目的：观察视网膜光凝术联合玻璃体腔注射低剂量雷珠单抗治疗急进型后极部早产儿视网膜病变(ROP)的疗效。

方法：选取2016-03/2018-05在我院新生儿中心住院筛查确诊为双眼急进型后极部ROP的患儿18例36眼，随机分为注药组和联合组，各9例18眼。注药组行玻璃体腔注射雷珠单抗0.4mg，联合组行后极部Ⅰ区及其颞侧2个视乳头直径以外无血管区域激光光凝联合玻璃体腔注射雷珠单抗0.25mg。术后随访12mo以上，观察两组患儿视网膜无血管区血管发育情况，血管嵴、附加病变、虹膜红变消退时间及不良反应发生情况。

结果：术后平均随访18.7±6.3mo，两组患儿视网膜病变和虹膜红变均不同程度消退，视网膜血管继续向周边发育至锯齿缘或病变瘢痕化； 注药组患儿血管嵴、附加病变、虹膜红变消退时间(2.01±0.32、1.92±0.51、1.59±0.07wk)均大于联合组(1.75±0.29、1.75±0.29、1.34±0.18wk)(均P<0.05)； 注药组新增视网膜前出血3眼，出血均自行吸收，联合组未出现局部出血及纤维增生。两组患儿术中和术后均未出现严重眼部和全身不良反应。

结论：激光光凝术联合玻璃体腔注射低剂量雷珠单抗治疗急进型后极部ROP安全、有效。

METHODS: Medical records of 36 eyes of 18 premature infants with a primary diagnosis of AP-ROP were reviewed and analyzed retrospectively. All the lesions were located in posterior zone, with 22 eyes in zone 1 and 14 eyes in zone 2. Six eyes had iris rubeosis, while 8 eyes combined with vitreous hemorrhage. All participants were divided into injection group(0.4mg)or combined group(0.25mg)randomly. Laser photocoagulation was applied on the avascular retina, sparing two-disc diameter width temporal avascular area anterior to ridge in the combined group, meanwhile, a minimal dose(0.25mg)of IVR was conducted. Follow-up ranged from 12-24mo, with a mean of 18.7±6.3mo. The anatomical results and complications were recorded after treatment.

RESULTS: AP-ROP regressed after single therapy in two groups. No infants had localized proliferation or detachment post total treatment. The regression time of neovascular ridges and plus-diseases were 2.01±0.32 and 1.92±0.51wk respectively in injection group, and both were 1.75±0.29wk in combined group. The differences between those two groups were statistically significant(t=3.32, 4.16; P<0.05). The regression time of rubeosis was 1.59±0.07wk in injection group, 1.34±0.18wk in combined group. The differences between those two groups were statistically significant(P<0.05).

CONCLUSION: The combination of laser photocoagulation and intravitreal injection of minimal dosage of ranibizumab is safe and effective in the treatment of AP-ROP.