早产儿视网膜病变孤立性视网膜新生血管：临床相关性及预后意义。
Isolated Retinal Neovascularization in Retinopathy of Prematurity: Clinical Associations and Prognostic Implications.
机构信息
Casey Eye Institute, Oregon Health and Science University, Portland, Oregon.
National Eye Institute, National Institutes of Health, Bethesda, Maryland; National Library of Medicine, National Institutes of Health, Bethesda, Maryland.
出版信息
Ophthalmol Retina. 2024 Oct;8(10):1021-1028. doi: 10.1016/j.oret.2024.04.025. Epub 2024 May 11.
OBJECTIVE
Isolated retinal neovascularization (IRNV) is a common finding in patients with stage 2 and 3 retinopathy of prematurity (ROP). This study aimed to further classify the clinical course and significance of these lesions (previously described as "popcorn" based on clinical appearance) in patients with ROP as visualized with ultrawidefield OCT (UWF-OCT).
DESIGN
Single center, retrospective case series.
PARTICIPANTS
Images were collected from 136 babies in the Oregon Health and Science University neonatal intensive care unit.
METHODS
A prototype UWF-OCT device captured en face scans (>140°), which were reviewed for the presence of IRNV along with standard zone, stage, and plus classification. In a cross-sectional analysis we compared demographics and the clinical course of eyes with and without IRNV. Longitudinally, we compared ROP severity using a clinician-assigned vascular severity score (VSS) and compared the risk of progression among eyes with and without IRNV using multivariable logistic regression.
MAIN OUTCOME MEASURES
Differences in clinical demographics and disease progression between patients with and without IRNV.
RESULTS
Of the 136 patients, 60 developed stage 2 or worse ROP during their disease course, 22 of whom had IRNV visualized on UWF-OCT (37%). On average, patients with IRNV had lower birth weights (BWs) (660.1 vs. 916.8 g, P = 0.001), gestational age (GA) (24.9 vs. 26.1 weeks, P = 0.01), and were more likely to present with ROP in zone I (63.4% vs. 15.8%, P < 0.001). They were also more likely to progress to stage 3 (68.2% vs. 13.2%, P < 0.001) and receive treatment (54.5% vs. 15.8%, P = 0.002). Eyes with IRNV had a higher peak VSS (5.61 vs. 3.73, P < 0.001) and averaged a higher VSS throughout their disease course. On multivariable logistic regression, IRNV was independently associated with progression to stage 3 (P = 0.02) and requiring treatment (P = 0.03), controlling for GA, BW, and initial zone 1 disease.
CONCLUSIONS
In this single center study, we found that IRNV occurs in higher risk babies and was an independent risk factor for ROP progression and treatment. These findings may have implications for OCT-based ROP classifications in the future.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的
孤立性视网膜新生血管（IRNV）是 2 期和 3 期早产儿视网膜病变（ROP）患者的常见表现。本研究旨在通过超广角光学相干断层扫描（UWF-OCT）进一步对这些病变（以前根据临床外观描述为“爆米花”）的临床病程和意义进行分类。
设计
单中心回顾性病例系列。
参与者
来自俄勒冈健康与科学大学新生儿重症监护病房的 136 名婴儿的图像被收集。
方法
原型 UWF-OCT 设备捕获了 >140°的眼前节扫描，同时评估了 IRNV 的存在以及标准的区域、分期和加号分类。在横断面分析中，我们比较了有和无 IRNV 的眼睛的人口统计学和临床病程。在纵向研究中，我们使用临床医生分配的血管严重程度评分（VSS）比较 ROP 严重程度，并使用多变量逻辑回归比较有和无 IRNV 的眼睛的进展风险。
主要观察指标
有和无 IRNV 的患者之间的临床人口统计学和疾病进展差异。
结果
在 136 名患者中，60 名患者在疾病过程中发展为 2 期或更严重的 ROP，其中 22 名患者在 UWF-OCT 上显示有 IRNV（37%）。平均而言，有 IRNV 的患者体重（BW）较低（660.1 与 916.8g，P=0.001），胎龄（GA）较短（24.9 与 26.1 周，P=0.01），且更有可能在 I 区出现 ROP（63.4% 与 15.8%，P<0.001）。他们也更有可能进展到 3 期（68.2% 与 13.2%，P<0.001）并接受治疗（54.5% 与 15.8%，P=0.002）。有 IRNV 的眼睛 VSS 峰值更高（5.61 与 3.73，P<0.001），整个病程中 VSS 平均值更高。多变量逻辑回归显示，IRNV 与进展到 3 期（P=0.02）和需要治疗（P=0.03）独立相关，控制 GA、BW 和初始 1 区疾病。
结论
在这项单中心研究中，我们发现 IRNV 发生在风险较高的婴儿中，是 ROP 进展和治疗的独立危险因素。这些发现可能对未来基于 OCT 的 ROP 分类有影响。
Zotero 插件