前言：白内障手术日益成熟，但特殊病史患者的术后管理仍面临挑战。早产儿视网膜病变（ROP）患者成年后接受白内障手术，视网膜并发症风险增加。目前，针对这类患者术后视网膜并发症的风险因素、监测管理等方面的研究尚不完善。近日，第43届美国视网膜专家学会（ASRS 2025）年会于美国长滩圆满落下帷幕。会议现场，《国际眼科时讯》有幸采访到Wills眼科医院Nikhil Bommakanti教授进行了深度采访，围绕ROP患者成年后接受白内障手术的相关话题展开探讨，其独到见解与宝贵经验，对改善有ROP史白内障患者的术后预后具有重要意义。

《国际眼科时讯》：对于有ROP史的成人白内障术患者，白内障术后视网膜并发症的发生风险与哪些因素相关？

Nikhil Bommakanti教授：我们通过分析美国眼科学会IRIS注册中心的数据，旨在明确白内障术后视网膜并发症的相关风险因素及其他关联情况。该研究纳入了约1000名有ROP病史且接受过白内障手术的成人患者的1500只眼。研究周期为七年，且每只眼在白内障术后至少随访三年。在白内障术后三年内，13.8%眼出现了视网膜裂孔或视网膜脱离。年龄较小（18~49岁）和格子样变性是视网膜裂孔和视网膜脱离的强风险因素。

We performed an IRIS Registry analysis to answer this question. The study involved approximately 1500 eyes from 1000 adult patients with a history of ROP who underwent cataract surgery. Our study interval was seven years, and eyes had a minimum of 3 years of follow up after cataract surgery. Within three years of cataract surgery, 13.8% of eyes developed retinal tears or retinal detachment. Younger age (18-49 years) and lattice degeneration emerged as strong risk factors for both retinal tear and detachment.

《国际眼科时讯》：对于这些患者，白内障术后需要哪些特殊的监测和管理措施？是否有标准化的随访计划或优先进行的诊断评估项目？

Nikhil Bommakanti教授：我们的研究凸显了识别这些患者并给予恰当告知的重要性。眼底检查结果可能较为隐匿，我们还发现有相当一部分ROP病情较轻的成年患者后来也出现了视网膜并发症。这强调了在术前评估时询问ROP病史并将其牢记于心的重要性。至于随访或标准方案的调整，应在患者与医师充分讨论后根据个体情况制定。对于这些患者，白内障手术医师和视网膜医师开展更紧密的合作也可能有所帮助。

Our study demonstrates the importance of identifying these patients and counseling them appropriately. The fundus examination findings can be subtle, and we also found a not insubstantial number of adult patients with milder stages of ROP who went on to develop retinal complications. This underscores the importance of asking about a history of ROP and keeping it in mind during the preoperative evaluation. As to changes in follow up or standard protocols, those should be made on an individualized basis after a good discussion between the patient and physician. It may also be helpful for cataract surgeons and retina specialists to collaborate more closely for these patients. 

《国际眼科时讯》：对于有ROP史的白内障患者，在术后视网膜并发症的预防与管理方面，您有哪些临床见解或实践建议？

Nikhil Bommakanti教授：同样，术前识别ROP病史非常重要，因为这些患者术后发生视网膜并发症的风险更高。由于格子样变性是一个强风险因素，眼科医师可考虑在为这些患者进行白内障手术前，针对格子样变性进行预防性激光视网膜光凝术，不过这一决策应根据个体情况制定。我们还发现，这些患者发生复杂白内障手术的风险较高，因此，对于白内障手术医师而言，了解患者的病史对术中操作和术后管理都很重要。

Again, it’s important to identify a history of ROP preoperatively, because these patients are at higher risk for retinal complications after surgery. As lattice degeneration was a strong risk factor, retina specialists may consider prophylactic laser retinopexy for lattice degeneration before cataract surgery for these patients, however this decision should be made on an individualized basis. We also found that these patients at higher risk for having a complex cataract surgery, so knowledge of their history is important intraoperatively for cataract surgeons and postoperatively.

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