急进性早产儿视网膜病变治疗后儿童期屈光调节功能异常一例
Abnormal Refractive Accommodation Function in Childhood after Treatment for Aggressive Retinopathy of Prematurity: A Case Report
摘要: 本文报道1例极低体重的急进性早产儿视网膜病变(aggressive ROP, A-ROP)患儿(女，24+4周，出生体重590 g)，抗VEGF联合激光治疗后随访三年出现屈光大幅度波动、持续调节功能异常，经1%阿托品眼用凝胶联合视觉训练个体化干预后屈光度稳定，但延长或给药间隔后再次出现调节功能失代偿。提示ROP患儿眼底病变消退后仍可能存在屈光及调节异常，应重视远期视功能随访与个体化干预。
Abstract: This report describes a female infant with A-ROP born at 24+4 weeks of gestation with a birth weight of 590 g. Three years after anti-VEGF therapy and laser photocoagulation, marked refractive fluctuations and persistent accommodative dysfunction developed. After individualized treatment with 1% atropine ophthalmic gel and visual training, refraction stabilized, but accommodative decompensation recurred after extending the dosing interval. This suggests that children with ROP may still have refractive and accommodative abnormalities after regression of fundus lesions. This case highlights the need for long-term visual function follow-up and individualized intervention in children with ROP.
文章引用：晁彦雯, 张坚. 急进性早产儿视网膜病变治疗后儿童期屈光调节功能异常一例[J]. 临床医学进展, 2026, 16(9): 2101-2108. https://doi.org/10.12677/acm.2026.1693255

