{"title":"早产儿4A期视网膜病变玻璃体切除术后再手术的危险因素。","authors":"Masaki Fukushima, Chiharu Iwahashi, Tomoki Kurihara, Kazuki Kuniyoshi, Fukutaro Mano, Takao Endo, Atsushi Hayashi, Shunji Kusaka","doi":"10.1016/j.oret.2025.05.008","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To determine risk factors for reoperation after vitrectomy for stage 4A retinopathy of prematurity (ROP).</p><p><strong>Design: </strong>Retrospective, comparative case series.</p><p><strong>Participants: </strong>The selected patients had undergone vitrectomy for stage 4A ROP with a minimum follow-up period of 6 months between 2010 and 2023.</p><p><strong>Methods: </strong>Data collected from patients' charts included gender, gestational age at birth (GA), birth weight (BW), stage of ROP, postmenstrual age (PMA) at vitrectomy, extent of fibrovascular membrane (FVM), preoperative fluorescein angiography, surgical procedure, and subsequent reoperation during the follow-up period.</p><p><strong>Main outcome measures: </strong>Anatomical success rate, incidence of postoperative vitreous hemorrhage (VH) and redetachment caused by reproliferation, and risk factors for reoperation to treat these postoperative complications.</p><p><strong>Results: </strong>We included 132 consecutive eyes (42 bilateral and 48 unilateral) of 90 patients (48 female and 42 male). The mean GA, BW, and PMA at surgery were 24.6 ± 1.6 weeks, 623.3 ± 180.3 g, and 41.6 ± 4.1 weeks, respectively. Final anatomic success was achieved in 128 eyes (97%). Reoperations were necessary due to postoperative VH in 31 eyes (23%), redetachment caused by reproliferation in 8 eyes (6%), and both VH and redetachment caused by reproliferation in 4 eyes (3%). Multivariable logistic regression analysis showed that plus disease (P = 0.007; odds ratio [OR], 3.681; 95% confidence interval [CI], 1.43-9.46) was a risk factor for reoperation due to postoperative VH, and greater extent of fibrovascular membrane (FVM) (P = 0.047: OR, 1.335; 95% CI, 1.004-1.776) and higher grade of fluorescein leakage (P = 0.033; OR, 5.675; 95% CI, 1.149-28.040) were risk factors for reoperation due to redetachment caused by reproliferation. In eyes with plus disease, anti-VEGF therapy as a preoperative adjunct significantly reduced the rate of reoperation for postoperative VH (20.0% vs. 60.7%, P=0.002).</p><p><strong>Conclusion: </strong>High anatomical success rates could be achieved by vitrectomy for stage 4A ROP. However, eyes with plus disease, greater extent of FVM, or higher grade of fluorescein leakage may have an increased risk of reoperation. In addition, preoperative anti-VEGF therapy may reduce reoperations due to postoperative VH in patients with plus disease.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":4.4000,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk factors for reoperation in vitrectomy for stage 4A retinopathy of prematurity.\",\"authors\":\"Masaki Fukushima, Chiharu Iwahashi, Tomoki Kurihara, Kazuki Kuniyoshi, Fukutaro Mano, Takao Endo, Atsushi Hayashi, Shunji Kusaka\",\"doi\":\"10.1016/j.oret.2025.05.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To determine risk factors for reoperation after vitrectomy for stage 4A retinopathy of prematurity (ROP).</p><p><strong>Design: </strong>Retrospective, comparative case series.</p><p><strong>Participants: </strong>The selected patients had undergone vitrectomy for stage 4A ROP with a minimum follow-up period of 6 months between 2010 and 2023.</p><p><strong>Methods: </strong>Data collected from patients' charts included gender, gestational age at birth (GA), birth weight (BW), stage of ROP, postmenstrual age (PMA) at vitrectomy, extent of fibrovascular membrane (FVM), preoperative fluorescein angiography, surgical procedure, and subsequent reoperation during the follow-up period.</p><p><strong>Main outcome measures: </strong>Anatomical success rate, incidence of postoperative vitreous hemorrhage (VH) and redetachment caused by reproliferation, and risk factors for reoperation to treat these postoperative complications.