PDF(Pubmed)
Abstract：
Retinopathy of prematurity (ROP) is a rare proliferative ocular condition that can happen in premature babies (born preterm <36 weeks) or who weigh <1.5 kg at birth (low birth weight babies). ROP is a major cause of childhood blindness. It is a premature disease since retina vascularization is completed only by 40 weeks of life. The survivability for preterm infants has increased owing to recent improvements in neonatal care during the past decade. As a result, the prevalence of ROP has risen concurrently. The abnormal development of blood vessels in the retina is the cause of this illness. It occurs in two phases, phases 1 and 2. Most preterm infants weighing <1.5 kg need supplemental oxygen for respiratory support at birth. This leads to the initiation of phase 1 (vasoconstrictive phase). Phase 1 is characterized by loss of maternal-fetal connection and hyperoxia due to supplemental oxygen therapy. Oxygen\'s vasoconstrictive and obliterative action is primarily observed in developing retinal vessels. The inhibition of vascular endothelial growth factor follows from this. Phase 2 (vasoproliferative phase) shows the dilatation and tortuosity of the bigger existing vessels together with neovascularization and proliferation of new vessels into the vitreous when the baby is shifted from respiratory support to room air. Now, the retina gets hypoxic, where the retina becomes more metabolically active but is yet minimally vascularized, leading to VEGF-induced vasoproliferation, which might result in retinal detachment. Patients with ROP face the danger of loss of vision. If correct and quick treatment is not provided, they might land into permanent blindness. Yet, ROP remains one of the most preventable causes of childhood blindness worldwide. Blindness caused by ROP can only be avoided if screening programs are readily available, pertinent, and appropriate. The initial stage in the therapy of ROP is the screening of premature neonates. Timely screening and management for ROP is important to avoid this irreversible loss of vision. The treatment is based on the severity of the disease. Management may include pharmacological interventions like intravitreal and anti-vascular endothelial growth factor and non-pharmacological interventions like laser surgery, vitrectomy, and scleral buckling. We conducted a thorough literature search of studies on pathogenesis, risk factors, classification, and various treatment options for retinopathy of prematurity in infants, using a mixture of pertinent keywords. Only those studies published in peer-reviewed journals between 2010 and 2023 and written in English were included. Duplicate studies, unavailable in full-text for free, or studies unrelated to our subject matter were excluded. After thoroughly evaluating the selected studies, the results were synthesized and presented narratively. This article sheds light on the pathogenesis of ROP, particularly its relation to oxygen use, screening, and potential therapeutic management of ROP. Today advances in screening techniques have improved the outcomes for infants with ROP. Still, ongoing research is needed to optimize management strategies and reduce the burden of this condition.
摘要：
早产儿视网膜病变（ROP）是一种罕见的增生性眼部疾病，可发生在早产儿（早产<36周）或出生时体重<1.5kg（低出生体重婴儿）。ROP是儿童失明的主要原因。这是一种过早的疾病，因为视网膜血管化只能在40周的生命中完成。由于在过去十年中新生儿护理的最近改善，早产儿的生存能力有所提高。因此,ROP的患病率同时上升。视网膜血管的异常发育是这种疾病的原因。它发生在两个阶段，阶段1和2。大多数体重<1.5kg的早产儿在出生时需要补充氧气以进行呼吸支持。这导致阶段1(血管收缩阶段)的开始。阶段1的特征是母胎连接的丧失和由于补充氧疗引起的高氧。氧的血管收缩和闭塞作用主要在发育中的视网膜血管中观察到。血管内皮生长因子的抑制由此产生。第2阶段（血管增生阶段）显示，当婴儿从呼吸支持转移到室内空气时，较大的现有血管的扩张和弯曲以及新血管的新生血管形成和向玻璃体的增殖。现在,视网膜缺氧,那里的视网膜变得更代谢活跃，但血管化程度最低，导致VEGF诱导的血管增殖，这可能会导致视网膜脱离.ROP患者面临视力丧失的危险。如果没有提供正确和快速的治疗，他们可能会陷入永久性失明。然而，ROP仍然是全球儿童失明的最可预防的原因之一。只有在筛查程序随时可用的情况下，才能避免ROP造成的失明，相关，和适当的。ROP治疗的初始阶段是早产儿的筛查。及时筛查和管理ROP对于避免这种不可逆转的视力丧失很重要。治疗基于疾病的严重程度。管理可能包括药物干预，如玻璃体内和抗血管内皮生长因子和非药物干预，如激光手术，玻璃体切除术,巩膜扣带.我们对发病机制的研究进行了深入的文献检索，危险因素，分类，以及各种早产儿视网膜病变的治疗方案，使用相关关键字的混合。仅包括2010年至2023年在同行评审期刊上发表并以英文撰写的研究。重复研究，无法免费提供全文，或者与我们的主题无关的研究被排除.在彻底评估选定的研究之后，对结果进行了综合和叙述。本文对ROP的发病机制进行了阐述,特别是它与氧气使用的关系，筛选,和潜在的ROP治疗管理。如今，筛查技术的进步改善了ROP婴儿的预后。尽管如此，需要持续的研究来优化管理策略并减轻这种情况的负担。
