早產(chǎn)兒視網(wǎng)膜病變（ROP）對(duì)早產(chǎn)兒來(lái)說(shuō)，眼部血管后半段的發(fā)育只能留在出生之后完成。在長(zhǎng)時(shí)間、高濃度（FiO2＞0.4）的血氧環(huán)境下，未發(fā)育完成的眼底血管不再向視乳突邊緣生長(zhǎng)延伸，而是在原生長(zhǎng)位膨脹、變粗、打結(jié)，纖維素滲出甚至出血，纖維膜形成，纖維收縮、牽拉，可使視網(wǎng)膜剝脫。發(fā)病機(jī)制BrianW.FleckandNeilMcIntosh.RetinopathyofPrematurity:RecentDevelopmentsNeoReviews,Jan2009;10.

NormalimmatureretinaNormalmatureretina視網(wǎng)膜血管化Vascularizationoftheretinabeginsatapproximately16weeksgestationattheopticnerveandproceedsperipherally.Retinalvesselsreachtheoraserrata(theperipheryoftheeye)onthenasalsideat32weeksgestationandonthetemporalsideat36to40weeksgestation.Thenumbersinthefigureareweeksofgestation.ROP分區(qū)Hemisectionlookingdownintothelefteyewiththetemporalsidetotheleftandthenasalsidetotheright.Classification.Stage1.ROPIStage1.DemarcationlineAflatlineofdemarcationoccursbetweenthevascularandavascularretina.ROPIIRidge.Stage2.RidgeThelineofdemarcationacquiresvolumetobecomearidge.ROPIIIStage3ROPinZoneII.Extraretinal

fibrovascularproliferationNeovascularizationcanbeseenwithintheridge,andextraretinal

vascularizationextendsoutoftheretina.ROPIVBRetinalDetachment.4A:extrafoveal4B:fovealStage4ROPPartialretinaldetachmentROPVRetinalDetachment.Stage5.

TotalretinaldetachmentFromtheUnitedKingdomGuidelinesfortheScreeningandTreatmentofRetinopathyofPrematurity.ROPPlusDisease:increasedvenousdilatationarteriolartortuosityoftheposteriorretinalvessels.Twoquadrantsoftheeyemustbeinvolvedforthechangestobecharacterisedasplusdisease.合理統(tǒng)一的篩查標(biāo)準(zhǔn)：美國(guó)ROP篩查標(biāo)準(zhǔn)為BW<1500g或胎齡<28周英國(guó)ROP篩查標(biāo)準(zhǔn)為BW<1500g或胎齡<31周研究認(rèn)為BW<1250g或胎齡<30周,最經(jīng)濟(jì)有效

MathewMR,JEye,2002;16(5):538-542ROP篩查隨訪方法

首次檢查：生后4w隨訪時(shí)間：隨訪至視網(wǎng)膜發(fā)育成熟或病變穩(wěn)定完全血管化：3w

無(wú)ROP：q2w

發(fā)現(xiàn)ROP：

a.輕度病變：q2wb.閾值前病變2型：q1wc.閾值前病變1型：激光或冷凝治療激光早產(chǎn)兒視網(wǎng)膜病變（ROP）篩查目的是確認(rèn)活動(dòng)性ROP，以便切除病變視網(wǎng)膜而復(fù)原，阻止瘢痕愈合而造成失明最高危的新生兒是那些出生體重＜75