Tachibana Kuniko, Iwahashi Chiharu, Kuniyoshi Kazuki, Kusaka Shunji
Department of Ophthalmology, Faculty of Medicine, Kindai University, Osakasayama City, 377-2 Ohnohigashi, Osaka, 589-8511, Japan.
Graefes Arch Clin Exp Ophthalmol. 2025 Mar 22. doi: 10.1007/s00417-025-06801-0.
This study aimed to investigate longitudinal changes in best-corrected visual acuity (BCVA) and refraction in patients following vitrectomy for stage 4 retinopathy of prematurity (ROP).
We conducted a retrospective review of 42 eyes from 25 patients (35 eyes with stage 4A, 7 eyes with stage 4B) who had successful vitrectomy for stage 4 ROP and were followed for at least 8 years. Postoperative BCVAs and refractive errors between ages 5 and 8 years were compared. Factors related to BCVA at ages 5 and 8, as well as their differences, were analyzed.
In stage 4A ROP eyes, the mean logMAR BCVA improved significantly from 0.83 (20/135) to 0.63 (20/85) (p < 0.001) and a myopic shift of 1 D or more occurred in 21 eyes (61.8%) between ages 5 and 8. In the poor BCVA group at age 5 in the stage 4A eyes, dominant eyes showed a trend of BCVA improvement by ages 5-8 (p = 0.06). Multiple regression analysis of the patients with stage 4A ROP showed that phakic and dominant eyes at age 5 were independently associated with better BCVA at ages 5 and 8 (p = 0.006 and 0.016 for age 5; p = 0.009 and 0.002 for age 8). No significant BCVA improvement was noted in stage 4B ROP eyes during the same period.
This study indicated the possibility of continued visual improvement beyond age 5 in patients who underwent vitrectomy for stage 4A ROP, although a myopic shift occurred concurrently.
What is known Previous studies have reported long-term visual prognosis and refractive errors at specific time points after vitrectomy for ROP in small case series, but there has been limited research on serial changes. What is new This study demonstrates the potential for ongoing visual improvement beyond age 5 and highlights longitudinal myopic changes between ages 5 and 8 in patients who underwent vitrectomy for stage 4A ROP. In patients with poor visual acuity at age 5, being the dominant eye was significantly associated with improved visual acuity by age 8. The findings indicate that postoperative visual acuity in ROP patients gradually improves, even as myopia progresses, underscoring the need for long-term follow-up.
本研究旨在调查4期早产儿视网膜病变（ROP）患者玻璃体切除术后最佳矫正视力（BCVA）和屈光的纵向变化。
我们对25例患者的42只眼进行了回顾性研究（35只眼为4A期，7只眼为4B期），这些患者接受了成功的4期ROP玻璃体切除术，并随访至少8年。比较了5至8岁时的术后BCVA和屈光不正。分析了与5岁和8岁时BCVA相关的因素及其差异。
在4A期ROP眼中，平均logMAR BCVA从0.83（20/135）显著提高到0.63（20/85）（p < 0.001），21只眼（61.8%）在5至8岁之间出现了1 D或更大的近视漂移。在4A期眼中5岁时BCVA较差的组中，优势眼在5至8岁时有BCVA改善的趋势（p = 0.06）。对4A期ROP患者的多元回归分析表明，5岁时的有晶状体眼和优势眼与5岁和8岁时更好的BCVA独立相关（5岁时p = 0.006和0.016；8岁时p = 0.009和0.002）。在同一时期，4B期ROP眼中未观察到显著的BCVA改善。
本研究表明，接受4A期ROP玻璃体切除术的患者在5岁以后仍有可能持续改善视力，尽管同时出现了近视漂移。
已知情况 以往的研究在小病例系列中报告了ROP玻璃体切除术后特定时间点的长期视力预后和屈光不正，但对系列变化的研究有限。新发现 本研究证明了5岁以后视力持续改善的可能性，并突出了接受4A期ROP玻璃体切除术的患者在5至8岁之间的纵向近视变化。在5岁时视力较差的患者中，作为优势眼与8岁时视力改善显著相关。研究结果表明，ROP患者术后视力即使在近视进展的情况下也会逐渐改善，强调了长期随访的必要性。
