Institute of Biophotonics, National Yang Ming University, Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan.
Kaohsiung J Med Sci. 2012 Apr;28(4):204-11. doi: 10.1016/j.kjms.2011.10.010. Epub 2012 Feb 12.
This study evaluated the extent to which refractive morbidity is correlated to preterm birth or retinopathy of prematurity (ROP) itself, or both, and examined the risk factors associated with refractive errors in a cohort of preterm infants with and without ROP compared with full-term infants. This longitudinal, prospective, controlled cohort study enrolled 109 infants, including 74 preterm and 35 full-term infants. Infants were divided into the following groups: no ROP, regressed ROP, laser-treated threshold ROP, and full-term. Cycloplegic refraction was determined at 6 and 24 months' corrected age. Multiple regression models, analysis of variance (ANOVA) with post hoc comparisons, paired t test, and the χ(2) test were used for data analysis. ROP status was highly predictive of significant refractive errors in preterm infants. Eyes with laser-treated threshold ROP had significant myopia at both ages (mean spherical equivalent [MSE] in right eye at both refractions -0.72, -1.21 diopters [D]), astigmatism (MSE -1.62, -1.80 D), and anisometropia (MSE 0.82, 1.02 D; ANOVA p < 0.05), and increased refractive errors across ages (paired t test p < 0.05). Eyes with regressed ROP (MSE + 0.35 D) and eyes without ROP (MSE + 0.78 D) were less hyperopic than the controls (MSE + 1.60 D) before 1 year (post hoc comparisons p < 0.05). After 1 year, however, hyperopic status, astigmatism, and anisometropia were similar to eyes with regressed ROP (MSE + 0.38 D, astigmatism -0.94 D, anisometropia 0.32 D), eyes without ROP (MSE + 0.35 D, astigmatism -0.51 D, anisometropia 0.31 D) and the controls (MSE + 0.72 D, astigmatism -0.59 D, anisometropia 0.50 D) by post hoc comparisons (p > 0.05). Thus, the persistent hyperopic status across ages in patients with regressed ROP and in patients without ROP differed significantly (paired t test p > 0.05) from that in the full-term infants, with a reduction in hypermetropia noted for the first 2 years of life (paired t test p < 0.05). The incidence and magnitude of significant refractive errors increased with severe ROP and with age. Although the emmetropization process of preterm birth, including regressed ROP and no ROP, differed from full-term birth in early infancy, we found no differences in the refractive status after 1 year in patients with regressed ROP and in patients without ROP, who were at risk of developing ametropia similar to that of full-term patients. Therefore, apart from laser-treated ROP, children with regressed ROP and without ROP can likely be observed with a verbal vision screening at 3-4 years of age.
本研究评估了近视发病率与早产儿或早产儿视网膜病变（ROP）本身、或两者之间的相关性，并研究了与ROP 相比，患有和不患有 ROP 的早产儿与足月儿之间与屈光不正相关的危险因素。这是一项前瞻性、纵向、对照队列研究，共纳入 109 名婴儿，包括 74 名早产儿和 35 名足月儿。婴儿分为以下几组：无 ROP、退行性 ROP、激光治疗阈值 ROP 和足月儿。在矫正年龄 6 个月和 24 个月时进行睫状肌麻痹验光。采用多元回归模型、方差分析（ANOVA）、配对 t 检验和卡方检验进行数据分析。ROP 状态高度预测早产儿的显著屈光不正。接受激光治疗阈值 ROP 的眼睛在两个年龄都有明显的近视（右眼均数等效球镜 [MSE] -0.72、-1.21 屈光度 [D]）、散光（MSE -1.62、-1.80 D）和屈光参差（MSE 0.82、1.02 D；ANOVA p<0.05），且随着年龄的增长，屈光不正程度也在增加（配对 t 检验 p<0.05）。患有退行性 ROP（MSE +0.35 D）和无 ROP（MSE +0.78 D）的眼睛在 1 岁前比对照组（MSE +1.60 D）更远视（事后比较 p<0.05）。然而，1 岁后，远视状态、散光和屈光参差与退行性 ROP （MSE +0.38 D，散光 -0.94 D，屈光参差 0.32 D）、无 ROP（MSE +0.35 D，散光 -0.51 D，屈光参差 0.31 D）和对照组（MSE +0.72 D，散光 -0.59 D，屈光参差 0.50 D）的眼睛相似（事后比较 p>0.05）。因此，患有退行性 ROP 和无 ROP 的患者在整个年龄段的持续远视状态与足月儿明显不同（配对 t 检验 p>0.05），在生命的前 2 年观察到远视程度的降低（配对 t 检验 p<0.05）。严重 ROP 和年龄的增加会导致显著屈光不正的发生率和程度增加。尽管早产儿出生后的眼屈光发育过程（包括退行性 ROP 和无 ROP）与足月儿出生时不同，但我们发现，患有退行性 ROP 和无 ROP 的患者在 1 岁后与足月儿患者的屈光状态没有差异，他们有发生类似足月儿患者的屈光不正的风险。因此，除了接受激光治疗的 ROP 外，患有退行性 ROP 和无 ROP 的儿童可以在 3-4 岁时通过口头视力筛查进行观察。
