Gotz-Wieckowska Anna, Rydlewska-Fojut Małgorzata, Siennicka Agnieszka, Burchardt-Kroll Ewa, Gadzinowski Janusz
Katedry i Kliniki Okulistyki Akademii Medycznej w Poznaniu.
Klin Oczna. 2006;108(1-3):39-42.
The aim of this study was to analyze risk factors influencing diode laser treatment of active phase of retinopathy of prematurity.
106 premature infants were treated with the use of diode laser at Department of Neonatology since 1.01.2003-30.11.2004. The mean gestational age was 27.3, mean birth weight 1022 g. The earliest age of laser therapy was 37th day of life and the latest one 104th day (mean 64.3 days). 18 neonates were excluded from the study because they were from other departments, and 2 because they died. The results of treatment of the rest 86 children were evaluated. The occurence of retinal detachment or macular ectopy was classified as unfavorable outcome.
The complete remission was obtained in 143 eyes (83.2%),the macular ectopy was diagnosed in 10 eyes (5.8%), the retinal detachment in 19 eyes (11%). Children with unfavorable outcomes were divided in two groups. The first one included 6 extremely immature infants, born between 24 to 25th week of gestation. The ROP in this group was diagnosed in I zone with plus disease. The second group included children with gestation age from 28 to 32 Hbd. 9 of them had severe infection (sepsis, congenital pneumonia, urinary tract infection), 1 serious maternal history (R type of diabetes). The procedure of laser therapy was performed on average at 72th day of life at the first group, and at 50th day at the second one.
(1) Important risk factors of treatment failure of active phase of retinopathy of prematurity, is low gestational age and infections which take place in perinatal period. (2) In the second group of infants (gestational age from 28-32 Hbd), with treatment failure the retinopathy of prematurity occured much more earlier then in the group with successful treatment. (3) When making decision of the patient treatment besides estimation of the eye fundus and the progress of changes, we should also consider risk factors which have influence on retinopathy of prematurity, after treatment.
本研究旨在分析影响早产儿视网膜病变活动期二极管激光治疗的危险因素。
自2003年1月1日至2004年11月30日，新生儿科对106例早产儿使用二极管激光进行治疗。平均胎龄为27.3周，平均出生体重为1022克。激光治疗的最早年龄为出生后第37天，最晚为第104天（平均64.3天）。18例新生儿因来自其他科室被排除在研究之外，2例因死亡被排除。对其余86名儿童的治疗结果进行了评估。视网膜脱离或黄斑异位的发生被归类为不良结局。
143只眼（83.2%）完全缓解，10只眼（5.8%）诊断为黄斑异位，19只眼（11%）发生视网膜脱离。不良结局的儿童分为两组。第一组包括6例极不成熟的婴儿，出生于妊娠24至25周之间。该组ROP在I区伴plus病被诊断。第二组包括胎龄为28至32周的儿童。其中9例有严重感染（败血症、先天性肺炎、尿路感染），1例有严重母亲病史（R型糖尿病）。第一组激光治疗平均在出生后第72天进行，第二组在第50天进行。
（1）早产儿视网膜病变活动期治疗失败的重要危险因素是低胎龄和围生期发生的感染。（2）在第二组婴儿（胎龄28 - 32周）中，治疗失败时早产儿视网膜病变比治疗成功组发生得更早。（3）在决定患者治疗时，除了评估眼底和病变进展外，还应考虑对治疗后早产儿视网膜病变有影响的危险因素。
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