康柏西普治疗早产儿视网膜病变患儿屈光状态改变的临床研究

doi:10.3760/cma.j.cn115909-20210927-00398

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摘要目的：观察玻璃体腔注射康柏西普（IVC）治疗早产儿视网膜病变（ROP）患儿后的屈光状态改变，探讨ROP患儿屈光状态与注药次数、孕周、出生体质量、眼轴、视网膜血管发育情况之间的相关性。方法：前瞻性临床研究。选取2017年4月至2021年6月就诊于潍坊眼科医院并诊断为“2型ROP阈值前病变”的患儿64例（127眼）。根据其病情严重程度按需行IVC治疗，以治疗次数分为注药0次（A 组）共22例（43眼）、注药1次（B组）共30例（53眼）、注药2次（C组）共18例（31眼），在其矫正胎龄3、 6、12个月时，观察屈光状态，记录等效球镜度（SE）、散光、眼轴、视网膜血管分区等情况。3组SE 比较采用单因素方差分析，散光比较采用Kruskal-Wallis非参数检验，SE与孕周、出生体质量、眼轴及视网膜血管分区的关系采用Pearson及Spearman相关性分析。结果：矫正胎龄3个月和6个月时，3 组SE及散光差异均无统计学意义；矫正胎龄12个月时，3组SE及散光差异均有统计学意义（F=6.59, P=0.002; H=7.39, P=0.025）。进一步两两比较，A组与B组、A组与C组之间SE差异有统计学意义（P=0.006; P=0.007），A组与C组散光差异有统计学意义（P=0.020）。矫正胎龄12个月时，3组屈光不正发生率、近视率差异无统计学意义，散光发生率差异有统计学意义（χ2 =8.96, P=0.011）。进一步两两比较，A组与C组、B组与C组差异有统计学意义（χ2 =7.08, P=0.008; χ2 =6.82, P=0.009）。矫正胎龄 3个月时，SE与孕周（r=-0.18, P=0.043）、出生体质量（r=-0.19, P=0.032）、眼轴（r=-0.26, P=0.003）、视网膜血管分区（r=-0.20, P=0.023）均呈负相关；矫正胎龄6个月、12个月时，SE与眼轴呈负相关（r=-0.30, P=0.001）。结论：矫正胎龄12个月时，IVC治疗后ROP患儿远视储备低于自发消退的ROP 患儿，重复注药对ROP患儿短期屈光状态无显著影响。

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关键词 ：早产儿视网膜病变, 屈光状态, 近视, 散光, 康柏西普, 抗血管内皮生长因子

Abstract：Objective: To study the changes in the refractive status of children with retinopathy of prematurity (ROP) after intravitreal injection of combercept, and to explore the relationship between refractive status and the number of injections, gestational weeks, birth weight, axial length and retinal vascularization zone. Methods: In this prospective clinical study, infants diagnosed with type 2 ROP pre-threshold disease in Weifang Eye Hospital from April 2017 to June 2021 were recruited. All infants underwent high myopia gene detection. Finally, 127 eyes of 64 cases were included in this study. According to the severity of the disease, Intravitreal conbercept (IVC) treatment was performed on demand, and the treatment times were divided into 3 groups, 22 cases (43 eyes) of infants were included in group A (0 injection), 30 cases (53 eyes) of infants were included in group B (1 injection) and 18 cases (31 eyes) of infants were included in group C (2 injection). When the corrected gestational age was 3, 6 and 12 months, the refractive state changes were observed, and the spherical equivalent (SE), astigmatism, axial length and retinal vascularization zone were recorded. The refractive status of the three groups with different corrected gestational ages was compared to understand the relationship between refractive status and the number of injections, gestational weeks, birth weight, axial length and retinal vascularization zone. One-way ANOVA analysis of variance was used for the comparison of the SE in the three groups. The Kruskal-Wallis test was used for comparison of astigmatism. Pearson correlation analysis was used for data analysis on the correlation between equivalent spherical errors and the development of the ocular axis and the retinal vascularization zone. Results: At the corrected gestational age of 3 months and 6 months, there was no significant difference in SE and astigmatism among the three groups. At the corrected gestational age of 12 months, the average SE and astigmatism of groups A, B and C were statistically significant (F=6.59, P=0.002; H=7.39, P=0.025). Further comparison after ANOVA showed that the average SE difference between group A and group B and group A and group C was statistically significant (P=0.006; P=0.007). The difference in astigmatism between groups A and C was statistically significant (P=0.020). At the corrected gestational age of 12 months, there was no significant difference in the incidence of refractive error and myopia rate among the three groups. However, the incidence of astigmatism was statistically significant (χ2 =8.96, P=0.011). Further pairwise comparisons showed that the differences between group A and group C, group B and group C were statistically significant (χ2 =7.08, P=0.008; χ2 =6.82, P=0.009). At the corrected gestational age of 3 months, SE was related to gestational age (r=-0.18, P=0.043), birth weight (r=-0.19, P=0.032), and axial length (r=-0.26, P=0.003). The retinal vascular divisions (r=- 0.20, P=0.023) were all negatively correlated. When the corrected ages were 6 months and 12 months, SE was negatively correlated with axial length (r=-0.30, P=0.001). Conclusions: At the corrected gestational age of 12 months, the hyperopia reserve of children with ROP after IVC treatment is lower than that of children with spontaneous regression of ROP. Repeated injection has no significant effect on the short-term refractive status of children with ROP.

Key words： retinopathy of prematuriry refractive status myopia astigmatism conbercept anti-vascular endothelial growth factor

收稿日期: 2021-09-27

PACS:

基金资助:

山东省自然科学基金面上项目（ZR2021MH411）；
白求恩·浪沐中青年眼科科研基金（BJLM2019005J）；
潍坊市软科学研究计划项目（2021RKX104）

通讯作者: 张杰（ORCID: 0000-0003-3920-2980），Email：zhangjie9jiezuo@126.com

引用本文:

冉宏运, 任建涛, 李姝婵, 等.. 康柏西普治疗早产儿视网膜病变患儿屈光状态改变的临床研究[J]. 中华眼视光学与视觉科学杂志, 2022, 24(4): 298-303. Hongyun Ran, Jiantao Ren, Shuchan Li,et al. Clinical Study of Conbercept in the Treatment of Refractive Status Changes in Infants with Retinopathy of Prematurity. Chinese Journal of Optometry Ophthalmology and Visual science, 2022, 24(4): 298-303. DOI: 10.3760/cma.j.cn115909-20210927-00398

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20210927-00398 或 https://www.cjoovs.com/CN/Y2022/V24/I4/298

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