Analysis Of Influencing Factors Of Recurrence Of Retinopathy Of Prematurity Treated With Anti-VEGF

BackgroundRetinopathy of prematurity(ROP)is a kind of retinal vascular abnormal proliferative disease,which is the main cause of preventable blindness in children.In addition to blindness,ROP can also cause a wide range of visual function defects,including contrast sensitivity reduction,visual field defects,color vision defects,strabismus and ametropia.Laser photocoagulation is a standardized treatment for ROP.Intravitreal injection of anti vascular endothelial growth factor(anti-VEGF)is a new treatment for ROP,Compared with the traditional laser photocoagulation therapy,anti VEGF therapy not only has the advantages of short operation time and no need of general anesthesia,but also avoids the visual field defect and severe ametropia caused by the destruction of the surrounding retina.Although anti VEGF therapy has many advantages,the obvious increase of the risk of recurrence can not be ignored.However,there are few studies on the recurrence of ROP after anti VEGF treatment,and the influencing factors of ROP recurrence after anti VEGF treatment are poorly understood.This study intends to explore the influencing factors of ROP recurrence after anti VEGF treatment from five aspects:general information,maternal pregnancy and perinatal factors,complications during hospitalization,treatment during hospitalization and preoperative examination,analyze the clinical characteristics of recurrence,and try to build a recurrence prediction model to guide clinical practice.MethodsThe paper analyzed 111 cases of ROP treated with anti-VEGF from January 2016 to December 2020 in the First Affiliated Hospital of Zhengzhou University.32 clinical data were collected from five aspects,including general data,maternal pregnancy and perinatal factors,complications,treatment and preoperative examination.The basic clinical characteristics of the included cases were reviewed.According to the recurrence after anti VEGF treatment,the patients were divided into recurrence group and non recurrence group.The clinical characteristics of the recurrence group were analyzed,the influencing factors of the recurrence of ROP after anti VEGF treatment were discussed,and the recurrence prediction model was established.SPSS 21.0 software was used to analyze the data statistically,P<0.05 showed that the difference was statistically significant.Results1.111 children with ROP treated with anti VEGF were included in this study.The gestational age(GA)was 28.61 ± 1.71 weeks.There were 45 cases(40.5%)with GA<28 weeks,63 cases(56.8%)with GA ≤32 weeks,and 3 cases(18.4%)with GA≥ 32 weeks.The birth weight(BW)was 1032.97± 244.77g,including 48 cases(43.2%)with BW<1000g,58 cases(52.3%)with BW≤1000g,4 cases(4.6%)with BW ≤2000g and 1 case(0.9%)with BW≥2000g.In the recurrent group,GA was 27.02 ± 1.31 weeks,BW was 918.67± 32.14g,The mean corrected gestational age at recurrence was 43.74 ± 3.39 weeks,while the interval between recurrence and initial operation was 8.6± 2.74 weeks.2.Univariate analysis showed that there were significant differences in gestational age,length of hospital stay,average weight gain during hospitalization,multiple pregnancy,AOP,BPD,pneumonia,times of red blood cell transfusion,total oxygen consumption,duration of invasive mechanical ventilation,preoperative hemoglobin level,preoperative hematocrit,preoperative fundus hemorrhage between recurrence group and non recurrence group.3.Multivariate logistic regression analysis showed that total oxygen consumption,AOP,preoperative fundus screening and fundus hemorrhage were independent risk factors for recurrence.4.The logistic regression model of ROP recurrence was established,and the regression equation was ln[P/(1-P)]=-5.782+1.044 × total oxygen duration+21.232 × AOP+5.686 × preoperative fundus screening for fundus hemorrhage.The area under the ROC curve(AUC)was 0.923,the best cut-off was 67.128,the sensitivity was 80.0%,and the specificity was 97.3%.Conclusion1.It is necessary to focus on the high-risk recurrence period of 8 weeks after operation in children with ROP treated with anti VEGF therapy,and the high-risk recurrence corrected gestational age of 44 weeks after correction of gestational age.2.AOP,prolonged oxygen use time and preoperative fundus hemorrhage are independent risk factors for recurrence of ROP after anti-VEGF treatment.3.The logistic regression model combined with AOP,total oxygen duration and preoperative fundus hemorrhage has a good predictive value for the recurrence of ROP after anti-VEGF treatment.