方法：前瞻性随访观察2014-06/2016-06由我院ROP筛查协作组在门诊以及NICU床旁筛查发现并进行视网膜激光光凝治疗的患儿186例372眼，激光光凝术后嵴前存在部分无血管区的患儿26例32眼，其中男17例18眼，女9例14眼，平均出生胎龄(29.4 ± 0.4)周，平均出生体质量1222.8 ± 70.3g，阈值前1型10例12眼，阈值期12例14眼、急性进展性后极部型4例6眼，分别于激光术后1、3、8、12wk行Retcam眼底照相复查，观察病变嵴、嵴前无血管区以及附加病变的消退情况。随访中如发现病变嵴或附加病变加重，则给予补充视网膜激光光凝或行玻璃体腔抗VEGF治疗，直至病变嵴和附加病变完全消退，病情稳定。

结果：患儿26例均在激光术后1wk复查时发现病变嵴前无血管区，但附加病变减轻，病变嵴由3期向2期、1期消退，阈值前1型消退最明显； 3wk复查时27眼(84%)病变嵴为1期或不明显、无血管区逐渐缩小，视网膜血管向周边发育； 5眼(16%)无血管区缩小不显著，附加病变(+～++)，病变嵴3～4期、或伴有出血，其中3眼(9%)为阈值期病变患儿，2眼(6%)为急性进展性后极部型患儿，遂及时给予补充视网膜光凝； 8wk复查，未补充视网膜光凝的27眼嵴前无血管区已血管化，嵴及附加病变消退； 补充光凝中3眼(9%)病情得到控制、稳定，其中阈值期2眼、急性进展性后极部型1眼，2眼(6%)嵴上新生血管消退不明显、附加病变依然存在，其中阈值期1眼、急性进展性后极部型1眼，故给予玻璃体腔抗VEGF治疗，12wk复查时见附加病变、病变嵴消退，视网膜血管向颞侧走形稍僵直。

结论：视网膜激光光凝是ROP治疗的有效方法，光凝术后嵴前部分无血管区多可自行发育完善。对于少数激光术后病情活动的阈值期及急性进展性后极部型嵴前部分无血管区需及时补充激光光凝治疗，必要时可联合玻璃体腔抗VEGF治疗。

METHODS: For a prospective follow-up observation from June 2014 to June 2016, 186 cases(372 eyes)underwent retinal laser photocoagulation were screened out in the ROP screening clinic and neonatal intensive care unit(NICU)bedside screening by the cooperative group of screening for ROP in our hospital. Non-vascularization area were exist in 26 cases(32 eyes). There were 17 male patients(18 eyes)and 9 females(14 eyes), the gestational age at birth was 29.4±0.4wk, and the average birth weight was 1222.8±70.3g. Among these cases, 10 patients(12 eyes)developed pre-threshold type 1 ROP, 12 patients(14 eyes)developed threshold ROP, and 4 cases(6 eyes)developed aggressive posterior-ROP. The Retcam fundus photography was performed at 1, 3, 8 and 12wk after laser surgery respectively. The changes of the non-vascularization area, the lesions and the additional lesions were observed. During following-up, if the lesions were found to increase, retinal laser photocoagulation or intravitreal injection of anti- vascular endothelial growth factor(VEGF)would be performed, until the lesions were completely under control.

RESULTS: In the all 26 patients, non-vascularization areas were found in 1wk after laser resection, but the lesions ridge dissipated from the stage 3 to stage 2 and stage 1. The dissipation were more obviously in patients with ROP of pre-threshold type 1. The range of non-vascularization areas was narrowed at 3wk in 27 eyes(84%), and the retinal vessels continued to develop to the surrounding areas,but in the other 5 eyes(16%),the non-vascularization areas were not significantly narrowed, the lesion ridge developed stage 3-4, with bleeding and proliferation phenomenon, then we timely to gave additional retinal laser photocoagulation. In these 5 eyes, 3(9%)developed threshold ROP, and 2 developed aggressive posterior-ROP. At the 8th week, 3 eyes(9%)of the 5 eyes were found with additional photocoagulation, the condition was controlled and stable. In 2 eyes(6%), the neovascularization disappeared in the ridge and the lesion was not found, then intravitreal injection of anti-VEGF were given. At the 12th week, the additional lesions in the 2 eyes had subsided, the ridge subsided, and the retinal blood vessels to the temporal shaped slightly stiff.

CONCLUSION: Retinal laser photocoagulation is an effective method for the treatment of retinopathy in premature infants. Most retinal blood vessels would develope in missing areas after the laser photocoagulation. A small proportion of patients need timely replenishment of laser photocoagulation treatment, if necessary, combined with intravitreal injection of anti-VEGF.