Long-term peripapillary retinal nerve fiber layer thickness in untreated retinopathy of prematurity with spontaneous regression at or beyond 45 weeks’ postmenstrual age

Abstract

Retinopathy of prematurity (ROP) may be associated with persistent retinal structural differences despite spontaneous clinical regression. This study evaluated long-term peripapillary retinal nerve fiber layer (RNFL) thickness in preterm children with untreated ROP that regressed at or beyond 45 weeks’ postmenstrual age (PMA). This single-center comparative study included 42 preterm children aged 6–10 years: 21 with bilateral untreated ROP that regressed at or beyond 45 weeks’ PMA and 21 gestational age– and examination age–matched preterm controls without ROP. Eligible children were identified retrospectively from screening records and underwent a standardized cross-sectional ophthalmologic examination. Both eyes were analyzed using generalized estimating equations to account for inter-eye correlation. Multivariable models included gestational age, age at examination, axial length, sex, and eye laterality. Eighty-four eyes were analyzed. Median best-corrected visual acuity was 0.00 logMAR in both groups, and visual acuity, refractive status, axial length, intraocular pressure, and sex distribution did not differ significantly. Compared with controls, the ROP group had greater temporal RNFL thickness (79.74 ± 15.60 vs. 71.57 ± 11.73 μm; difference, 8.17 μm; 95% confidence interval [CI], 0.50–15.83; p = 0.037) and lower nasal RNFL thickness (62.86 ± 13.48 vs. 70.29 ± 13.73 μm; difference, − 7.43 μm; 95% CI, − 14.78 to − 0.08; p = 0.048). In adjusted models, ROP status remained associated with greater temporal RNFL thickness (B = 7.59 μm; 95% CI, 1.18–13.99; p = 0.020) and lower nasal RNFL thickness (B = − 7.57 μm; 95% CI, − 13.37 to − 1.76; p = 0.011). Axial length was independently associated with both sectors. Within the ROP group, PMA at regression (45–50 weeks) was not independently associated with nasal or temporal RNFL thickness after multivariable adjustment. Preterm children with untreated ROP that regressed at or beyond 45 weeks’ PMA showed greater temporal and lower nasal RNFL thickness than matched preterm controls without ROP. These findings indicate persistent sectoral peripapillary RNFL differences in this predefined population but do not establish that the pattern is specifically attributable to later regression timing.