Retinopathy of prematurity is a serious disease that can lead to retinal detachment and vision loss. Vascular endothelial growth factors (VEGF) play a key role in the pathogenesis of this disease. The gold standard of treatment used since the 1990s is laser coagulation of non-vascularized retina. Anti-VEGF drugs introduced in recent years administered as intravitreal injections neutralize excess VEGF factors. The main advantage of these drugs is very fast action, very short and uncomplicated administration procedure, full field of view expected. Drugs, however, are absorbed into the bloodstream, which can affect the physiological maturation of internal organs in a child born prematurely. Another important problem is the appearance of late recurrences of retinopathy, even several months after the injection. These drugs should be used prudently, especially in patients with retinopathy in zone I.
PL
Retinopatia wcześniaków jest poważnym schorzeniem siatkówki, mogącym doprowadzić do jej odwarstwienia i w konsekwencji do utraty widzenia. W patogenezie tej choroby kluczową rolę odgrywają wytwarzane w nadmiarze naczyniowo- śródbłonkowe czynniki wzrostu (VEGF, vascular endothelial growth factors). Złotym standardem leczenia jest wciąż stosowana od lat 90. XX w. laserowa fotokoagulacja obwodowej nieunaczynionej siatkówki. Wprowadzone w ostatnich latach leki anty-VEGF podawane w postaci iniekcji do ciała szklistego neutralizują wytworzone w nadmiarze czynniki VEGF. Podstawowymi zaletami tych leków są: bardzo szybkie działanie, bardzo krótka i nieskomplikowana procedura podania oraz spodziewane pełne pole widzenia. Leki są jednak wchłaniane do krwiobiegu, co może zaburzać fizjologiczne dojrzewanie narządów wewnętrznych u dziecka urodzonego przedwcześnie. Innym ważnym problemem jest pojawienie się późnych wznów retinopatii, nawet kilka miesięcy po iniekcji. Leki te powinny być stosowane rozważnie, przede wszystkim u pacjentów z retinopatią w I strefie.
Despite improvements in neonatal care, retinopathy of prematurity is still leading cause of blindness in the world. The most treatment problems pose stage 4 and 5 of this disease. Performing vitrectomy in stage 5 is a subject of controversy among ophthalmologists due to unsatisfactory functional results after the surgery. Therefore, our aim was to present the results of 1000 vitrectomies performed by the author in years 1994–2019 in 1018 eyes of 692 children with stage 5 retinopathy of prematurity. In these children lens sparing vitrectomies and lensectomy-vitrectomy with limbal approach were performed. The results were compared with visual function of 127 untreated children with stage 5 retinopathy of prematurity. Visual acuity of treated patients ranged from 0.05 to no light perception in stage 5 and from no light perception to finger counting in the untreated group. Comparing the functional results of treated and untreated patients, it can be concluded that vitrectomy gives a better chance of gaining useful vision.
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