摘要目的 观察影响1区早产儿视网膜病变(ROP)激光治疗效果的相关因素.方法 回顾性分析35例1区ROP患儿69只眼的临床资料.所有患儿均经过间接检眼镜检查确诊,根据病变在视网膜的位置分为前部1区和后部1区,分别为49、20只眼.69只跟中急进性ROP(AP-ROP)12只眼,前部1区4只眼,后部1区8只眼.在+20 D透镜辅助以及巩膜压迫器压迫下,采用二极管间接检眼镜激光对嵴前周边视网膜无血管区进行激光光凝,随访观察时间2～48个月.平均观察时间(10.85±11.35)个月.嵴消退,病情稳定为治愈;视网膜病变进展为4期或5期为视网膜病变进展.结果 69只眼中,治愈42只眼,占60.87%;视网膜病变进展27只眼,占39.13%.前部1区49只眼中,治愈34只眼,占69.38%;进展15只眼,占30.62%.后部1区20只眼中,治愈8只眼,占40.00%;进展12只眼,占60.00%.前部1区和后部1区视网膜病变进展率比较,差异有统计学意义(X~2=5.15,P<0.05).AP-ROP 12只眼中激光光凝后视网膜脱离9只眼.发现视网膜病变进展的时间在激光光凝治疗后2～18周.Logistic回归分析表明,激光光凝治疗后ROP的进展与治疗前视网膜纤维血管网的范围有关(回归系数0.235,P=0.00),与早产儿的出生体重(回归系数0.000,P=0.091)、胎龄(回归系数-0.037,P=0.359)、激光治疗时矫正胎龄(回归系数0.013,P=0.651)及激光光凝点数量(回归系数-5.7E-0.05,P=0.800)的多少无关.结论 1区ROP激光光凝治疗有效,前部1区的激光光凝治疗预后较后部1区好;激光光凝治疗后的视网膜病变进展与治疗前视网膜纤维血管网范围有关.

abstractsObjective To observe the factors influencing for results of laser treatment of zone one retinopathy of premature(ROP).Methods The clinical data of 35 patients(69 eyes)with ROP in zone one who diagnosed by examination of indirect ophthalmoscopy were retrospectively analyzed.The eyes were divided into anterior zone one(49 eyes)and posterior zone one(20 eyes).The 69 eyes,aggressive posterior ROP(AP-ROP)in 12 eyes,anterior zone one in four eyes and posterior zone one in eight eyes.The laser photocoagulation of diode indirect ophthalmoscopy with+20 D lens and sclera compressor were used to entire avascular retina.Follow-up ranged from two to 48 months with the mean of(10.85±11.35)months.Take the cristae fadeaway and stable condition as cure;retinopathy proceed to the stage 4 and 5 ROP as retinopathy progress.Results Forty-two out of 69 eyes(60.87%)were cured and retinopathy progress in 27 eyes(39.13%).Thirty-four out of 49 eyes(69.38%)with anterior zone one were cured and retinopathy progress in 15 eyes(30.61%);eight out of 20 eyes(40.00%)with posterior zone one were cured and retinopathy progress in 12 eyes(60.00%).The difference of progress rate between anterior and posterior zone one was statistically significant(X~2=5.15,P<0.05).Conclusions Laser photocoagulation is effective for treatment of zone one ROP,the prognosis of anterior zone one is better than posterior zone one;retinopathy progress after photocoagulation was associated with extent of fibrovascular organization.