Retina and Vitreous of Texas, Houston, Texas; Henry Ford Health System, Detroit, Michigan.
Kellogg Eye Center, University of Michigan School of Medicine, Ann Arbor, Michigan.
Ophthalmol Retina. 2020 Jun;4(6):602-612. doi: 10.1016/j.oret.2019.12.015. Epub 2019 Dec 24.
To investigate late retinal findings and complications of eyes with a history of retinopathy of prematurity (ROP) that did not meet treatment criteria and did not receive treatment during infancy.
Retrospective, nonconsecutive, noncomparative, multicenter case series.
Three hundred sixty-three eyes of 186 patients.
Data were requested from multiple providers on premature patients with a history of ROP and no treatment during infancy who demonstrated late retinal findings or complications and included age, gender, gestational age and weight, zone and stage at infancy, visual acuity, current retina vascularization status, vitreous character, presence of peripheral retinal findings such as lattice retinal tears and detachments (RDs), retinoschisis, and fluorescein findings.
Rate of RDs and factors conferring a higher risk of RDs.
The average age was 34.5 years (range, 7-76 years), average gestational age was 26.6 weeks (range, 23-34 weeks), and average birth weight was 875 g (range, 425-1590 g). Findings included lattice in 196 eyes (54.0%), atrophic holes in 126 eyes (34.7%), retinal tears in 111 eyes (30.6%), RDs in 140 eyes (38.6 %), tractional retinoschisis in 44 eyes (11.9%), and visible vitreous condensation ridge-like interface in 112 eyes (30.5%). Fluorescein angiography (FA) was performed in 113 eyes, of which 59 eyes (52.2%) showed leakage and 16 eyes (14.2%) showed neovascularization. Incomplete vascularization posterior to zone 3 was common (71.6% of eyes). Retinal detachments were more likely in patients with a gestational age of 29 weeks or less (P < 0.05) and in eyes with furthest vascularization to posterior zone 2 eyes compared with zone 3 eyes (P = 0.009).
Eyes with ROP not meeting the treatment threshold during infancy showed various late retinal findings and complications, of which RDs were the most concerning. Complications were seen in all age groups, including patients born after the Early Treatment for Retinopathy of Prematurity Study. Contributing factors to RDs included atrophic holes within peripheral avascular retina, visible vitreous condensation ridge-like interface with residual traction, and premature vitreous syneresis. We recommend regular examinations and consideration of ultra-widefield FA examinations. Prospective studies are needed to explore the frequency of complications and benefit of prophylactic treatment and if eyes treated with anti-vascular endothelial growth factor therapy are at risk of similar findings and complications.
研究未接受治疗的早产儿视网膜病变（ROP）患儿的晚期眼部发现和并发症，这些患儿的 ROP 不符合治疗标准且在婴儿期未接受治疗。
回顾性、非连续、非对照、多中心病例系列研究。
186 名患者的 363 只眼。
从多名提供者处获取有 ROP 病史且婴儿期未接受治疗的早产儿的数据，这些早产儿的晚期视网膜发现或并发症包括年龄、性别、胎龄和体重、婴儿期的区和期、视力、当前视网膜血管化状态、玻璃体特征、是否存在周边视网膜发现，如格子状视网膜裂孔和脱离（RD）、视网膜劈裂和荧光素血管造影（FA）结果。
RD 的发生率和导致 RD 风险增加的因素。
平均年龄为 34.5 岁（7-76 岁），平均胎龄为 26.6 周（23-34 周），平均出生体重为 875 g（425-1590 g）。发现包括 196 只眼（54.0%）有格子状、126 只眼（34.7%）有萎缩性孔、111 只眼（30.6%）有视网膜裂孔、140 只眼（38.6%）有 RD、44 只眼（11.9%）有牵引性视网膜劈裂、112 只眼（30.5%）有可见玻璃体浓缩脊样界面。对 113 只眼进行了 FA 检查，其中 59 只眼（52.2%）有渗漏，16 只眼（14.2%）有新生血管形成。后部区 3 未完全血管化较为常见（71.6%的眼）。胎龄为 29 周或更小的患者（P < 0.05）和血管化最远至后部区 2 的眼比血管化至区 3 的眼（P = 0.009）更易发生 RD。
婴儿期未达到治疗阈值的 ROP 患儿出现各种晚期眼部发现和并发症，其中 RD 最令人担忧。所有年龄组均可见并发症，包括在早龄早产儿视网膜病变治疗研究后出生的患者。RD 的相关因素包括周边无血管视网膜的萎缩孔、可见玻璃体浓缩脊样界面伴残余牵引和早期玻璃体后脱离。我们建议定期检查，并考虑进行超广角 FA 检查。需要前瞻性研究来探讨并发症的频率和预防性治疗的益处，以及是否接受抗血管内皮生长因子治疗的眼有发生类似发现和并发症的风险。
