摘要目的 观察并探讨玻璃体腔注射康柏西普治疗早产儿视网膜病变(ROP)的疗效和影响因素.方法 回顾性病例研究.2017年10月至2018年6月在河南省人民医院新生儿重症监护室和眼科筛查确诊为阈值前期1型、阈值期和急进型后极部ROP (AP-ROP)患儿57例57只眼纳入研究.其中,阈值前期1型30例30只眼,阈值期21例21只眼,AP-ROP 6例6只眼.所有患儿在确诊后24 h内常规玻璃体腔注射10.00 mg/ml的康柏西普0.025 ml(含康柏西普0.25 mg).注射后7d内行眼底检查,其后根据眼底情况决定检查间隔时间为1～3周/次.随访时间≥24周,平均随访时间(30.1±4.6)周.病情复发或治疗无反应者,给予重复玻璃体腔注射康柏西普或激光光凝治疗.随访观察患眼视网膜血管变化情况.疗效多因素相关性检验采用logistic逐步回归分析.结果 57只眼中,行1、2次玻璃体注射康柏西普治疗分别为49、8只眼.治疗后24周,57只眼中,治愈26只眼(45.6％),好转22只眼(38.6％),复发8只眼(14.0％),加重1只眼(1.8％).复发时间为首次治疗后(12.9±4.5)周,矫正胎龄(49.0±6.7)周.治愈、好转与复发患眼之间首次注射时间(F=5.124)、病变范围(F=7.122)比较,差异有统计学意义(P＜0.01、＜0.01);治愈、好转、复发患眼之间不同ROP类型、病变分区和分期、有无附加病变比较,差异均有统计学意义(x2=11.784、14.100、6.896、9.935,P＜0.01、＜0.01、＜0.05、＜0.01).Logistic逐步回归分析结果显示,Ⅰ区病变较Ⅱ区病变更易复发(Wald值=9.879,OR=27.333,P=0.002).所有患眼治疗中和随访过程中后均未出现眼内炎、白内障、青光眼等与注射相关的并发症.结论 玻璃体腔注射康柏西普治疗ROP有效,无明显不良反应;病变分区与治疗后复发相关.

abstractsObjective To observe the effect ofintravitreal injection ofconbercept in the treatment of retinopathy of premature (ROP) and to analyze the factors related to the therapy.Methods A retrospective study.A total of 57 patients (57 eyes) with pre-threshold type 1 (30 patients,30 eyes),threshold ROP (21 patients,21 eyes) and acute aggressive posterior ROP (APROP,6 patients,6 eyes)) from premature infants by retinal screening in Henan Provincial People's Hospital during October 2017 and June 2018 were enrolled in this study.All children were received routinely intravitreal injected 10 mg/ml conbercept 0.025 ml (0.25 mg) within 24 hours after diagnosis.Fundus examination was performed 7 days after injection.The interval of examination was 1-3 weeks according to fundus conditions.The mean follow-up was 30.1 ± 4.6 weeks.For patients with relapse or no response to treatment,repeated intravitreal injection of conbercept or laser photocoagulation therapy was given.The retinal blood vessels of the affected eyes were observed.Logistic stepwise regression analysis was used for the correlation test of multiple factors.Results Among 57 eyes,49eyes and 8 eyes were treated with 1 or 2 times of intravitreal injection of conbercept.After 24 weeks of treatment,in 57 eyes,26 eyes were cured (45.6％),22 eyes improved (38.6％),8 eyes relapsed (14.0％),and 1 eye aggravated (1.8％).The recurrence time was 12.9± 4.5 weeks after the first injection,and the corrected gestational age was 49.0±6.7 weeks.There were significant differences in initial injection time,lesion range among the cure,improved and recurrence eyes (F=5.124,7.122;P＜0.01,＜ 0.01).Parameters of ROP condition,including ROP diagnosis (pre-threshold type 1,threshold and APROP),zone (zone 1 and 2),stage (stage 2 and 3) and plus lesions,were significant different among the cure,improved and recurrence eyes (x2=l 1.784,14.100,6.896,9.935;P＜0.01,＜0.01,＜0.05,＜0.01).Logistic stepwise regression analysis showed that the recurrence rate was correlated with ROP zone,more likely recurrence at zone 1 than zone 2 (Wald=9.879,OR=27.333,P=0.002).No injection-related complications such as endophthalmitis,cataract and glaucoma were found during treatment and follow-up period.Conclusions Intravitreal injection ofconbercept is effective in the treatment of ROP without obvious adverse reactions.Lesion zoning is associated with recurrence after treatment.