未熟児網膜症治療例の検討

Review of retinopathy of prematurity treated by laser photocoagulation

目的：レーザー光凝固を行った未熟児網膜症で転帰が不良であった因子の解析。対象と方法：2004年までの4年間にレーザー光凝固を行った未熟児網膜症33例64眼を対象とした。これら症例の出生体重は428g～1,238g（平均631g），出生在胎週数は22～31週（平均25週）である。厚生省瘢痕期分類2度以上を転帰不良と定義した。結果：瘢痕期2度以上の11例と1度以下の22例の比較で，出生体重は前群が542g，後群が675gであり有意差があった（p＜0.05）。治療適応となった時点での修正在胎週数は前群が34.4週，後群が36.2週であり有意差があった（p＜0.05）。瘢痕期2度以上の症例は，国際分類によるzone Ⅰの未熟児網膜症に多かった。結論：出生体重が小さく，網膜血管の発育状態が不完全であり，治療適応となった時点での修正在胎週数が短いことは，レーザー光凝固で治療した未熟児網膜症の予後不良因子である。

Purpose：To identify factors related to poor outcome following laser photocoagulation for retinopathy of prematurity（ROP）. Cases and Method：This retrospective study was made on 64 eyes of 33 infants that received laser photocoagulation for ROP during 4 years through 2004. The birthweight ranged from 428 to 1,238g, average631g. They were born after gestation from 22 to 31 weeks, average 25 weeks. Results：A total of 22 cases resulted in cicatricial grade 1 or less, and 11 cases resulted in cicatricial grade 2 or over. The birthweight averaged 675g in the former group and 542g in the latter. The difference was significant（p＜0.05）. Laser treatment was performed at the postconceptional age of average 36.2 weeks in the former and 34.4 weeks in the latter. The difference was significant（p＜0.05）. ROP of grade 2 or over was more frequent in cases with zone Ⅰ ROP. Conclusion：Following features of ROP are prognostic of poor outcome：low birthweight, poorly developed retinal vessels, and short postconceptional age at the time of photocoagulation.

Rinsho Ganka（Jpn J Clin Ophthalmol）60（8）：1385-1389, 2006