Importance Preterm infants are at risk for poor visual acuity (VA) outcomes, even without retinal problems on ophthalmoscopy. Infant retinal microanatomy may provide insight as to potential causes. Objective To evaluate the association between preterm infant retinal microanatomy and VA at 9 months' corrected age. Design, Setting, and Participants This prospective observational study took place from November 2016 and December 2019 at a single academic medical center and included preterm infants enrolled in Study of Eye Imaging in Preterm Infants (BabySTEPS). Infants were eligible for enrollment in BabySTEPS if they met criteria for retinopathy of prematurity (ROP) screening, were 35 weeks' postmenstrual age or older at the time of first OCT imaging, and a parent or guardian provided written informed consent. Of 118 infants enrolled in BabySTEPS, 61 were included in this analysis. Data were analyzed from March to April 2021. Exposures Bedside optical coherence tomography (OCT) imaging at a mean (SD) 39.85 (0.79) weeks' postmenstrual age and monocular grating VA measurement at 9 months' corrected age. Main Outcomes and Measures Presence and severity of macular edema and presence of ellipsoid zone at the fovea measured by extracting semiautomated thicknesses of inner nuclear layer, inner retina, and total retina at the foveal center; choroid across foveal 1 mm; and retinal nerve fiber layer (RNFL) across the papillomacular bundle (PMB). Pearson correlation coefficients were calculated and 95% CIs were bootstrapped for the association between retinal layer thicknesses and continuous logMAR VA. Associations were analyzed between retinal microanatomy and normal (3.70 cycles/degree or greater) vs subnormal grating VA at 9 months' corrected age using logistic regression and with logMAR VA using linear regression, adjusting for birth weight, gestational age, and ROP severity at the time of OCT imaging and accounting for intereye correlation using generalized estimating equations. Results The mean (SD; range) gestational age of included infants was 27.6 (2.8; 23.0-34.6) weeks, and mean (SD; range) birth weight was 958.2 (293.7; 480-1580) g. In 122 eyes of 61 infants, the correlations between retinal layer thicknesses and logMAR VA were as follows: r, 0.01 (95% CI, -0.07 to -0.27) for inner nuclear layer; r, 0.19 (95% CI, 0.01 to 0.35) for inner retina; r, 0.15 (95% CI, -0.02 to 0.31) for total retina; r, -0.22 (95% CI, -0.38 to -0.03) for choroid; and r, -0.27 (95% CI, -0.45 to 0.10) for RNFL across the PMB. In multivariable analysis, thinner RNFL across the PMB (regression coefficient, -0.05 per 10-μm increase in RNFL thickness; 95% CI, -0.10 to -0.01; P = .046) and prior ROP treatment (regression coefficient, 0.33 for ROP treatment; 95% CI, 0.11 to 0.56; P = .003) were independently associated with poorer 9-month logMAR VA. Conclusions and Relevance In preterm infants, RNFL thinning across the PMB was associated with poorer 9-month VA, independent of birth weight, gestational age, need for ROP treatment, and macular microanatomy. Evaluation of RNFL thickness using OCT may help identify preterm infants at risk for poor vision outcomes.

