ObjectiveTo screen compounds or drugs can affect the hypoxia induced-gene expression of retinal vascular endothelial cell based on gene expression microarrays and connectivity map (CMAP) technology. MethodsTotally 326 up-regulated and down-regulated genes of hypoxic human embryonic retinal microvascular endothelial cells minduced by cobalt chloride in the previous study were converted into query signature format documents. Gene profile of the disease characteristics was then compared with that of control in CMAP website database, positive and negative compounds related to retinopathy of prematurity (ROP) were finally screened out. Results44 and 18 compounds or drugs have positive and negative relationship with ROP respectively by searching CMAP database with differentially expressed genes. Ciclopirox, cobalt chloride, gossypol and withaferin A have positive relationship with ROP. Cyclic adenosine monophosphate, harmalol, naringin and probenecid have a negative effect on ROP. ConclusionsCiclopirox, cobalt chloride, gossypol and withaferin A have a positive effect on ROP. However, cyclic adenosine monophosphate, harmalol, naringin and probenecid have a negative effect.
ObjectiveTo observe clinical outcomes of laser photocoagulation on retinopathy of prematurity (ROP). MethodsClinical data of 64 cases of ROP infants (127 eyes) were studied retrospectively. Fifteen infants (30 eyes) were diagnosed of pre-threshold ROP (type Ⅰ, 23.6%) and 49 cases (97 eyes) of threshold ROP (76.4%). All the eyes underwent photocoagulation through binocular indirect ophthalmoscope (532 nm or 810 nm) within 72 hours after the confirmation ROP. In all the 15 cases (30 eyes) of pre-threshold ROP (type Ⅰ), 6 of them (12 eyes) were photocoagulated by laser of 532 nm, and the other 9 ones (18 eyes) were treated with 810 nm. In 49 threshold ROP infants (97 eyes), 37 cases (73 eyes) and 12 ones (24 eyes) were treated with laser of 532 nm or 810 nm respectively. All the infants were followed up 12-36 months (18.4 months) since photocoagulation to investigate regression of ROP. All the data of ROP infants photocoagulated, such as recovery rate of one-time photocoagulation, repeat rate, unfavorable outcomes, and complications, were analyzed statistically according to the severity of ROP and wave length of laser employed. ResultsIn all the 127 photocoagulation treated eyes, ROP regressed completely in 125 eyes (98.4%), temporal retinal traction remained in 2 eyes (1.6%), and no retinal detachment was found. ROP regressed completely in 118 eyes (92.9%) after one-time photocoagulation, recovered totally in 6 eyes (4.7%) after repeating photocoagulation 2-3 times, and resorted to cryotherapy in 3 eyes (2.4%). Subconjunctiva hemorrhage, found in 12 eyes (9.4%), was the most common complication. During photocoagulation, anesthetic accident occurred in 1 infant (1.6%), and 1 eye developed cataract (0.8%). It was suggested from statistical analysis that there was no significant difference on efficiency or safety between pre-threshold (type Ⅰ) and threshold ROP photocoagulated by laser of 532 nm or 810 nm. However, almost all of the ROP infants need repeat photocoagulation or additional cryotherapy, and patients with unfavorable outcomes or severe complications, occurred in threshold ROP treated with 532 nm laser. ConclusionPhotocoagulation with 532 nm or 810 nm laser is effective for type Ⅰ pre-threshold or threshold ROP.
