Abstract
A review of literature was performed, focused on the etiopathogenesis of aggressive posterior retinopathy of prematurity (APROP), the characteristic and atypical clinical features, management strategies, anatomical and visual outcomes. Characteristically APROP has zone I/posterior zone II involvement with prominent plus disease, featureless junction, large vascular loops, flat extra-retinal fibrovascular proliferation, and a rapidly progressive course. The risk factors for APROP are extreme prematurity (birth weight ≤1000 gram and/or gestational age ≤28 weeks), dysregulated oxygen supplementation, intrauterine growth retardation, sepsis, and thrombocytopenia. The uncommon presentations include small zone I disease, a hybrid disease with additional ridge tissue, and APROP in bigger babies with birth weight greater than 1500 g. Laser photocoagulation role is limited by the resultant visual field loss and high refractive error. Although anti-vascular endothelial growth factor injection allows peripheral retinal vascularization; reactivation of disease, systemic absorption of the drug and long-term safety are the chief concerns. Early vitrectomy is required when tractional retinal detachment develops. The visual outcome depends upon the morphology and vascular development of the macula. With the limited yet emerging new understanding of the pathophysiology, a multifaceted rational and individualized treatment strategy is suggested for APROP. Best practices in neonatal intensive care may prevent the occurrence of APROP. Further studies need to be performed for the prevention and safe, effective management of APROP.
摘要
急性进展性后极部早产儿视网膜病变的最新文献综述
摘要:
本文回顾了相关文献, 着重讨论急性进展性后极部早产儿视网膜病变 (aggressive posterior retinopathy of prematurity, APROP) 的发病机制、临床特征、非典型临床特征、治疗策略、解剖及视力的临床结局。APROP的特征性表现为视网膜I区/ 后极部II区受累并且伴有显著的附加病变: 无特征性粘连、大血管袢、平的重度视网膜纤维血管增殖以及病程进展迅速。APROP的危险因素为极度早产儿 (出生体重≤1000克和/或孕周28周) 、吸氧治疗管理不佳、宫内发育迟缓、败血症和血小板减少症。不常见的临床表现包括小范围I区病变、带有额外脊状组织的融合病变, 以及出生体重大于1500克的较大婴儿的APROP。激光光凝由于会导致视野缺损和严重的屈光不正而应用受限。虽然玻璃体内抗血管内皮生长因子注射可导致周边视网膜血管化, 但疾病再度活跃、药物的全身吸收以及长期安全性是主要考虑的因素。当牵拉性视网膜脱离发生时, 需要及早行玻璃体切除术。视力结局取决于黄斑形态和血管的发育。随着我们对APROP病理生理学虽然有限但不断深入的认识, 全面且合理的个体化治疗策略已经提出。最佳的新生儿重症监护可预防APROP发生。为了预防、安全、有效地管理APROP, 需要进行进一步的研究.
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Kumawat, D., Sachan, A., Shah, P. et al. Aggressive posterior retinopathy of prematurity: a review on current understanding. Eye 35, 1140–1158 (2021). https://doi.org/10.1038/s41433-021-01392-6
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DOI: https://doi.org/10.1038/s41433-021-01392-6
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