• 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Progress in retinal and eye research >Pathophysiology, screening and treatment of ROP: A multi-disciplinary perspective
【24h】

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

获取原文
获取原文并翻译 | 示例
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

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：摘要早产儿视网膜病变（ROP）高危婴儿的数量因地区而异；在新生儿重症监护服务发达的国家，风险最高的婴儿是小于28周胎龄（GA）和小于1？公斤出生时，在新生儿重症监护和眼科护理的许多方面都无法常规获得的地区，出生时体重在2000克及37克以下的更成熟婴儿？周？GA也有发生严重ROP的风险。这两组患者的治疗方案包括标准的视网膜激光光凝，或者最近的玻璃体内抗VEGF药物。除了ROP的检测和治疗外，本综述还强调了远程医疗带来的新机遇，远程位置ROP的筛查和诊断可以由非眼科医生使用数字眼底摄像头进行。ROP婴儿的眼科护理是在新生儿护理和婴儿总体健康的更广泛背景下进行的。基于这种背景，本综述从多学科的角度出发，由视网膜血管生物学家、儿科眼科医生、流行病学家和新生儿学家提供意见。本综述重点介绍了关于人类婴儿视网膜血管形成的细胞和分子机制、ROP的发病机制、严重ROP的检测和治疗、抗VEGF治疗的风险和益处、新疗法的识别、最佳新生儿护理方案以获得最佳ROP结果的最新见解，远程医疗在ROP远程筛查和诊断中的益处和缺陷，所有这些都有可能改善ROP的结果。亮点？本综述从多学科的角度对ROP进行了综述，汇集了视网膜血管生物学家、儿科眼科医生、流行病学家和新生儿学家的贡献？发达国家和发展中国家有两个不同的ROP婴儿群体，因此必须采取不同的方法治疗该疾病？这篇综述详细介绍了目前对人类视网膜血管形成的细胞和分子机制的理解，详细阐述了急性ROP两个阶段的发病机制？我们强调抗VEGF治疗ROP的风险和益处。鉴于VEGF在许多器官的发育中起着关键作用，并且在胚胎发育过程中也是神经元存活因子，因此全身暴露于抗VEGF药物的潜在危害需要进一步研究？我们建议，除某些关键情况外，仍需谨慎使用抗VEGF药物作为ROP的治疗干预，因为：；1） 视网膜周围血管不完整导致视网膜病变晚期复发的风险；2） 可能的长期全身副作用；3）正确剂量的不确定性？我们确定了新的治疗方法，最佳的新生儿护理方案以获得最佳ROP结果，以及远程医疗在ROP远程筛查和诊断中的益处和缺陷，所有这些都有可能改善ROP结果。

著录项

  • 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;

  • 收录信息
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 眼科学;
  • 关键词

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号