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Pathophysiology, screening and treatment of ROP: A multi-disciplinary perspective

机译：ROP的病理生理学，筛查和治疗：多学科视角

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摘要

Abstract The population of infants at risk for retinopathy of prematurity (ROP) varies by world region; in countries with well developed neonatal intensive care services, the highest risk infants are those born at less than 28 weeks gestational age (GA) and less than 1?kg?at birth, while, in regions where many aspects of neonatal intensive and ophthalmological care are not routinely available, more mature infants up to 2000 g at birth and 37?weeks?GA are also at risk for severe ROP. Treatment options for both groups of patients include standard retinal laser photocoagulation or, more recently, intravitreal anti-VEGF drugs. In addition to detection and treatment of ROP, this review highlights new opportunities created by telemedicine, where screening and diagnosis of ROP in remote locations can be undertaken by non-ophthalmologists using digital fundus cameras. The ophthalmological care of the ROP infant is undertaken in the wider context of neonatal care and general wellbeing of the infant. Because of this context, this review takes a multi-disciplinary perspective with contributions from retinal vascular biologists, pediatric ophthalmologists, an epidemiologist and a neonatologist. This review highlights the latest insights regarding cellular and molecular mechanisms in the formation of the retinal vasculature in the human infant, pathogenesis of ROP, detection and treatment of severe ROP, the risks and benefits of anti-VEGF therapy, the identification of new therapies over the horizon, and the optimal neonatal care regimen for best ROP outcomes, and the benefits and pitfalls of telemedicine in the remote screening and diagnosis of ROP, all of which have the potential to improve ROP outcomes. Highlights ? This review takes a multi-disciplinary perspective on ROP, bringing together contributions from retinal vascular biologists, pediatric ophthalmologists, epidemiologists and neonatologists. ? With two distinct populations of infants with ROP in the developed and developing world, different approaches to the disease must be undertaken. ? This review details the current understanding of the cellular and molecular mechanisms of human retinal vascular formation, detailing the mechanisms underlying the pathogenesis of the two phases of acute ROP. ? We highlight the risks and benefits of anti-VEGF therapy in ROP. The potential harm from systemic exposure to anti-VEGF agents needs further study, given that VEGF has key roles in the development of many organs and also acts as a neuronal survival factor during embryonic development. ? We recommend with the exception of certain key circumstances, use of anti-VEGF agents as a therapeutic intervention in ROP still needs to be approached with caution because of; 1) the risk of late recurrence of retinopathy due to incomplete peripheral retinal vascularization; 2) possible long term systemic side effects; and 3) the uncertainty about the correct dosage. ? We identify new therapies over the horizon, and the optimal neonatal care regimen for best ROP outcomes, and the benefits and pitfalls of telemedicine in the remote screening and diagnosis of ROP, all of which have the potential to improve ROP outcomes.
机译：摘要早产儿（ROP）视网膜病变风险的婴儿人口因世界地区而异;在发达新生儿重症监护服务的国家，风险最高的风险婴儿是出生于胎龄（GA）少于28周（GA）和少于1？KG？在出生时，而在新生儿密集和眼科护理的许多方面的地区在出生时不经常使用，更成熟的婴儿高达2000克，37个？几周？GA也处于严重ROP的风险。两组患者的治疗方案包括标准视网膜激光光凝，或者最近，玻璃体内抗VEGF药物。除了检测和治疗ROP之外，该综述突出了远程医疗的新机会，其中偏远地区ROP的筛查和诊断可以通过使用数字眼底照相机进行的非眼科医生来进行。 ROP婴儿的眼科护理是在新生儿护理和婴儿通用福祉的广泛背景下进行的。由于这种背景，这篇评论采取了多学科视角，具有视网膜血管生物学家，儿科眼科医生，流行病学家和新生学家的贡献。本综述凸显了对人婴儿的视网膜脉管系统，ROP发病机制，严重循环的发病机制，抗VEGF治疗的风险和益处，鉴定了新疗法地平线，以及最佳的新生儿护理方案，以最佳ROP结果，以及远程诊断在遥控和诊断中的远程医疗的益处和缺陷，所有这些都有可能改善ROP结果。强调 ？该评论对ROP采取了多学科的观点，从而从视网膜血管生物学家，儿科眼科，流行病学家和新生药学家的贡献。还在发达国家和发展中国家中有两种不同的婴儿婴幼儿，必须进行不同的疾病方法。还该审查详细说明了目前对人类视网膜血管形成的细胞和分子机制的理解，详细说明了急性ROP两相的发病机制下的机制。还我们突出了抗VEGF治疗ROP的风险和益处。鉴于VEGF在许多器官的发育中具有关键作用，促进了抗VEGF试剂的潜在危害需要进一步研究，并且在胚胎发育期间也是神经元存活因子。还我们建议在某些关键环境下，使用抗VEGF代理作为ROP治疗干预的使用仍然需要谨慎接近; 1）由于外周视网膜内视网膜内血管形成，视网膜病变晚期复发的风险; 2）可能的长期全身副作用; 3）对正确剂量的不确定性。还我们确定了地平线的新疗法，以及最佳的新生儿护理方案，以获得最佳ROP结果，以及远程筛选中远程筛选和诊断的远程疗养的益处和缺陷，所有这些都有可能改善ROP结果。

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  • 来源
    《Progress in retinal and eye research》 |2018年第2018期|共43页
  • 作者

    Tailoi Chan-Ling; Glen A. Gole; Graham E. Quinn; Samuel J. Adamson; Brian A. Darlow;

  • 作者单位

    Department of Anatomy School of Medical Sciences and Bosch Institute University of Sydney;

    Discipline of Paediatrics and Child Health University of Queensland Qld Children's Hospital;

    Division of Ophthalmology The Children's Hospital of Philadelphia and Department of Ophthalmology;

    Department of Anatomy School of Medical Sciences and Bosch Institute University of Sydney;

    Department of Paediatrics University of Otago;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 眼科学;
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