Retinopathy of prematurity: the need for prevention.
Retinopathy of prematurity: the need for prevention.
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作者：
Liegl R;Hellström A;Smith LE
在美国，每年有超过45万婴儿早产。即使是最脆弱的低体重早产儿的存活率提高，尽管改善了健康结果，但导致早产并发症的复苏，包括儿童失明的主要原因之一，早产儿视网膜病变（ROP）。目前ROP治疗的主流是激光光凝和在新血管形成开始后的疾病晚期注射血管内皮生长因子（VEGF）抗体。这两种方法都是眼科医生治疗严重的晚期ROP的有效选择。然而，激光光凝破坏视网膜的主要部分，并且注射VEGF抗体，尽管施用相当简单，但可能引起正常血管形成的全身抑制，这尚未进行足够深入的研究。然而，VEGF抗体和激光治疗都不能预防ROP，这应该是长期目标。通过更密切地模拟早产后的宫内环境，应该可以预防ROP。这些预防措施包括预防出生后的毒性影响（例如，氧过量）以及提供缺失的宫内因子（例如，胰岛素生长因子1），并且可能还减少早产的其他并发症以及ROP。本文旨在总结目前对ROP的预防知识，特别强调胰岛素生长因子1补充剂的使用。
More than 450,000 babies are born prematurely in the USA every year. The improved survival of even the most vulnerable low body weight preterm infants has, despite improving health outcomes, led to the resurgence in preterm complications including one of the major causes for blindness in children, retinopathy of prematurity (ROP). The current mainstay in ROP therapy is laser photocoagulation and the injection of vascular endothelial growth factor (VEGF) antibodies in the late stages of the disease after the onset of neovascularization. Both are proven options for ophthalmologists to treat the severe forms of late ROP. However, laser photocoagulation destroys major parts of the retina, and the injection of VEGF antibodies, although rather simple to administer, may cause a systemic suppression of normal vascularization, which has not been studied in sufficient depth. However, the use of neither VEGF antibody nor laser treatment prevents ROP, which should be the long-term goal. It should be possible to prevent ROP by more closely mimicking the intrauterine environment after preterm birth. Such preventive measures include preventing the toxic postbirth influences (eg, oxygen excess) as well as providing the missing intrauterine factors (eg, insulin growth factor 1) and are likely to also reduce other complications of premature birth as well as ROP. This review is meant to summarize the current knowledge on the prevention of ROP with a particular emphasize on the use of insulin growth factor 1 supplementation.