早产儿视网膜病变进展期行即刻序贯双侧玻璃体视网膜手术的疗效观察。
Surgical outcomes of immediate sequential bilateral vitreoretinal surgery for advancing retinopathy of prematurity.
机构信息
Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Department of Ocular Anaesthesia, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
出版信息
Indian J Ophthalmol. 2019 Jun;67(6):903-907. doi: 10.4103/ijo.IJO_741_18.
PURPOSE
Bilateral eye surgery in the same session may be required for advancing stage 4 retinopathy of prematurity (ROP). The purpose of this study was to evaluate the outcomes of immediate sequential bilateral vitreoretinal surgery (ISBVS) in stage 4 ROP.
METHODS
In a retrospective interventional study at a tertiary care center, 60 eyes of 30 infants who underwent ISBVS for stage 4 ROP between December 2015 and May 2017 were studied. In cases with clear retrolental access, 25G or 27G lens sparing vitrectomy (LSV) was performed and in the rest 25G lensectomy with vitrectomy (LV) was performed through clear corneal entries. The final anatomical outcome measures were the status of tractional retinal detachment (TRD) and macular status.
RESULTS
The mean gestational age was 28.4 ± 2.0 weeks and birth weight was 1214.5 ± 329.7gms. The mean postconceptional age at surgery was 40.8 ± 2.2 weeks. Stages 4a and 4b were present in 86.7% and 13.3% eyes respectively. LSV was performed in 95% eyes whereas LV was performed in the rest. None of the eyes developed lens touch, choroidal hemorrhage, postoperative hypotony, corneal decompensation, or endophthalmitis. At last follow-up (mean 45 weeks, range 20-68 weeks), macula was attached in 90% eyes with the TRD resolved completely in 61.7% eyes and significantly decreased in another 25% eyes. Sequalae included macular drag, epiretinal membrane, and progression to fibrotic stage 5 disease.
CONCLUSION
ISBVS is safe and effective for bilateral stage 4 ROP and should be recommended in rapidly progressive cases.
目的
对于进展期 4 期早产儿视网膜病变（ROP），可能需要在同一期进行双眼手术。本研究旨在评估即时序贯双侧玻璃体视网膜手术（ISBVS）在 4 期 ROP 中的疗效。
方法
在一家三级保健中心进行的回顾性干预性研究中，对 2015 年 12 月至 2017 年 5 月间接受 ISBVS 治疗的 30 例婴儿的 60 只眼的 4 期 ROP 患者进行了研究。对于有明确的后玻璃体视网膜接触的病例，行 25G 或 27G 晶状体保留玻璃体切除术（LSV）；对于其余病例，行 25G 晶状体切除术联合玻璃体切除术（LV），通过透明角膜切口进行。最终的解剖学疗效评估指标是牵拉性视网膜脱离（TRD）的状态和黄斑的情况。
结果
平均胎龄为 28.4±2.0 周，出生体重为 1214.5±329.7g。手术时的平均孕龄为 40.8±2.2 周。4a 期和 4b 期分别占 86.7%和 13.3%的眼。95%的眼行 LSV，其余的眼行 LV。无眼发生晶状体接触、脉络膜出血、术后低眼压、角膜失代偿或眼内炎。末次随访（平均 45 周，范围 20-68 周）时，90%的眼黄斑区贴附，61.7%的眼完全解除 TRD，另 25%的眼明显减轻。后遗症包括黄斑牵引、视网膜内膜和进展为纤维性 5 期病变。
结论
ISBVS 治疗双侧 4 期 ROP 是安全有效的，对于快速进展的病例应推荐使用。
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