Chandra Parijat, Kumawat Devesh, Agarwal Divya, Chawla Rohan
J Pediatr Ophthalmol Strabismus. 2020 Jan 1;57(1):61-66. doi: 10.3928/01913913-20191030-01.
To study the role of combined vitrectomy and intravitreal anti-vascular endothelial growth factor (VEGF) injection for stage 4 retinopathy of prematurity (ROP) with extensive neovascular proliferation.
In a retrospective interventional study at a tertiary eye care center, 15 eyes (9 infants) with advanced stage 4 ROP underwent 25-gauge vitrectomy combined with intravitreal 0.625 mg of bevacizumab (n = 12) or 0.25 mg of ranibizumab (n = 3) injection and were followed up until 65 weeks' postconceptional age (PCA). The perinatal history, tractional retinal detachment (TRD) characteristics (zone, stage, and presence of "plus" disease), treatment details, and anatomical outcomes were reviewed. The main outcome measures were fibrovascular tissue and TRD regression and final macular status.
Mean gestational age and birth weight were 28.5 ± 1.2 weeks and 1,167 ± 185 g, respectively. Thirteen eyes had zone I disease and 2 eyes had zone II disease. Thirteen eyes were stage 4A and 2 eyes were stage 4B ROP. The morphology was aggressive posterior ROP in 10 eyes. The mean PCA at surgery was 37.8 ± 2.3 weeks. Lensectomy was also performed in 2 eyes. Rapid fibrovascular tissue regression was seen in 14 eyes within 2 weeks, followed by TRD regression and macular vascularization, although 2 eyes had macular pucker formation. Persistent vitreous bleeding was present in 1 eye, which needed lavage, and eventually the TRD regressed. Disease reactivation was noted in 1 eye at 5 weeks and was managed with repeat intravitreal anti-VEGF injection.
Anti-VEGF treatment combined with vitrectomy leads to rapid disease regression in advanced stage 4 ROP with extensive neovascular proliferation. [J Pediatr Ophthalmol Strabismus. 2020;57(1):61-66.].
研究玻璃体切除术联合玻璃体内注射抗血管内皮生长因子（VEGF）对伴有广泛新生血管增殖的4期早产儿视网膜病变（ROP）的作用。
在一家三级眼科护理中心进行的一项回顾性干预研究中，15只眼（9名婴儿）患有晚期4期ROP，接受了25G玻璃体切除术联合玻璃体内注射0.625mg贝伐单抗（n = 12）或0.25mg雷珠单抗（n = 3），并随访至孕龄65周（PCA）。回顾围产期病史、牵拉性视网膜脱离（TRD）特征（区域、阶段和“plus”病的存在情况）、治疗细节和解剖学结果。主要观察指标为纤维血管组织和TRD消退情况以及最终黄斑状态。
平均胎龄和出生体重分别为28.5±1.2周和1167±185g。13只眼患有I区疾病，2只眼患有II区疾病。13只眼为4A期ROP，2只眼为4B期ROP。10只眼的形态为侵袭性后部ROP。手术时的平均PCA为37.8±2.3周。2只眼还进行了晶状体切除术。14只眼在2周内可见纤维血管组织迅速消退，随后TRD消退和黄斑血管化，尽管有2只眼形成了黄斑皱襞。1只眼存在持续性玻璃体积血，需要冲洗，最终TRD消退。1只眼在5周时疾病复发，通过重复玻璃体内注射抗VEGF进行治疗。
抗VEGF治疗联合玻璃体切除术可使伴有广泛新生血管增殖的晚期4期ROP疾病迅速消退。[《小儿眼科与斜视杂志》。2020；57(1)：61 - 66。]
