the infants without satisfied outcomes,retinal laser photocoagulation can be performed.
Objective To evaluate the efficacy and safety of the treatment of retinopathy of premature( ROP) using laser photocoagulation( LP) and intravitreal injection ranibizumab( IVR). Methods Totally 32 infants( 64 eyes) with ROP underwent IVR,followed by observation of the regression of the plus diseases,ridges,neovascularization on the ridge and the development of peripheral retinal vessels. Besides,12 patients( 24 eyes) of 32 infants whose plus diseases,ridges and neovascularization on the ridge did not still improve continued to undergo LP. Results In the 64 eyes,the lesions completely disappeared by IVR in 40 eyes,accounting for 62.5%,and the recurrence in 24 eyes was recovered by combined laser photocoagulation,accounting for 37. 5%. Among the 24 eyes with recurrent lesions,14 eyes were aggressive posterior retinopathy of prematurity( AP-ROP),6 eyes were ROP at threshold stage,and 4 eyes were pre-threshold ROP. All infants with retinal lesions improved to some degree. Intravitreal injection of ranibizumab could approach neovascular and hemorrhagic absorption,and vascular development to serrate or scar lesions. And 24 eyes of recurrence lesions were improved after photocoagulation; no ocular or the systematic adverse reactions were observed. Conclusion Intravitreal injection of ranibizumab for the treatment of ROP can achieve satisfied outcomes; as for the infants without satisfied outcomes,retinal laser photocoagulation can be performed.
引文
[1]LUO LL,CHEN DP,QU Y,MU DZ.Analysis of 218 cases of retinopathy of prematurity[J].Chin J Appl Clin Pediatr,2013,28(14):1058-1060.罗黎力,陈大鹏,屈艺,母得志.早产儿218例视网膜病变筛查分析[J].中华实用儿科临床杂志,2013,28(14):1058-1060.
[2]ZHANG S,LI QP,KONG XY,ZHANG XY,ZHANG YP,WANG ZZ,et al.Association of the Frizzled-4 gene polymorphism with susceptibility to retinopathy of prematurity[J].Chin J Appl Clin Pediatr,2014,29(14):1055-1059.章晟,李秋平,孔祥永,张小英,张玉佩,王自珍,等.卷曲蛋白4基因多态性与早产儿视网膜病变易感性的关系[J].中华实用儿科临床杂志,2014,29(14):1055-1059.
[3]ZHAO PQ,FEI P.Screening and treatment of retinopathy of prematurity:current status,problems and prospects in China[J].Chin J Ocul Funds Dis,2012,28(1):3-7.赵培泉,费萍.早产儿视网膜病变诊断治疗研究现状、问题及展望[J].中华眼底病杂志,2012,28(1):3-7.
[4]International Committee for the Classification of Retinopathy of Prematurity.The international classification of retinopathy of prematurity revisited[J].Arch Ophthalmol,2005,123(7):991-999.
[5]WU WC,KUO HK,YEH PT,YANG CM,LAI CC,CHEN SN.An updated study of the use of bevacizumab in the treatment of patients with prethreshold retinopathy of prematurity in Taiwan[J].Am J Ophthalmol,2013,155(1):150-158.
[6]XU Y,ZHANG Q,JI XD,CAI X,YU SY,FEI P,et al.Combination of intravitreal injection of ranibizumab and laser photocoagulation for the treatment of aggressive posterior retinopathy of prematurity[J].Chin J Ocul Funds Dis,2014,30(1):28-32.许宇,张琦,季迅达,蔡璇,虞思伊,费萍等.玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab联合激光光凝治疗急进性后部型早产儿视网膜病变的疗效观察[J].中华眼底病杂志,2014,30(1):28-32.
[7]LI XX.Characteristics and screening guidelines of retinopathy of prematurity in our country[J].Chin J Ocul Funds Dis,2004,20(6):384-386.黎晓新.我国早产儿视网膜病变特点和筛查指南[J].中华眼底病杂志,2004,20(6):384-386.
