早產(chǎn)兒視網(wǎng)膜病課件

早產(chǎn)兒視網(wǎng)膜病變（ROP）對早產(chǎn)兒來說，眼部血管后半段的發(fā)育只能留在出生之后完成。在長時間、高濃度（FiO2＞0.4）的血氧環(huán)境下，未發(fā)育完成的眼底血管不再向視乳突邊緣生長延伸，而是在原生長位膨脹、變粗、打結(jié)，纖維素滲出甚至出血，纖維膜形成，纖維收縮、牽拉，可使視網(wǎng)膜剝脫。早產(chǎn)兒視網(wǎng)膜病變（ROP）1發(fā)病機制BrianW.FleckandNeilMcIntosh.RetinopathyofPrematurity:RecentDevelopmentsNeoReviews,Jan2009;10.

NormalimmatureretinaNormalmatureretina發(fā)病機制BrianW.FleckandNeilMc2視網(wǎng)膜血管化Vascularizationoftheretinabeginsatapproximately16weeksgestationattheopticnerveandproceedsperipherally.Retinalvesselsreachtheoraserrata(theperipheryoftheeye)onthenasalsideat32weeksgestationandonthetemporalsideat36to40weeksgestation.Thenumbersinthefigureareweeksofgestation.視網(wǎng)膜血管化Vascularizationofther3ROP分區(qū)ROP分區(qū)4Hemisectionlookingdownintothelefteyewiththetemporalsidetotheleftandthenasalsidetotheright.Hemisectionlookingdowninto5Classification.Stage1.Classification.Stage1.6ROPIROPI7Stage1.DemarcationlineAflatlineofdemarcationoccursbetweenthevascularandavascularretina.Stage1.Demarcationline8ROPIIROPII9Ridge.Ridge.10Stage2.RidgeThelineofdemarcationacquiresvolumetobecomearidge.Stage2.Ridge11ROPIIIROPIII12Stage3ROPinZoneII.ExtraretinalfibrovascularproliferationNeovascularizationcanbeseenwithintheridge,andextraretinalvascularizationextendsoutoftheretina.Stage3ROPinZoneII.Extrar13ROPIVBROPIVB14RetinalDetachment.RetinalDetachment.154A:extrafoveal4B:fovealStage4ROPPartialretinaldetachment4A:extrafoveal4B:fovealStage16ROPVROPV17RetinalDetachment.RetinalDetachment.18Stage5.

TotalretinaldetachmentStage5.

Totalretinaldetachm19FromtheUnitedKingdomGuidelinesfortheScreeningandTreatmentofRetinopathyofPrematurity.FromtheUnitedKingdomGuidel20ROPPlusDisease:increasedvenousdilatationarteriolartortuosityoftheposteriorretinalvessels.Twoquadrantsoftheeyemustbeinvolvedforthechangestobecharacterisedasplusdisease.ROPPlusDisease:21合理統(tǒng)一的篩查標準：美國ROP篩查標準為BW<1500g或胎齡<28周英國ROP篩查標準為BW<1500g或胎齡<31周研究認為BW<1250g或胎齡<30周,最經(jīng)濟有效

