嚴重早產兒視網膜病變以眼內注射抑制新生血管因子(Bevacizumab)與眼內雷射治療在黃斑部中心小凹的臨床表現

Foveal contour in advanced ROP following intravitreal bevacizumab or laser

早產兒視網膜病變依然是現今造成孩童失明的重要原因之一，因而需要及時的篩檢及治療以改善其視網膜結構及功能的預後。眼內雷射及眼內注射抑制血管新生因子為目前主要兩種可以減少第一型早產兒視網膜病變視網膜新生血管生成的治療方式。過去文獻刊載兩種治療方式皆可發現有患者之中心小凹發展形成異常，因此本研究蒐集19位第一型早產兒視網膜病變病人(38隻眼)，其中15位病人接受眼內雷射治療，4位接受眼內注射Bevacizumab。在追蹤98.3個月之後以視網膜光學斷層掃描儀檢查，發現呈現中央小凹結構異常者占24隻眼(63.2%)，正常的中央小凹占14隻眼(36.8%)。分析統計顯示中央小凹的形成異常與治療時的孕週數顯著相關(p=0.002)，且有較不成熟之視網膜(zone 1)、較差的視力、及較厚的中央小凹厚度的趨勢。

 

Purpose: To investigate the foveal contour (FC) in advanced retinopathy of prematurity (ROP) following intravitreal bevacizumab or laser treatment. Methods: From January 2002 to August 2011, we collected patients with type 1 ROP treated by monotherapy of intravitreal bevacizumab or peripheral retinal diode laser photocoagulation. The cases were examined by macular spectral-domain optical coherence tomography, cycloplegic refraction, and best corrected visual acuity. Abnormal FC, that is, incomplete fovealization was defined as retention of inner retina structures, including retinal ganglion cell, inner plexiform, and inner nuclear layers. The gestation age, birth body weight, postmenstrual age for treatment, foveal contour, treatment regimen, fundus findings, and follow-up periods were recorded by chart review. Results: We collected 19 patients (38 eyes) with type 1 ROP, including 14 male and 5 female infants. Laser treatment was administered in 15 patients, and bevacizumab injection for 4 infants. After mean follow-up period of 98.3 months, all had favorable anatomical outcome following single session of laser or injection treatment. Of these infants, 24 (63.2%) eyes owned abnormal FC and 14 (36.8%) with normal FC. No significant difference was found between normal and abnormal FC groups in various clinical factors except for postmenstrual age of treatment (p = 0.002). There was a trend that patients with abnormal FC were associated with smaller gestational age (p = 0.05), more zone 1 disease (p = 0.06), poorer BCVA (p = 0.09), and thicker CFT (p = 0.09). Conclusion: All the patients with advanced ROP treated by bevacizumab or laser therapy had favorable anatomical structure. Abnormal FC could be found in nearly two third of the cases. Incomplete fovealization had correlation with younger baby, more immature retina, earlier postmenstrual age of treatment, poorer BCVA, and thicker CFT.