[8]LYNCH SS,CHENG CM.Bevacizumab for neocascular ocular diseases[J].Ann Pharmacother,2007,41(4):614-625.
[9]LASHKARI K,HIROSE T,YAZDANY J.Vascular endothelial growth and hepatocyte growth factor levels are differentially elevated in patients with advanced retinopathy of prematurity[J].Am Pathol,2000,156(4):1337-1344.
[10]MINTZ-HITTNER HA.Treatment of retinopathy of prematurity with vascular endothelial growth factor inhibitors[J].Early Hum Dev,2012,88(12):937-941
[11]Early Treatment for Retinopathy of Prematurity Cooperative Group.Revised indications for the treatment of retinopathy of prematurity:results of the early treatment for retinopathy of prematurity randomized trial[J].Arch Ophthalmol,2003,121(12):1684-1694.
[2]ZHANG S,LI QP,KONG XY,ZHANG XY,ZHANG YP,WANG ZZ,et al.Association of the Frizzled-4 gene polymorphism with susceptibility to retinopathy of prematurity[J].Chin J Appl Clin Pediatr,2014,29(14):1055-1059.章晟,李秋平,孔祥永,张小英,张玉佩,王自珍,等.卷曲蛋白4基因多态性与早产儿视网膜病变易感性的关系[J].中华实用儿科临床杂志,2014,29(14):1055-1059.
[3]ZHAO PQ,FEI P.Screening and treatment of retinopathy of prematurity:current status,problems and prospects in China[J].Chin J Ocul Funds Dis,2012,28(1):3-7.赵培泉,费萍.早产儿视网膜病变诊断治疗研究现状、问题及展望[J].中华眼底病杂志,2012,28(1):3-7.
[4]International Committee for the Classification of Retinopathy of Prematurity.The international classification of retinopathy of prematurity revisited[J].Arch Ophthalmol,2005,123(7):991-999.
[5]WU WC,KUO HK,YEH PT,YANG CM,LAI CC,CHEN SN.An updated study of the use of bevacizumab in the treatment of patients with prethreshold retinopathy of prematurity in Taiwan[J].Am J Ophthalmol,2013,155(1):150-158.
[6]XU Y,ZHANG Q,JI XD,CAI X,YU SY,FEI P,et al.Combination of intravitreal injection of ranibizumab and laser photocoagulation for the treatment of aggressive posterior retinopathy of prematurity[J].Chin J Ocul Funds Dis,2014,30(1):28-32.许宇,张琦,季迅达,蔡璇,虞思伊,费萍等.玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab联合激光光凝治疗急进性后部型早产儿视网膜病变的疗效观察[J].中华眼底病杂志,2014,30(1):28-32.
[7]LI XX.Characteristics and screening guidelines of retinopathy of prematurity in our country[J].Chin J Ocul Funds Dis,2004,20(6):384-386.黎晓新.我国早产儿视网膜病变特点和筛查指南[J].中华眼底病杂志,2004,20(6):384-386.
[8]LYNCH SS,CHENG CM.Bevacizumab for neocascular ocular diseases[J].Ann Pharmacother,2007,41(4):614-625.
[9]LASHKARI K,HIROSE T,YAZDANY J.Vascular endothelial growth and hepatocyte growth factor levels are differentially elevated in patients with advanced retinopathy of prematurity[J].Am Pathol,2000,156(4):1337-1344.
[10]MINTZ-HITTNER HA.Treatment of retinopathy of prematurity with vascular endothelial growth factor inhibitors[J].Early Hum Dev,2012,88(12):937-941
[11]Early Treatment for Retinopathy of Prematurity Cooperative Group.Revised indications for the treatment of retinopathy of prematurity:results of the early treatment for retinopathy of prematurity randomized trial[J].Arch Ophthalmol,2003,121(12):1684-1694.
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