</p><p><strong>Results: </strong>We included 132 consecutive eyes (42 bilateral and 48 unilateral) of 90 patients (48 female and 42 male). The mean GA, BW, and PMA at surgery were 24.6 ± 1.6 weeks, 623.3 ± 180.3 g, and 41.6 ± 4.1 weeks, respectively. Final anatomic success was achieved in 128 eyes (97%). Reoperations were necessary due to postoperative VH in 31 eyes (23%), redetachment caused by reproliferation in 8 eyes (6%), and both VH and redetachment caused by reproliferation in 4 eyes (3%). Multivariable logistic regression analysis showed that plus disease (P = 0.007; odds ratio [OR], 3.681; 95% confidence interval [CI], 1.43-9.46) was a risk factor for reoperation due to postoperative VH, and greater extent of fibrovascular membrane (FVM) (P = 0.047: OR, 1.335; 95% CI, 1.004-1.776) and higher grade of fluorescein leakage (P = 0.033; OR, 5.675; 95% CI, 1.149-28.040) were risk factors for reoperation due to redetachment caused by reproliferation. In eyes with plus disease, anti-VEGF therapy as a preoperative adjunct significantly reduced the rate of reoperation for postoperative VH (20.0% vs. 60.7%, P=0.002).</p><p><strong>Conclusion: </strong>High anatomical success rates could be achieved by vitrectomy for stage 4A ROP. However, eyes with plus disease, greater extent of FVM, or higher grade of fluorescein leakage may have an increased risk of reoperation. In addition, preoperative anti-VEGF therapy may reduce reoperations due to postoperative VH in patients with plus disease.</p>\",\"PeriodicalId\":19501,\"journal\":{\"name\":\"Ophthalmology. Retina\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2025-05-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Ophthalmology. Retina\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.oret.2025.05.008\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ophthalmology. Retina","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.oret.2025.05.008","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
Risk factors for reoperation in vitrectomy for stage 4A retinopathy of prematurity.
Purpose: To determine risk factors for reoperation after vitrectomy for stage 4A retinopathy of prematurity (ROP).
Design: Retrospective, comparative case series.
Participants: The selected patients had undergone vitrectomy for stage 4A ROP with a minimum follow-up period of 6 months between 2010 and 2023.
Methods: Data collected from patients' charts included gender, gestational age at birth (GA), birth weight (BW), stage of ROP, postmenstrual age (PMA) at vitrectomy, extent of fibrovascular membrane (FVM), preoperative fluorescein angiography, surgical procedure, and subsequent reoperation during the follow-up period.
Main outcome measures: Anatomical success rate, incidence of postoperative vitreous hemorrhage (VH) and redetachment caused by reproliferation, and risk factors for reoperation to treat these postoperative complications.
Results: We included 132 consecutive eyes (42 bilateral and 48 unilateral) of 90 patients (48 female and 42 male). The mean GA, BW, and PMA at surgery were 24.6 ± 1.6 weeks, 623.3 ± 180.3 g, and 41.6 ± 4.1 weeks, respectively. Final anatomic success was achieved in 128 eyes (97%). Reoperations were necessary due to postoperative VH in 31 eyes (23%), redetachment caused by reproliferation in 8 eyes (6%), and both VH and redetachment caused by reproliferation in 4 eyes (3%). Multivariable logistic regression analysis showed that plus disease (P = 0.007; odds ratio [OR], 3.681; 95% confidence interval [CI], 1.43-9.46) was a risk factor for reoperation due to postoperative VH, and greater extent of fibrovascular membrane (FVM) (P = 0.047: OR, 1.335; 95% CI, 1.004-1.776) and higher grade of fluorescein leakage (P = 0.033; OR, 5.675; 95% CI, 1.149-28.040) were risk factors for reoperation due to redetachment caused by reproliferation. In eyes with plus disease, anti-VEGF therapy as a preoperative adjunct significantly reduced the rate of reoperation for postoperative VH (20.0% vs. 60.7%, P=0.002).
Conclusion: High anatomical success rates could be achieved by vitrectomy for stage 4A ROP. However, eyes with plus disease, greater extent of FVM, or higher grade of fluorescein leakage may have an increased risk of reoperation. In addition, preoperative anti-VEGF therapy may reduce reoperations due to postoperative VH in patients with plus disease.
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