作者：杜红俊,徐 渊,胡 丹,董责红,王海燕,王雨生
作者单位：中国陕西省西安市，第四军医大学西京医院眼科 全军眼科研究所
【摘要】 目的：报道1例角膜接触镜治疗准分子激光原位角膜磨镶术（laser in situkeratomileusis，LASIK）术后双眼圆锥角膜3a随访结果，并对相关文献进行简要回顾。方法：一位27岁的女性患者行常规LASIK治疗中度近视。术前散瞳验光的结果为右眼5.50/0.50×50°和左眼 4.50/1.00×15°。中央角膜厚度分别为右眼526μm和左眼541μm。术前角膜地形图正常，没有显示任何圆锥角膜或者亚临床期圆锥角膜的改变。手术中制作160μm角膜瓣后进行激光切削，切削深度分别是右眼102μm和左眼86μm，预计剩余角膜厚度为264μm和295μm。结果：术后29mo，患者双眼出现明显视力下降，下方角膜膨出，中央角膜曲率变大。验光结果分别为右眼12.50/ 4.00×160°和左眼 6.00/ 4.25×125°。中央角膜厚度变薄。诊断双眼继发性圆锥角膜，给予硬性角膜接触镜配戴。3a的随访（期间曾两次更换镜片）显示患者病情基本稳定，视力矫正满意，接触镜全天佩戴耐受性良好，并发症较少。 结论：虽然经过严格的术前筛查，轻度到中度的近视LASIK治疗术后仍可能出现继发性圆锥角膜。硬性角膜接触镜是改善此类患者视力安全和可逆的方法，也可以延迟或避免患者进行角膜内基质环的植入和穿透性角膜移植。
【关键词】 圆锥角膜；近视；准分子激光原位角膜磨镶术；角膜接触镜·Original article·
Retinopathy of prematurity screening in a tertiarycare hospital in Malaysia
M M Choo1, U T Chan1, N Khalidin1, C T Lim2
1Department of Ophthalmology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
2Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
AbstractAIM: To determine the incidence and trend of retinopathy of prematurity (ROP) cases in a tertiarycare hospital in Malaysia.
METHODS: This was a retrospective study of infants born in 2003 to 2005 who underwent screening for ROP. The outcome measures included the worst stage of ROP recorded for each patient.
RESULTS: 188 infants were screened. Their mean birth weight was 1105.3±300.6 grams and mean gestation was 29.2±2.6 weeks. The overall incidence of ROP detection in these babies was 29.18 % (55/188). The incidence was 76.2% for babies whose birth weight was 750 grams or less. The trend over the three years showed an increase in the number of smaller sized infants and an increase in the number of cases developing severe ROP (P<0.05). There was negative correlation (P=0.000) between the number of examinations performed on the infant and birth weight. Birth weight below 751 grams required 2.4 times more examinations than infants between 751 to 1250 grams.
CONCLUSION: There was an increase in the percentage of cases detected to have ROP as the proportion of infants with lower birth weight and gestational age increased.
KEYWORDS: retinopathy of prematurity screening; incidence of ROP; risk factors
Choo MM, Chan UT, Khalidin N, Lim CT. Retinopathy of prematurity screening in a tertiarycare hospital in Malaysia. Int J
Ophthalmol(Guoji Yanke Zazhi)2008;8(11):21732177
INTRODUCTION
Retinopathy of prematurity (ROP) is a disease seen in premature infants which results in the finding of a proliferative vasculopathy, much similar to proliferative diabetic retinopathy [1]. Mild stages of ROP can regress spontaneously. However, in patients whose disease does not regress, the disease can progress to a more severe stage which may be complicated by vitreous haemorrhage and tractional retinal detachment, leading to blindness. These are mainly seen in patients with Threshold disease (Stage 3 ROP) and patients with Zone 1 ROP (as well as other Prethreshold disease) [2].
