早产儿视网膜病变:从氧气管理到分子操作。

IF 2.4 Q1 PEDIATRICS Molecular and cellular pediatrics Pub Date : 2023-09-15 DOI:10.1186/s40348-023-00163-5
Jonathan Woods, Susmito Biswas
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摘要

简介:早产儿视网膜病变(ROP)是一种早产儿视网膜血管增殖性疾病,有可能发展为视网膜外新生血管。本文就早产儿视网膜病变(ROP)的病理生理、诊断和治疗的关键部分作一综述。传统上,ROP是通过间接眼科检查诊断的,并根据解剖区域、疾病分期和有无“附加疾病”(主要视网膜小动脉和小静脉的扩张和扭曲)进行分类。ROP具有双期病理生理:最初的高氧导致视网膜血管化减少,随后由血管内皮生长因子(VEGF)驱动的缺氧导致病理性血管增殖。管理方面的进展:本综述总结了以前在新生儿中建立最佳氧暴露水平的试验,以及最近局部递送抗vegf药物以阻断病理性新生血管的发展,这在技术上比激光治疗更容易管理且破坏性更小。未来方向:玻璃体内给药抗vegf对早产儿整体发育的潜在不良全身影响仍是一个持续关注的问题。正在进行的剂量研究可以通过确定阻断视网膜外新生血管所需的最低有效剂量来减轻这些担忧。
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Retinopathy of prematurity: from oxygen management to molecular manipulation.

Introduction: Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the premature retina with the potential to progress to extraretinal neovascularisation. This review serves as an introduction to retinopathy of prematurity (ROP), outlining key parts of ROP pathophysiology, diagnosis and treatment. ROP is traditionally diagnosed by indirect ophthalmoscopy and classified using anatomical zones, stages of disease, and the presence or absence of "plus disease" (dilation and tortuosity of the major retinal arterioles and venules). ROP has a bi-phasic pathophysiology: initial hyperoxia causes reduced retinal vascularisation, followed by pathological vaso-proliferation resulting from subsequent hypoxia and driven by vascular endothelial growth factor (VEGF).

Advancements in management: This review summarises previous trials to establish optimum oxygen exposure levels in newborns and more recently the development of anti-VEGF agents locally delivered to block pathological neovascularisation, which is technically easier to administer and less destructive than laser treatment.

Future directions: There remains an ongoing concern regarding the potential unwanted systemic effects of intravitreally administered anti-VEGF on the overall development of the premature baby. Ongoing dosing studies may lessen these fears by identifying the minimally effective dose required to block extraretinal neovascularisation.

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