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ROP病理生理学,筛查和治疗:一项多学科研究方法

Chan-Ling, T., Gole, G.A., Quinn, G.E., Adamson, S.J., Darlow, B.A.

期刊名称:Progress in Retinal and Eye Research

卷期:2018年第62卷

摘要

摘要:在世界范围内,早产儿视网膜病变(ROP)风险的婴儿的数量有所不同; 在新生儿重症监护服务发展程度比较高的国家 ,患病风险最高的是未到28周胎龄(GA)和体重小于1公斤的新生儿,而在新生儿重症和眼科保健的许多方面存在很多不足的地区,出生时体重2000 g以及37周胎龄的更成熟的婴儿也存在患有视网膜病变的风险。两组患者的治疗方案包括标准视网膜激光光凝术以及更新一些的一种血管内皮生长因子抗体药物。除了对视网膜病变的检测和治疗,本文还强调了远程医疗所带来的治疗新手段:在偏远地区的视网膜病变筛查和诊断可以由使用数码眼底照相机的非眼科医生进行。视网膜病变婴儿的眼科护理是在新生儿护理和婴儿总体健康这个更广泛的背景下进行的。由于这一背景,这篇综述采用了多学科视角,将视网膜血管生物学家、儿科眼科医生、流行病学家和新生儿学家作出贡献集为一处。本文突出强调了在人类婴儿的视网膜血管形成过程中有关的细胞和分子机制的最新见解,视网膜病变的发病机理, 严重的视网膜病变诊断和治疗,抗血管治疗的风险和益处, 已露端倪的新疗法的鉴定,和针对视网膜病变最佳的新生儿护理方案,以及利用远程医疗进行视网膜病变的远程筛查和诊断的好处和缺陷,所有这些都有可能改善早产儿视网膜病变的现状。

The population of infants at risk for retinopathy of prematurity (ROP) varies by world region; in countries with well developed neonatal intensive care services, the highest risk infants are those born at less than 28 weeks gestational age (GA) and less than 1 kg at birth, while, in regions where many aspects of neonatal intensive and ophthalmological care are not routinely available, more mature infants up to 2000 g at birth and 37 weeks GA are also at risk for severe ROP. Treatment options for both groups of patients include standard retinal laser photocoagulation or, more recently, intravitreal anti-VEGF drugs. In addition to detection and treatment of ROP, this review highlights new opportunities created by telemedicine, where screening and diagnosis of ROP in remote locations can be undertaken by non-ophthalmologists using digital fundus cameras. The ophthalmological care of the ROP infant is undertaken in the wider context of neonatal care and general wellbeing of the infant. Because of this context, this review takes a multi-disciplinary perspective with contributions from retinal vascular biologists, pediatric ophthalmologists, an epidemiologist and a neonatologist. This review highlights the latest insights regarding cellular and molecular mechanisms in the formation of the retinal vasculature in the human infant, pathogenesis of ROP, detection and treatment of severe ROP, the risks and benefits of anti-VEGF therapy, the identification of new therapies over the horizon, and the optimal neonatal care regimen for best ROP outcomes, and the benefits and pitfalls of telemedicine in the remote screening and diagnosis of ROP, all of which have the potential to improve ROP outcomes.


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