早产儿视网膜病课件

产儿视网膜病变（ROP）1对早产儿来说，眼部血管后半段的发育只能留在出生之后完成。在长时间、高

浓度（FiO2＞0.4）的血氧环境下，未发

育完成的眼底血管不再向视乳突边缘生长延伸，而是在原生长位膨胀、变粗、打结，纤维素渗出甚至出血，纤维膜形成，纤维收缩、牵拉，可使视网膜剥脱。发病机制Normal

immature

retinaBrian

W.

Fleck

and

Neil

McIntosh.

Retinopathy

of

Prematurity:Recent

Developments

NeoReviews,Jan

2009;10.2Normal

mature

retina视网膜血管化Vascularization

of

the

retina

begins

atapproximately

16

weeks

gestation

atthe

optic

nerve

and

proceedsperipherally.

Retinal

vessels

reach

the

ora

serrata

(the

periphery

of

theeye)

on

the

nasal

side

at

32weeksgestation

and

on

the

temporal

side

at36

to

40

weeks

gestation.

Thenumbers

in

the

figure

are

weeks

ofgestation.3ROP分区4Hemisectionlooking

downinto

the

left

eyewith

thetemporal

side

tothe

left

and

thenasal

side

to

theright.5Classification.Stage1.6ROP

I7Stage

1.

Demarcation

lineA

flat

line

of

demarcation

occurs

between

the

vascular

and

avascular

retina.8ROP

II9Ridge.10Stage

2.

RidgeThe

line

of

demarcation

acquires

volume

to

become

a

ridge.11ROP

III12Stage

3

ROP

in

Zone

II.Extraretinal

fibrovascular

proliferationNeovascularization

can

be

seen

within

the

ridge,

and

extraretinalvascularization

extends

out

of

the

retina.13ROP

IV

B14Retinal

Detachment.154A:extrafoveal164B:fovealStage

4

ROP

Partialretinal

detachmentROP

V17Retinal

Detachment.18Stage5.Total

retinal

detachment19From

the

United

Kingdom

Guidelines

for

the

Screening

and

Treatment

ofRetinopathy

of

Prematurity.20ROP

Plus

Disease:increased

venous

dilatationarteriolar

tortuosity

of

the

posterior

retinal

vessels.Two

quadrants

of

the

eye

must

be

involved

for

the

changes

to

be

characterised

as

plus

disease.21合理统一的筛查标准：美国ROP筛查标准为BW<1500g或胎

龄<28周英国ROP筛查标准为BW<1500g或胎

龄<31周研究认为BW<1250g或胎龄<30周,最经济有效22ROP筛查随访方法首次检查：生后4w随访时间：随访至视网膜发育成熟或病变

稳定完全血管化：3w无

ROP：

q2w发现ROP：轻度病变：q2w阈值前病变2型：q1w阈值前病变1型：激光或冷凝23治疗激光24产儿视网膜病变（ROP）筛查25目的是确认活动性ROP，以便切除病变视网膜而复原，阻止瘢痕愈合而造成失明最高危的新生儿是那些出生体重＜750g的新生