Department of Ophthalmology and Laboratory of Cell Biology, National Center for Child Health and Development, Tokyo, Japan.
JAMA Ophthalmol. 2013 Oct;131(10):1309-13. doi: 10.1001/jamaophthalmol.2013.4148.
Aggressive posterior retinopathy of prematurity (AP-ROP) rapidly progresses to retinal detachment despite application of photocoagulation. Early vitreous surgery might achieve prompt regression of neovascular activity and a high incidence of retinal reattachment.
To evaluate visual outcomes in eyes with AP-ROP after early vitreous surgery.
Retrospective nonrandomized study of patients who underwent early vitreous surgery with lensectomy when retinal detachment developed despite photocoagulation. Aphakic correction with spectacles or contact lenses and the use of orthoptics were continued postoperatively. The best-corrected visual acuity (VA) was measured in eyes with a total retinal reattachment using the preferential looking technique in patients ranging in age from 8 months to no more than 3 years and a VA chart with Landolt rings or pictures for older children. The VA findings were converted to Snellen lines.
Institutional ophthalmology practice.
Of the 103 eyes (57 patients) that underwent early vitreous surgery for AP-ROP, the VA was measured in 58 (32 patients) at a corrected age ranging from 8 months to 4 years.
Early vitreous surgery and VA measurement using the preferential looking technique and a VA chart.
Postoperative VA, ROP stage, extent of fibrovascular tissue (FT) growth, and laterality of the eyes that underwent surgery.
The VAs ranged from 20/2000 to 20/40. The VA may not be related to the preoperative ROP stage 4A or 4B but may depend on the preoperative extent of FT growth. In 39 of 58 eyes (67.2%), the FT had not reached the vitreous base preoperatively, and foveal formation occurred postoperatively with nearly age-appropriate VA (range, 20/250 to 20/40). In 17 of 58 eyes (29.3%), the FT had reached the vitreous base, and no fovea formed (VA range, 20/2000 to 20/250). Two of 58 eyes (3.4%) had deprivation amblyopia with a VA worse than 20/1600. The difference in VA between both eyes of patients who underwent bilateral vitreous surgery depended on ROP progression; patients who underwent a unilateral procedure in which the fellow eyes with ROP stabilized after photocoagulation tended to have poor vision because of deprivation amblyopia.
Early vitreous surgery may be beneficial for AP-ROP and should be performed before the FT reaches the vitreous base to facilitate foveal formation and good VA outcomes. The roles of photocoagulation, vitreous surgery, and anti-vascular endothelial growth factor therapy in the treatment of AP-ROP should be investigated in randomized trials regarding efficacy, safety, convenience, and cost.
尽管进行了光凝治疗，侵袭性早产儿后发性视网膜病变（AP-ROP）仍迅速进展为视网膜脱离。早期玻璃体手术可能会迅速消退新生血管活动，并使视网膜再附着的发生率较高。
评估 AP-ROP 患者接受早期玻璃体手术后的视力结果。
对接受玻璃体切除术和晶状体切除术的患者进行回顾性非随机研究，这些患者在光凝治疗后发生视网膜脱离。在术后继续使用眼镜或隐形眼镜进行无晶状体矫正，并进行斜视矫正。对年龄在 8 个月至 3 岁之间的患者，使用优先注视技术测量完全视网膜再附着眼的最佳矫正视力（VA），对年龄较大的患者使用视力图表测量 VA，视力图表上有 Landolt 环或图片。将 VA 结果转换为 Snellen 线。
机构眼科。
在 103 只眼（57 例）接受早期玻璃体手术治疗 AP-ROP 中，58 只眼（32 例）在矫正年龄 8 个月至 4 岁之间进行了 VA 测量。
早期玻璃体手术和使用优先注视技术和视力图表测量 VA。
术后 VA、ROP 分期、纤维血管组织（FT）生长程度以及接受手术的眼的侧别。
VA 范围从 20/2000 到 20/40。VA 可能与术前 ROP 4A 或 4B 期无关，但可能取决于术前 FT 生长程度。在 58 只眼中的 39 只（67.2%），FT 术前未到达玻璃体基底，术后出现黄斑形成，VA 接近年龄匹配（范围为 20/250 至 20/40）。在 58 只眼中的 17 只（29.3%），FT 已到达玻璃体基底，未形成黄斑（VA 范围为 20/2000 至 20/250）。58 只眼中的 2 只（3.4%）因剥夺性弱视而视力低于 20/1600。接受双侧玻璃体手术患者的双眼 VA 差异取决于 ROP 进展；在接受单侧手术的患者中，接受光凝治疗后病情稳定的对侧眼由于剥夺性弱视而视力较差。
早期玻璃体手术可能对 AP-ROP 有益，应在 FT 到达玻璃体基底之前进行，以促进黄斑形成和良好的 VA 结果。应在随机试验中研究光凝、玻璃体手术和抗血管内皮生长因子治疗在 AP-ROP 治疗中的作用，以评估疗效、安全性、便利性和成本。
