早产儿视网膜病课件

早产儿视网膜病变（ROP）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。早产儿视网膜病变（ROP）1发病机制BrianW.FleckandNeilMcIntosh.RetinopathyofPrematurity:RecentDevelopmentsNeoReviews,Jan2009;10.

NormalimmatureretinaNormalmatureretina发病机制BrianW.FleckandNeilMc2视网膜血管化Vascularizationoftheretinabeginsatapproximately16weeksgestationattheopticnerveandproceedsperipherally.Retinalvesselsreachtheoraserrata(theperipheryoftheeye)onthenasalsideat32weeksgestationandonthetemporalsideat36to40weeksgestation.Thenumbersinthefigureareweeksofgestation.视网膜血管化Vascularizationofther3ROP分区ROP分区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

MathewMR,JEye,2002;16(5):538-542ROP筛查合理统一的筛查标准：ROP筛查22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：

a.轻度病变：q2wb.阈值前病变2型：q1wc.阈值前病变1型：激光或冷凝随访方法

首次检查：生后4w23治疗激光治疗激光24早产儿视网膜病变（ROP）筛查目的是确认活动性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的新生儿。早产儿尤其低出生体重儿（体重＜1500g），除非有生命威胁的低血氧症，否则不主张长期用氧。更高的氧饱和度范围（95%~98%）对于依靠供氧的早产儿生长和发育无明显益处，而且将增加对健康的损伤。早产儿视网膜病变（ROP）筛查目的是确认活动性ROP，以便切25早产儿视网膜病变（ROP）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。早产儿视网膜病变（ROP）26发病机制BrianW.FleckandNeilMcIntosh.RetinopathyofPrematurity:RecentDevelopmentsNeoReviews,Jan2009;10.

NormalimmatureretinaNormalmatureretina发病机制BrianW.FleckandNeilMc27视网膜血管化Vascularizationoftheretinabeginsatapproximately16weeksgestationattheopticnerveandproceedsperipherally.Retinalvesselsreachtheoraserrata(theperipheryoftheeye)onthenasalsideat32weeksgestationandonthetemporalsideat36to40weeksgestation.Thenumbersinthefigureareweeksofgestation.视网膜血管化Vascularizationofther28ROP分区ROP分区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

MathewMR,JEye,2002;16(5):538-542ROP筛查合理统一的筛查标准：ROP筛查47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：

a.轻度病变：q2wb.阈值前病变2型：q1w