MathewMR,JEye,2002;16(5):538-542ROP篩查合理統(tǒng)一的篩查標準：ROP篩查22隨訪方法

首次檢查：生后4w隨訪時間：隨訪至視網(wǎng)膜發(fā)育成熟或病變穩(wěn)定完全血管化：3w無ROP：q2w發(fā)現(xiàn)ROP：

a.輕度病變：q2wb.閾值前病變2型：q1wc.閾值前病變1型：激光或冷凝隨訪方法

首次檢查：生后4w23治療激光治療激光24早產(chǎn)兒視網(wǎng)膜病變（ROP）篩查目的是確認活動性ROP，以便切除病變視網(wǎng)膜而復(fù)原，阻止瘢痕愈合而造成失明最高危的新生兒是那些出生體重＜750g的新生兒。早產(chǎn)兒尤其低出生體重兒（體重＜1500g），除非有生命威脅的低血氧癥，否則不主張長期用氧。更高的氧飽和度范圍（95%~98%）對于依靠供氧的早產(chǎn)兒生長和發(fā)育無明顯益處，而且將增加對健康的損傷。早產(chǎn)兒視網(wǎng)膜病變（ROP）篩查目的是確認活動性ROP，以便切25早產(chǎn)兒視網(wǎng)膜病變（ROP）對早產(chǎn)兒來說，眼部血管后半段的發(fā)育只能留在出生之后完成。在長時間、高濃度（FiO2＞0.4）的血氧環(huán)境下，未發(fā)育完成的眼底血管不再向視乳突邊緣生長延伸，而是在原生長位膨脹、變粗、打結(jié)，纖維素滲出甚至出血，纖維膜形成，纖維收縮、牽拉，可使視網(wǎng)膜剝脫。早產(chǎn)兒視網(wǎng)膜病變（ROP）26發(fā)病機制BrianW.FleckandNeilMcIntosh.RetinopathyofPrematurity:RecentDevelopmentsNeoReviews,Jan2009;10.

NormalimmatureretinaNormalmatureretina發(fā)病機制BrianW.FleckandNeilMc27視網(wǎng)膜血管化Vascularizationoftheretinabeginsatapproximately16weeksgestationattheopticnerveandproceedsperipherally.Retinalvesselsreachtheoraserrata(theperipheryoftheeye)onthenasalsideat32weeksgestationandonthetemporalsideat36to40weeksgestation.Thenumbersinthefigureareweeksofgestation.視網(wǎng)膜血管化Vascularizationofther28ROP分區(qū)ROP分區(qū)29Hemisectionlookingdownintothelefteyewiththetemporalsidetotheleftandthenasalsidetotheright.Hemisectionlookingdowninto30Classification.Stage1.Classification.Stage1.31ROPIROPI32Stage1.DemarcationlineAflatlineofdemarcationoccursbetweenthevascularandavascularretina.Stage1.Demarcationline33ROPIIROPII34Ridge.Ridge.35Stage2.RidgeThelineofdemarcationacquiresvolumetobecomearidge.Stage2.Ridge36ROPIIIROPIII37Stage3ROPinZoneII.ExtraretinalfibrovascularproliferationNeovascularizationcanbeseenwithintheridge,andextraretinalvascularizationextendsoutoftheretina.Stage3ROPinZoneII.Extrar38ROPIVBROPIVB39RetinalDetachment.RetinalDetachment.404A:extrafoveal4B:fovealStage4ROPPartialretinaldetachment4A:extrafoveal4B:fovealStage41ROPVROPV42RetinalDetachment.RetinalDetachment.43Stage5.

TotalretinaldetachmentStage5.

Totalretinaldetachm44FromtheUnitedKingdomGuidelinesfortheScreeningandTreatmentofRetinopathyofPrematurity.FromtheUnitedKingdomGuidel45ROPPlusDisease:increasedvenousdilatationarteriolartortuosityoftheposteriorretinalvessels.Twoquadrantsoftheeyemustbeinvolvedforthechangestobecharacterisedasplusdisease.ROPPlusDisease:46合理統(tǒng)一的篩查標準：美國ROP篩查標準為BW<1500g或胎齡<28周英國ROP篩查標準為BW<1500g或胎齡<31周研究認為BW<1250g或胎齡<30周,最經(jīng)濟有效

MathewMR,JEye,2002;16(5):538-542ROP篩查合理統(tǒng)一的篩查標準：ROP篩查47隨訪方法

首次檢查：生后4w隨訪時間：隨訪至視網(wǎng)膜發(fā)育成熟或病變穩(wěn)定完全血管化：3w無ROP：q2w發(fā)現(xiàn)ROP：

a.輕度病變：q2wb.閾值前病變2型：q1w