中文翻译：

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早产儿视网膜显微解剖与 9 个月视力之间的关联。

重要性 早产儿即使在检眼镜检查时没有出现视网膜问题，也有视力 (VA) 结果不佳的风险。婴儿视网膜显微解剖学可以提供有关潜在原因的见解。目的 评估早产儿视网膜显微解剖结构与矫正年龄 9 个月时 VA 的关系。设计、设置和参与者 这项前瞻性观察研究于 2016 年 11 月和 2019 年 12 月在一个学术医疗中心进行，包括参加早产儿眼部成像研究 (BabySTEPS) 的早产儿。如果婴儿符合早产儿视网膜病变 (ROP) 筛查标准，在第一次 OCT 成像时月经后年龄为 35 周或以上，并且父母或监护人提供了书面知情同意书，则他们有资格参加 BabySTEPS。在参加 BabySTEPS 的 118 名婴儿中，有 61 名被纳入该分析。对 2021 年 3 月至 2021 年 4 月的数据进行了分析。曝光 平均 (SD) 39.85 (0.79) 周绝经后年龄的床边光学相干断层扫描 (OCT) 成像和 9 个月矫正年龄的单眼光栅 VA 测量。主要结果和测量 黄斑水肿的存在和严重程度以及中央凹椭圆体区域的存在，通过提取中央凹中心的内核层、内层视网膜和全视网膜的半自动厚度来测量；脉络膜横跨中心凹 1 毫米；和横跨乳头黄斑束 (PMB) 的视网膜神经纤维层 (RNFL)。计算 Pearson 相关系数，并为视网膜层厚度和连续 logMAR VA 之间的关联引导 95% CI。使用逻辑回归分析视网膜显微解剖学与正常（3.70 周期/度或更高）与亚正常光栅 VA 在 9 个月校正年龄之间的关联，并使用线性回归分析 logMAR VA，调整出生体重、胎龄和 ROP 严重程度OCT 成像时间和使用广义估计方程计算眼间相关性。结果纳入婴儿的平均（SD；范围）胎龄为27.6（2.8；23.0～34.6）周，平均（SD；范围）出生体重为958.2（293.7；480～1580）g。在 61 名婴儿的 122 只眼中，视网膜层厚度与 logMAR VA 之间的相关性如下：内核层 r，0.01（95% CI，-0.07 至 -0.27）；r, 0.19 (95% CI, 0.01 to 0.35) 内层视网膜；r, 0.15 (95% CI, -0.02 to 0.31) 对于总视网膜；r，-0.22（95% CI，-0.38 至 -0。03) 对于脉络膜；和 r，-0.27（95% CI，-0.45 至 0.10）用于整个 PMB 的 RNFL。在多变量分析中，PMB 上较薄的 RNFL（回归系数，RNFL 厚度每增加 10 μm，-0.05；95% CI，-0.10 至 -0.01；P = .046）和之前的 ROP 治疗（ROP 的回归系数，0.33）治疗；95% CI，0.11 至 0.56；P = .003）与较差的 9 个月 logMAR VA 独立相关。结论和相关性 在早产儿中，横跨 PMB 的 RNFL 变薄与较差的 9 个月视力相关，与出生体重、胎龄、ROP 治疗需要和黄斑显微解剖无关。使用 OCT 评估 RNFL 厚度可能有助于识别有视力不良风险的早产儿。PMB 上更薄的 RNFL（回归系数，RNFL 厚度每增加 10 μm -0.05；95% CI，-0.10 至 -0.01；P = .046）和之前的 ROP 治疗（回归系数，ROP 治疗的回归系数为 0.33；95% CI，0.11 至 0.56；P = .003）与较差的 9 个月 logMAR VA 独立相关。结论和相关性 在早产儿中，横跨 PMB 的 RNFL 变薄与较差的 9 个月视力相关，与出生体重、胎龄、ROP 治疗需要和黄斑显微解剖无关。使用 OCT 评估 RNFL 厚度可能有助于识别有视力不良风险的早产儿。PMB 上更薄的 RNFL（回归系数，RNFL 厚度每增加 10 μm -0.05；95% CI，-0.10 至 -0.01；P = .046）和之前的 ROP 治疗（回归系数，ROP 治疗的回归系数为 0.33；95% CI，0.11 至 0.56；P = .003）与较差的 9 个月 logMAR VA 独立相关。结论和相关性 在早产儿中，横跨 PMB 的 RNFL 变薄与较差的 9 个月视力相关，与出生体重、胎龄、ROP 治疗需要和黄斑显微解剖无关。使用 OCT 评估 RNFL 厚度可能有助于识别有视力不良风险的早产儿。003) 与较差的 9 个月 logMAR VA 独立相关。结论和相关性 在早产儿中，横跨 PMB 的 RNFL 变薄与较差的 9 个月视力相关，与出生体重、胎龄、ROP 治疗需要和黄斑显微解剖无关。使用 OCT 评估 RNFL 厚度可能有助于识别有视力不良风险的早产儿。003) 与较差的 9 个月 logMAR VA 独立相关。结论和相关性 在早产儿中，横跨 PMB 的 RNFL 变薄与较差的 9 个月视力相关，与出生体重、胎龄、ROP 治疗需要和黄斑显微解剖无关。使用 OCT 评估 RNFL 厚度可能有助于识别有视力不良风险的早产儿。