In the expert consensus published by the Pediatrics in 2013, it was first proposed that anti-VEGF drugs can be considered for retinopathy of prematurity (ROP) with stage 3, zone Ⅰ with plus disease. However, there are many problems worth the attention of ophthalmologists, including the advantages and disadvantages of anti-VEGF therapy compared with traditional laser therapy, systemic and ocular complications after anti-VEGF therapy, and what indicators are the end points of anti-VEGF therapy. Combined with this consensus and numerous research findings, we recommend that the first treatment for anti-VEGF or laser therapy should be considered from disease control effects. For the threshold and pre-threshold lesions, the effect of anti-VEGF therapy for zoneⅡ lesions is better than that for zone Ⅰ lesions and the single-time effective rate is high. So, it is suggested that anti-VEGF therapy should be preferred for the first treatment. The choice of repeat treatment should be considered from the final retinal structure and functional prognosis. Laser therapy is advisable for the abnormal vascular regression slower and abnormalities in the posterior pole. It can reduce the number of reexaminations and prolong the interval between re-examinations. However, the premature use of laser has an inevitable effect on peripheral vision field. Excluding the above problems, supplemental therapy can still choose anti-VEGF therapy again. Most of the children with twice anti-VEGF therapy are sufficient to control the disease. Anti-VEGF therapy should be terminated when there are signs such as plus regression, threshold or pre-threshold lesions controlled without recurrence, peripheral vascularization, etc.
【摘要】 目的 探讨早产儿视网膜病变（retinopathy of prematurity，ROP）的发生率及危险因素。 方法 收集2007年12月-2008年12月在四川省人民医院、成都市妇幼保健院、成都市妇产科医院住院的85例体重≤2 000 g或有严重疾病的早产儿,自出生后4~6周或矫正胎龄32周开始筛查，至周边视网膜血管化。 结果 85例早产儿中，有9例发生ROP，发病率10.58%。其中出生体重lt;1 500 g的早产儿ROP发病率为17.07%，孕周lt;30周的早产儿ROP发病率为40%。 结论 低体重、胎龄小、吸氧为早产儿发生ROP的重要危险因素；尽早进行眼底筛查是早期发现、诊断及治疗ROP的关键。【Abstract】 Objective To investigate the occurrence and risk factors of retinopathy of prematurity (ROP). Methods A total of 85 premature infants were enrolled from Sichuan provincial people′s hospital, Chengdu maternal and child health hospital, and Chengdu obstetric and gynecology hospital. The infants were born between December 2007 and December 2008, with a birth weight less than 2 000 g. The ocular funds examination was carried out four to six weeks after the birth or at the 32nd week of the corrected gestational age;the infants were followed up until the retina was entirely vascularized. Results ROP was found in 9 of the 85 premature infants, with a percentage of 10.58%. About 17.07% premature infants with a birth weight less than 1500 g and 40% infants with a gestational age shorter than 30 weeks had ROP. Conclusions A lower birth weight, a shorter gestational age and oxygen usage are the risk factors of ROP. It′s important to examine the ocular fundus in premature infants as early as possible so as to identify, diagnose and treat ROP at an early stage.
ObjectiveTo evaluate the effectiveness and complications associated with the use of ranibizumab in the treatment of ZoneⅠand ZoneⅡretinopathy of prematurity (ROP). MethodsData from patients of ROP who had received intravitreal ranibizumab (IVR) injections in Peking University People's Hospital for the treatment of ROP from July 2012 to December 2013 were collected. In total, 151 eyes from 85 patients (56 male and 29 female) were analyzed. The mean birth weight was (1438.6±334.5) g (range:790-2280 g), mean gestational age was (30.1±2.0) weeks (range:25-37 weeks), mean age at the time of intervention was (37.0±6.2) gestational weeks (range:32-45 weeks), mean follow-up was (4.9±3.3) months (range:1.4-20.8 months). The main outcome measures were the regression of ROP and the complications that were associated with the IVR injections. ResultsAfter receiving IVR injections, 120 eyes (79.5%) exhibited ROP regression after single injection. Twenty-six eyes (17.2%) required additional laser treatment for ROP regression after the absence of a positive response to the IVR injections. Five eyes (3%) progressed to stage 4 ROP and required vitrectomy to reattach the retinas. Fifty of 120 eyes which were regressed after single IVR had recurrence of ROP and need additional laser or additional IVR. All of the eyes (100.0%) had attached retinas after the various treatments that they received. No notable systemic complications related to the IVR injections were observed. ConclusionsIVR injection seems to be an effective and well-tolerated method to treat ZoneⅠand ZoneⅡROP. Recurrence of ROP is common and long-term follow up may be needed.