Retinal, visual, and refractive development in retinopathy of prematurity.
Retinal, visual, and refractive development in retinopathy of prematurity.
复制标题
作者：
Moskowitz A;Hansen RM;Fulton AB
神经感觉视网膜在早产儿视网膜病变（ROP）疾病过程中的关键作用已在大鼠模型中得到充分证明。我们假设类似的细胞过程在人类ROP中起作用，并在一系列关于婴儿和儿童感光器和受体后外周和中央视网膜的非侵入性研究中评估了这些假设。关键的结果是光转导动力学减慢和感光细胞敏感性不足，在ROP根据临床标准完全解决后持续数年。另一方面，无论ROP的严重程度如何，受体后敏感性的缺陷都存在于婴儿期，但如果ROP非常轻微，不需要治疗并且在没有临床痕迹的情况下解决，则不存在于年龄较大的儿童中。伴随着光感受器敏感性的持续缺陷，在ROP受试者的外周视网膜中存在增加的感受野大小和感受器后视网膜层的增厚。在调节视敏度的晚期成熟的中央视网膜中，受体后视网膜中多焦视网膜电图活动的衰减导致我们发现黄斑区的浅中心凹凹陷和受体后视网膜层的显著增厚;这最有可能是由于中心凹发育期间受体后细胞的正常离心运动失败。至于屈光发育，ROP受试者的近视（有时为高度近视）比对照受试者更常见，这与其他前早产儿人群的屈光结果雅阁。关于感觉神经视网膜的信息增强了对具有ROP病史的患者的视力的理解，并且作为一个整体，提高了感觉神经视网膜是治疗干预的目标的可能性。
The pivotal role of the neurosensory retina in retinopathy of prematurity (ROP) disease processes has been amply demonstrated in rat models. We have hypothesized that analogous cellular processes are operative in human ROP and have evaluated these presumptions in a series on non-invasive investigations of the photoreceptor and post-receptor peripheral and central retina in infants and children. Key results are slowed kinetics of phototransduction and deficits in photoreceptor sensitivity that persist years after ROP has completely resolved based on clinical criteria. On the other hand, deficits in post-receptor sensitivity are present in infancy regardless of the severity of the ROP but are not present in older children if the ROP was so mild that it never required treatment and resolved without a clinical trace. Accompanying the persistent deficits in photoreceptor sensitivity, there is increased receptive field size and thickening of the post-receptor retinal laminae in the peripheral retina of ROP subjects. In the late maturing central retina, which mediates visual acuity, attenuation of multifocal electroretinogram activity in the post-receptor retina led us to the discovery of a shallow foveal pit and significant thickening of the post-receptor retinal laminae in the macular region; this is most likely due to failure of the normal centrifugal movement of the post-receptor cells during foveal development. As for refractive development, myopia, at times high, is more common in ROP subjects than in control subjects, in accord with refractive findings in other populations of former preterms. This information about the neurosensory retina enhances understanding of vision in patients with a history of ROP, and taken as a whole, raises the possibility that the neurosensory retina is a target for therapeutic intervention.