参考文献

[1] 中华医学会眼科学分会眼底病学组, 中国医师协会眼科医师分会眼底病专委会. 中国早产儿视网膜病变分类和治疗专家共识(2023年) [J]. 中华眼底病杂志, 2023, 39(9): 720-727.
[2] 中华医学会眼科学分会斜视与小儿眼科学组. 中国儿童睫状肌麻痹验光及安全用药专家共识(2019年) [J]. 中华眼科杂志, 2019, 55(1): 7-12.
[3] 中国民族医药协会眼视光学分会, 北京眼视光学会, 中国近视前期管理专家共识(2025年) [J]. 中华眼科杂志, 2025, 61(12): 957-967.
[4] Rozema, J.J., Herscovici, Z., Snir, M. and Axer‐Siegel, R. (2018) Analysing the Ocular Biometry of Newborn Infants. Ophthalmic and Physiological Optics, 38, 119-128.
https://doi.org/10.1111/opo.12433
[5] Zhu, X., Zhao, R., Wang, Y., Ouyang, L., Yang, J., Li, Y., et al. (2017) Refractive State and Optical Compositions of Preterm Children with and without Retinopathy of Prematurity in the First 6 Years of Life. Medicine (Baltimore), 96, e8565.
https://doi.org/10.1097/md.0000000000008565
[6] Wang, Y., Pi, L., Zhao, R., Zhu, X. and Ke, N. (2020) Refractive Status and Optical Components of Premature Babies with or without Retinopathy of Prematurity at 7 Years Old. Translational Pediatrics, 9, 108-116.
https://doi.org/10.21037/tp.2020.03.01
[7] Pidro, A., Alajbegović-Halimić, J., Jovanović, N. and Pidro, A. (2019) Evaluation of Refractive Errors in Retinopathy of Prematurity Screening. Medicinski Glasnik, 16, 204-208.
https://doi.org/10.17392/992-19
[8] Seely, K.R., Mangalesh, S., Shen, L.L., McGeehan, B., Ying, G., Sarin, N., et al. (2022) Association between Retinal Microanatomy in Preterm Infants and 9-Month Visual Acuity. JAMA Ophthalmology, 140, 699-706.
https://doi.org/10.1001/jamaophthalmol.2022.1643
[9] Balasubramanian, S., Beckmann, J., Mehta, H., Sadda, S.R., Chanwimol, K., Nassisi, M., et al. (2019) Relationship between Retinal Thickness Profiles and Visual Outcomes in Young Adults Born Extremely Preterm: The EPICure@19 Study. Ophthalmology, 126, 107-112.
https://doi.org/10.1016/j.ophtha.2018.07.030
[10] 胡亚柔, 赵欣予, 吴桢泉, 等. 早产儿屈光状态与眼部生物特征的研究进展[J]. 山东大学耳鼻喉眼学报, 2024, 38(3): 144-150.
[11] 杨佳洁, 马继贤, 田思雯, 等. 早产儿视网膜病变患儿屈光不正的机制研究进展[J]. 眼科新进展, 2023, 43(10): 823-827.
[12] 王小芳, 刘涛. 多巴胺与早产儿视网膜病变近视的关系[J]. 中国斜视与小儿眼科杂志, 2016, 24(2): 44-45.
[13] Nickla, D.L., Jordan, K., Yang, J. and Singh, P. (2019) Effects of Time-of-Day on Inhibition of Lens-Induced Myopia by Quinpirole, Pirenzepine and Atropine in Chicks. Experimental Eye Research, 181, 5-14.
https://doi.org/10.1016/j.exer.2019.01.008
[14] Tedja, M.S., Wojciechowski, R., Hysi, P.G., Eriksson, N., Furlotte, N.A., Verhoeven, V.J.M., et al. (2018) Genome-wide Association Meta-Analysis Highlights Light-Induced Signaling as a Driver for Refractive Error. Nature Genetics, 50, 834-848.
https://doi.org/10.1038/s41588-018-0127-7
[15] Lau, J.C.M. and Linsenmeier, R.A. (2012) Oxygen Consumption and Distribution in the Long-Evans Rat Retina. Experimental Eye Research, 102, 50-58.
https://doi.org/10.1016/j.exer.2012.07.004
[16] Fulton, A.B., Hansen, R.M. and Moskowitz, A. (2008) The Cone Electroretinogram in Retinopathy of Prematurity. Investigative Opthalmology & Visual Science, 49, 814-819.
https://doi.org/10.1167/iovs.07-1226
[17] Luu, C.D., Koh, A.H.C. and Ling, Y. (2005) The ON/OFF-Response in Retinopathy of Prematurity Subjects with Myopia. Documenta Ophthalmologica, 110, 155-161.
https://doi.org/10.1007/s10633-005-3742-4
[18] Jain, S., Sim, P.Y., Beckmann, J., Ni, Y., Uddin, N., Unwin, B., et al. (2022) Functional Ophthalmic Factors Associated with Extreme Prematurity in Young Adults. JAMA Network Open, 5, e2145702.
https://doi.org/10.1001/jamanetworkopen.2021.45702
[19] Early Treatment for Retinopathy of Prematurity Cooperative Group (2003) Revised Indications for the Treatment of Retinopathy of Prematurity: Results of the Early Treatment for Retinopathy of Prematurity Randomized Trial. Archives of Ophthalmology, 121, 1684-1694.
[20] Young-Zvandasara, T., Popiela, M., Preston, H., Seow, E. and Watts, P. (2020) Is the Severity of Refractive Error Dependent on the Quantity and Extent of Retinal Laser Ablation for Retinopathy of Prematurity? Eye, 34, 740-745.
https://doi.org/10.1038/s41433-019-0605-x
[21] 王凤, 刘雪莲, 白宁艳. 激光与抗VEGF药物治疗早产儿视网膜病变不良反应的研究进展[J]. 四川医学, 2024, 45(4): 426-429.
[22] 童林利, 熊永强, 林春堤, 等. 抗VEGF玻璃体腔注射联合视网膜激光光凝术治疗早产儿视网膜病变的效果及对屈光状态视觉发育的影响[J]. 中国妇幼保健, 2026, 41(8): 1429-1433.
[23] Schein, Y., Yu, Y., Ying, G. and Binenbaum, G. (2022) Emmetropization during Early Childhood. Ophthalmology, 129, 461-463.
https://doi.org/10.1016/j.ophtha.2021.11.021
[24] Zhu, X., McBrien, N.A., Smith, E.L., Troilo, D. and Wallman, J. (2013) Eyes in Various Species Can Shorten to Compensate for Myopic Defocus. Investigative Opthalmology & Visual Science, 54, 2634-2644.
https://doi.org/10.1167/iovs.12-10514
[25] 弱视诊治指南[J]. 中国实用乡村医生杂志, 2019, 26(2): 3-5.
[26] 常枫, 张芬, 路宁, 等. 调节痉挛误诊为近视并验配角膜塑形镜1例[J]. 中国临床案例成果数据库, 2023, 5(1): E00217.
[27] 刘洁如, 张骏捷, 陈梦, 等. 1%阿托品“5 + 3”给药方案控制儿童青少年近视进展的有效性与安全性[J]. 中华眼视光学与视觉科学杂志(中英文), 2026, 28(1): 10-17.

为你推荐