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Spätfolgen der Frühgeborenenretinopathie im Kindesalter

Late sequelae of retinopathy of prematurity in infancy

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Zusammenfassung

Hintergrund

Die Frühgeborenenretinopathie („retinopathy of prematurity“ [ROP]) ist eine der häufigsten Ursachen für eine hochgradige Sehbehinderung oder Blindheit im Kindesalter und kann selbst nach Abheilung der initialen Erkrankung noch zu schwerwiegenden Spätfolgen bei Kindern führen.

Fragestellung

Die vorliegende Arbeit fasst mögliche Spätfolgen im Kindesalter nach behandelter oder unbehandelter ROP zusammen. Ein Fokus liegt dabei auf der Myopieentwicklung, auf Netzhautablösungen und der neurologischen und pulmonalen Entwicklung nach Anti-VEGF(„vascular endothelial growth factor“)-Therapie.

Material und Methoden

Die Arbeit basiert auf einer selektiven Literaturrecherche zu Spätfolgen im Kindesalter einer behandelten oder unbehandelten ROP.

Ergebnisse

Frühgeborene haben ein erhöhtes Risiko für die Entwicklung einer hochgradigen Myopie. Interessanterweise legen mittlerweile mehrere Studien nahe, dass sich dieses Risiko nach einer Anti-VEGF-Behandlung verringert. Dafür hat eine Anti-VEGF-Therapie den Nachteil, dass nach anfänglich erfolgreicher Behandlung Spätrezidive auch noch nach mehreren Monaten möglich sind, die langfristige und hochfrequente Nachuntersuchungen unerlässlich machen. Kontrovers diskutiert werden mögliche negative Auswirkungen einer Anti-VEGF-Therapie auf die neurologische und pulmonale Entwicklung. Sowohl nach behandelter als auch nach unbehandelter ROP sind rhegmatogene oder traktive Netzhautablösungen, Glaskörperblutungen, hohe Myopie und Strabismus mögliche Spätfolgen.

Diskussion

Kinder mit einer Vorgeschichte von ROP mit oder ohne Behandlung haben ein erhöhtes Risiko für späte okuläre Folgeerkrankungen, darunter hohe Myopie, Netzhautablösungen und Glaskörperblutungen sowie Strabismus. Ein nahtloser Übergang von ROP-Screening zu pädiatrischer und ophthalmologischer Weiterbetreuung ist daher unerlässlich, um mögliche Refraktionsfehler, Strabismus oder andere amblyogene Veränderungen frühzeitig feststellen und behandeln zu können.

Abstract

Background

Retinopathy of prematurity (ROP) is one of the most frequent causes of severe visual impairment or blindness in childhood and can lead to severe late complications in children even after the initial disease has resolved.

Purpose

The present study summarizes possible late effects in childhood after treated and untreated ROP. A special focus is on the development of myopia, retinal detachment, as well as neurological and pulmonary development after anti-vascular endothelial growth factor (VEGF) treatment.

Material and methods

This work is based on a selective literature search on late effects in childhood of treated or untreated ROP.

Results

Preterm infants have an increased risk of developing high-grade myopia. Interestingly, several studies indicate that the risk of myopia is reduced following anti-VEGF treatment. With anti-VEGF treatment, however, late recurrences after initial response are possible even after several months, making long-term and frequent follow-up examinations essential. Controversy exists regarding the possible negative effects of anti-VEGF treatment on neurological and pulmonary development. After both treated and untreated ROP, rhegmatogenous, tractional or exudative retinal detachment, vitreous hemorrhage, high myopia and strabismus are possible late complications.

Discussion

Children with a history of ROP with or without treatment have an increased risk for late ocular sequelae, such as high myopia, retinal detachment, vitreous hemorrhage and strabismus. A seamless transition from ROP screening to pediatric and ophthalmological follow-up care is therefore essential for timely detection and treatment of possible refractive errors, strabismus, or other amblyogenic changes.

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Funding

Open Access funding enabled and organized by Projekt DEAL.

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Authors and Affiliations

  1. Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    Jeany Q. Li & Tim U. Krohne

  2. Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Greifswald, Greifswald, Deutschland

    Johanna M. Pfeil & Andreas Stahl

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  1. Jeany Q. Li
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  2. Johanna M. Pfeil
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  3. Andreas Stahl
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Correspondence to Jeany Q. Li.

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Interessenkonflikt

J.Q. Li gibt an, dass kein Interessenkonflikt besteht. J.M. Pfeil weist auf folgende Beziehungen hin: Novartis. A. Stahl weist auf folgende Beziehungen hin: Allergan, Apellis, Bayer, Novartis, Roche. T.U. Krohne weist auf folgende Beziehungen hin: Alimera Sciences, Allergan, Bayer, Heidelberg Engineering, Novartis, Roche.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Li, J.Q., Pfeil, J.M., Stahl, A. et al. Spätfolgen der Frühgeborenenretinopathie im Kindesalter. Ophthalmologie 120, 588–596 (2023). https://doi.org/10.1007/s00347-023-01876-8

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