Department of Clinical Neuroscience, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
The Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Neonatology. 2024;121(5):608-615. doi: 10.1159/000538907. Epub 2024 May 22.
Retinopathy of prematurity (ROP), a potentially blinding disease, is increasing worldwide because of the increased survival of extremely preterm and preterm infants born where oxygen monitoring and ROP screening programs are insufficient. Repeated retinal examinations are stressful for infants, and laser photocoagulation treatment for sight-threatening ROP is destructive. The use of anti-VEGF agents instead of lasers is widespread but requires a long-term follow-up because of late recurrence of the disease. In addition, the optimal anti-VEGF agent dosage and long-term systemic effects require further study.
Interventions preventing ROP would be far preferable, and systemic interventions might promote better development of the brain and other organs. Interventions such as improved oxygen control, provision of fresh maternal milk, supplementation with arachidonic acid and docosahexaenoic acid, and fetal hemoglobin preservation by reducing blood sample volumes may help prevent ROP and reduce the need for treatment. Free readily available online tools to predict severe ROP may reduce unnecessary eye examinations and select, for screening, those at a high risk of needing treatment.
Treatment warranting ROP is a sign of impaired neurovascular development in the central nervous system. Preventative measures to improve the outcomes are available. Screening can be refined using tools that can predict severe ROP. Laser treatment and anti-VEGF agents are valuable treatment modalities that may complement each other in recurrent ROP.
早产儿视网膜病变（ROP）是一种潜在致盲性疾病，由于在氧气监测和 ROP 筛查计划不足的地区，极早产儿和早产儿的存活率增加，该病在全球范围内不断增加。反复的视网膜检查对婴儿来说是一种压力，而对威胁视力的 ROP 进行激光光凝治疗具有破坏性。抗血管内皮生长因子（VEGF）药物的使用代替了激光治疗，但由于疾病的后期复发，需要进行长期的随访。此外，最佳的抗 VEGF 药物剂量和长期的全身效应需要进一步研究。
预防 ROP 的干预措施要好得多，而全身干预措施可能会促进大脑和其他器官的更好发育。改善氧控制、提供新鲜母乳、补充花生四烯酸和二十二碳六烯酸、减少采血量以保存胎儿血红蛋白等干预措施可能有助于预防 ROP，并减少治疗的需要。免费的、易于获取的在线工具可以预测严重的 ROP，从而减少不必要的眼部检查，并筛选出需要治疗的高危人群。
需要 ROP 治疗的标志是中枢神经系统的神经血管发育受损。有改善预后的预防措施。可以使用预测严重 ROP 的工具来优化筛查。激光治疗和抗 VEGF 药物是有价值的治疗方式，它们可能在复发性 ROP 中相互补充。
