Kretzer F L, Mehta R S, Brown E S, Mintz-Hittner H A
Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77030.
Doc Ophthalmol. 1990 Mar;74(3):205-11. doi: 10.1007/BF02482610.
Our current surgical treatment for threshold retinopathy of prematurity (ROP) is based upon three concepts which emerged from morphologic and biochemical study of 250 pairs of whole eye donations obtained over a ten year period. 1) Spindle cells normally migrate and canalize to form inner retinal vessels, but when stressed, spindle cells secrete angiogenic factors. The clinical implication is that transretinal cryotherapy to the avascular retina is efficacious because it obliterates spindle cells. The number and timing of cryosessions are determined by the migration and kinetics of spindle cells. 2) Myofibroblasts originate from the shunt, are the major cellular component of extraretinal fibrovascular proliferation (EFP), and contract to produce retinal distortion and detachment. The clinical implication is that a second transretinal cryotherapy session should obliterate the shunt and the EFP, and should eliminate the source of retinal traction. 3) Anterior ocular growth occurs exponentially during the period when ROP develops and is treated. The clinical implication is that a prophylactic scleral buckle supports the fixed surface area of the developing retina while the choroid and sclera enlarge anteriorly. Retinal distortion produces misaligned photoreceptors, and retinal detachment results in rapid retinal death.
我们目前针对阈值早产儿视网膜病变（ROP）的手术治疗基于从十年间获取的250对全眼球捐赠的形态学和生物化学研究中得出的三个概念。1）纺锤状细胞通常迁移并形成管道以形成视网膜内血管，但在受到应激时，纺锤状细胞会分泌血管生成因子。临床意义在于，对无血管视网膜进行经视网膜冷冻疗法是有效的，因为它会消除纺锤状细胞。冷冻治疗的次数和时机由纺锤状细胞的迁移和动力学决定。2）肌成纤维细胞起源于分流处，是视网膜外纤维血管增殖（EFP）的主要细胞成分，并通过收缩产生视网膜变形和脱离。临床意义在于，第二次经视网膜冷冻治疗应消除分流处和EFP，并应消除视网膜牵引的来源。3）在ROP发生和治疗期间，眼前部生长呈指数增长。临床意义在于，预防性巩膜扣带在脉络膜和巩膜向前扩大时支撑发育中视网膜的固定表面积。视网膜变形会导致光感受器排列不齐，而视网膜脱离会导致视网膜迅速死亡。
