Holmström Gerd, Larsson Eva
Department of Ophthalmology, University Hospital, Uppsala, Sweden.
J AAPOS. 2008 Apr;12(2):157-62. doi: 10.1016/j.jaapos.2007.08.012. Epub 2007 Dec 21.
Prematurely born children have an increased risk of ophthalmologic problems. There is still no consensus on how they should be followed. The purpose of this study was to evaluate predictive factors for problems in premature children at ten years of age and to discuss follow-up recommendations.
One hundred ninety-nine children with a birth weight of 1500 g or less were screened for retinopathy of prematurity (ROP) in the neonatal period and thereafter ophthalmologically examined at 6 months, 1.5, 2.5, 3.5, and 10 years of age. "Visual dysfunction" at ten years of age was defined as visual acuity > or =0.1 logMAR and/or strabismus and/or subnormal contrast sensitivity. Multiple regression analyses were used to evaluate risk factors at an early age, which could predict problems at ten years of age.
Twenty-five percent of the cohort had visual dysfunction at ten years of age. Neurological complications, cryotreated ROP, anisometropia, and astigmatism were risk factors. The sensitivity was 75.5%, and the specificity 80.7% for the detection of visual dysfunction at ten years of age when all children with neurological complications, cryotreated ROP, strabismus, anisometropia > or =1 diopters (D) at 2.5 years, and astigmatism > or =2 D at 2.5 years were included in further follow-up.
Repeated ophthalmologic follow-up of prematurely born children should be performed in those with treated ROP and/or neurological conditions. For a third group without such problems, at least one follow-up is recommended. Such an examination also provides a good opportunity to identify neurological problems that warrant further ophthalmologic follow-up.
早产儿出现眼科问题的风险增加。对于如何对他们进行随访尚无共识。本研究的目的是评估10岁早产儿出现问题的预测因素，并讨论随访建议。
对199名出生体重1500克及以下的儿童在新生儿期进行早产儿视网膜病变（ROP）筛查，此后在6个月、1.5岁、2.5岁、3.5岁和10岁时进行眼科检查。10岁时的“视觉功能障碍”定义为视力≥0.1 logMAR和/或斜视和/或对比敏感度低于正常。采用多元回归分析评估早期可能预测10岁时出现问题的危险因素。
该队列中有25%的儿童在10岁时存在视觉功能障碍。神经并发症、接受冷冻治疗的ROP、屈光参差和散光为危险因素。当将所有患有神经并发症、接受冷冻治疗的ROP、斜视、2.5岁时屈光参差≥1屈光度（D）以及2.5岁时散光≥2 D的儿童纳入进一步随访时，检测10岁时视觉功能障碍的敏感度为75.5%，特异度为80.7%。
对于接受过ROP治疗和/或患有神经疾病的早产儿，应进行重复的眼科随访。对于第三组没有此类问题的儿童，建议至少进行一次随访。这样的检查也为识别需要进一步眼科随访的神经问题提供了一个好机会。
