Walz J M, Bemme S, Reichl S, Akman S, Breuß H, Süsskind D, Glitz B, Müller V C, Wagenfeld L, Gabel-Pfisterer A, Aisenbrey S, Engelmann K, Koutsonas A, Krohne T U, Stahl A
Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
Fakultät für Chemie und Pharmazie, Lehrstuhl Pharmakologie und Toxikologie, Universität Regensburg, Regensburg, Deutschland.
Ophthalmologe. 2018 Jun;115(6):476-488. doi: 10.1007/s00347-018-0701-5.
Retinopathy of prematurity (ROP) is one of the main reasons for childhood blindness. The number of infants requiring treatment, however, is low for individual centers. The Retina.net ROP registry has been founded to allow a joint analysis of treatment patterns and courses post treatment.
This paper reports treatment patterns over 5 years.
All infants born between January 2011 and December 2015 who were entered into the treatment registry by one of the 12 participating centers were analyzed.
The data of 150 infants (292 eyes) were analyzed and ROP 3+ in zone II was the most prevalent treatment indication. Gestational age and birth weight remained stable over the years. The treatment patterns, however, changed with anti-VEGF treatment (bevacizumab or ranibizumab) accounting for only 10% of treated eyes in 2011 but for 56% and 30% in 2014 and 2015, respectively. Almost all eyes with AP-ROP or zone I disease received anti-VEGF treatment. Zone II disease was predominantly treated with laser photocoagulation. Recurrences were more common and appeared later in the anti-VEGF group compared to the laser group (23%/interval 60 days vs. 17%/interval 23 days). Perioperative complications were evenly distributed across treatment groups.
The data in this analysis represent about 10-15% of treated infants in Germany. The results provide evidence for an increasing use of anti-VEGF agents for ROP. The data reflect a selection bias for anti-VEGF treatment in eyes with a more aggressive disease. This needs to be considered when interpreting data such as disease recurrence rates. The risk for late recurrences after anti-VEGF treatment is of particular clinical significance.
早产儿视网膜病变（ROP）是儿童失明的主要原因之一。然而，对于各个中心而言，需要治疗的婴儿数量较少。已建立Retina.net ROP登记处，以便对治疗模式和治疗后的病程进行联合分析。
本文报告5年期间的治疗模式。
分析了2011年1月至2015年12月期间由12个参与中心之一录入治疗登记处的所有婴儿。
分析了150例婴儿（292只眼）的数据，二区ROP 3+是最常见的治疗指征。多年来，胎龄和出生体重保持稳定。然而，治疗模式发生了变化，抗VEGF治疗（贝伐单抗或雷珠单抗）在2011年仅占治疗眼的10%，但在2014年和2015年分别占56%和30%。几乎所有急性后极部ROP或一区疾病的眼都接受了抗VEGF治疗。二区疾病主要采用激光光凝治疗。与激光治疗组相比，抗VEGF治疗组复发更常见且出现时间更晚（23%/间隔60天 vs. 17%/间隔23天）。围手术期并发症在各治疗组中分布均匀。
本分析中的数据代表了德国约10%-15%接受治疗的婴儿。结果为ROP抗VEGF药物使用的增加提供了证据。数据反映了在病情更严重的眼中抗VEGF治疗存在选择偏倚。在解释疾病复发率等数据时需要考虑这一点。抗VEGF治疗后晚期复发的风险具有特别的临床意义。
