目的:评估早产儿视网膜病变(ROP)国际分类(ICROP)指南外的发病率和临床适应症。
方法:回顾性分析2016年1月至2019年12月在一家三级护理眼科医院接受ROP治疗的患者的病历,以评估他们接受治疗的适应症。
结果:在241只眼睛中,33只眼睛(13.7%)在指南之外接受治疗。指南之外的治疗的原因是结构变化(n=24,72.7%),持续的第3阶段ROP在6周内未显示任何消退迹象(n=7,21.2%)和正在治疗的同侧眼的活动性ROP(n=2,6.1%)。记录的特定结构变化为切向牵引与颞部血管矫直有关黄斑变形和异位(n=5,15.2%),和3期新生血管形成或有前后牵引的山脊,有进展为4期疾病的风险(n=19,57.6%)。11只眼存在前加疾病(33.3%)。治疗后,在所有治疗的眼睛中,ROP阶段退化,视网膜血管生长直到Ora或至少进入III区。治疗后,没有一只眼睛显示出结构变化的恶化。患者的平均随访时间为12.4±11.7个月。
结论:专家偶尔会推荐对比1型ROP病情轻的眼睛进行治疗。这项研究可能有助于儿科视网膜从业者在临界病例中的决策。
OBJECTIVE: To evaluate the incidence and clinical indications for which eyes were treated for retinopathy of prematurity (ROP) outside the
guidelines set by International Classification of ROP (ICROP).
METHODS: Medical records of the patients treated at a single tertiary care ophthalmology hospital for ROP from January 2016 to December 2019 were retrospectively analysed to evaluate the indications for which they were treated.
RESULTS: Out of 241 eyes, 33 eyes (13.7%) were treated outside the
guidelines. The reasons for the treatment outside the
guidelines were structural changes (n = 24, 72.7%), persistent stage 3 ROP that did not show any sign of regression for 6 weeks (n = 7, 21.2%) and active ROP with fellow eye being treated (n = 2, 6.1%). The recorded specific structural changes were tangential traction with temporal vessel straightening concerning for macular distortion and ectopia (n = 5, 15.2%), and stage 3 neovascularisation or ridge with anteroposterior traction with risk of progression to stage 4 disease (n = 19, 57.6%). Pre-plus disease was present in 11 eyes (33.3%).After the treatment, ROP stages regressed and retinal vessels grew either until the ora or at least into zone III in all the treated eyes. None of the eyes showed worsening of structural changes after treatment. The mean follow-up of the patients was 12.4 ± 11.7 months.
CONCLUSIONS: Experts occasionally recommend treatment in eyes with disease milder than type 1 ROP. This study may help paediatric retinal practitioners in decision-making in borderline cases.