Treatment of ROP with Threshold or Prethreshold disease needs to be instituted as early as within 72 hours of detection as any delay will result in rapid deterioration, beyond treatment [1,3,4] . Treatment refers to the application of diode laser photocoagulation or cryotherapy to areas of nonvascularized retina.
The purpose of this study was to report on the ROP screening program and findings of premature infants admitted to the Special Care Nursery (SCN) in University of Malaya Medical Centre (UMMC), which is a tertiary referral centre. We also wanted to study the yearly incidence of this condition and to see if there were changes in the pattern of ROP disease detected over a 3year period. A comparison of our screening criteria will be made with the guidelines recommended by the Clinical Practice Guidelines on Management of Acute Retinopathy of Prematurity published by the Malaysian Ministry of Health and to assess if there is a need to change the screening criteria in UMMC.
MATERIALS AND METHODS
This was a retrospective study of premature infants born between 1 Jan 2003 to 31 Dec 2005 and subsequently admitted to the SCN in UMMC who underwent screening for ROP. The selection criteria for paediatrician referral of infants for ROP screening were gestational age ≤32 weeks, birth weight <1251 grams, ventilation ≥7 days and oxygen use for >1 month regardless of gestational age or birth weight. The first screening was performed at 4 weeks of chronological age.
The outcome measures included the presence or absence of ROP and the worst stage of ROP recorded for each patient. Information collected into a proforma for each patient included gestation, birth weight, perinatal history, medical problems, ROP findings at each examination, the total number of screening examinations conducted and total number of treatment sessions. The disease staging was according to the ICROP staging for ROP[2].
All the necessary clinical findings were entered into a standard proforma and the data were entered into the SPSS program 12.0 for statistical analysis. This study was approved by the Ethical Committee of the UMMC and was carried out in accordance with the Declaration of Helsinki.
RESULTS
The SCN ward in UMMC admitted a total of 221 babies born between 1 Jan 2003 to 31 Dec 2005. A total of 188 infants survived to undergo screening at the SCN in UMMC, based on the criteria for referral for ROP Screening of this hospital. The mean birth weight was 1105.28±300.56 grams (n=188) and mean gestation at birth was 29.18±2.54 weeks (n=188). ROP was detected in 55 out of 188 cases screened giving an overall incidence of 29.3% (55/188) (Table 1) and the differences in mean was significant for both gestation (P<0.001) and birth weight (P<0.001). The mean birth weight of our study patients who developed Stage 3 ROP was 833.5±206.5 grams (n=24, range: 600 1545). All Stage 3 ROP occurred in Zone 2. Three patients developed Zone 1 disease and their mean birth weight was 512±128.3 grams (n=3, range: 432 610).
The breakdown of birth weight of the screened infants is shown in Figure 1. In 2005, a higher number of infants whose birth weight was 750 grams or less were examined compared to year 2003 and 2004 (Figure 1). In 2003 and 2004, a large number of infants screened weighed over 1750 grams but in 2005, only one of the infant screened weighed more than 1750 grams. The gestational age of the screened infants are shown in Figure 2. There was a steep rise in the number of cases who underwent ROP screening whose gestational age was 24 to 26 weeks.
Table 2 shows the ROP screening findings for infants screened in 2003 to 2005. The number of cases screened had risen from 2003 to 2005. There was also an increase in the number of severe ROP cases (Stage 3 or worse) from 2003 to 2005. Of the 55 cases in whom ROP was detected, 50.9% (28/55) patients had Stage 1 or 2, 49.1% (27/55) patients had Stage 3 or worse (Table 2). A further look at the patients who had ROP showed that Stage 3 was found in 5/55 (9.1%) cases in 2003, 7/68 (10.3%) cases in 2004 and 15/65 (23.1%) cases in 2005 (Table 2). This difference was statistically significant.
There was an increase in the number of babies weighing less than 751 grams who were admitted to the SCN comparing 2003 with 2005 (Figure 3), and the number of infants who survived to undergo ROP screening examination had also increased yearly from 2003 to 2005.
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