Department of Ophthalmology, Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
Curr Opin Pediatr. 2011 Apr;23(2):173-8. doi: 10.1097/MOP.0b013e3283423f35.
Despite current treatments, retinopathy of prematurity (ROP) remains a major cause of blindness in premature infants and the incidence is increasing with increased survival of infants born at very early gestational ages. This review summarizes the recent literature on ROP with a special focus on recent advances in treatment options as well as newly developed methods for disease screening.
Genetic studies find a genetic predisposition to ROP-linking genes in the Wnt pathway with development of severe ROP. With regard to diagnosis, a new screening method has been developed that allows prediction of ROP risk based on postnatal body weight gain alone. Formerly weight gain postnatally in combination with insulin-like growth factor levels was found to predict treatable ROP. New treatment options for severe cases of ROP have been proposed targeting vascular endothelial growth factor (VEGF). Whether anti-VEGF treatment is well tolerated in preterm infants, however, has to be further evaluated in controlled clinical trials. Finally, new reports from the early treatment ROP group suggest that early laser treatment for type 1 but not type 2 high-risk prethreshold ROP improves visual acuity outcomes at 6 years of age.
With the increasing survival of premature infants and increased incidence of ROP, it is important to screen for ROP risk and treat at-risk patients in a timely manner to preserve their visual function and reduce complications.
尽管目前已有多种治疗方法,但早产儿视网膜病变(ROP)仍是导致早产儿失明的主要原因,且随着极早早产儿存活率的提高,ROP 的发病率也在不断上升。本文对 ROP 的最新文献进行综述,重点介绍治疗选择的最新进展以及疾病筛查的新方法。
遗传学研究发现 Wnt 通路中的某些基因与严重 ROP 的发生有关,存在遗传易感性。在诊断方面,已经开发出一种新的筛查方法,仅根据出生后体重增加即可预测 ROP 风险。以前发现出生后体重增加与胰岛素样生长因子水平相结合可预测可治疗性 ROP。针对血管内皮生长因子(VEGF),已提出严重 ROP 的新治疗选择。然而,抗 VEGF 治疗在早产儿中是否耐受良好,还需要在对照临床试验中进一步评估。最后,早期治疗 ROP 组的新报告表明,对于 1 型而非 2 型高危阈值前 ROP,早期激光治疗可改善 6 岁时的视力预后。
随着早产儿存活率的提高和 ROP 发病率的增加,及时筛查 ROP 风险并对高危患者进行治疗以保护其视力功能和减少并发症非常重要。