Darlow B A, Clemett R S
Paediatric Department, Christchurch Hospital, New Zealand.
Aust N Z J Ophthalmol. 1990 Feb;18(1):41-6. doi: 10.1111/j.1442-9071.1990.tb00583.x.
In recent years it has been standard practice to recommend that indirect ophthalmoscopy be carried out between six and nine weeks of age in very low birthweight infants to screen for the presence of retinopathy of prematurity (ROP). Following this recommendation we examined 85 infants over a two-year period. Acute ROP occurred in 29 (34%), and two (2.4%) developed cicatricial disease. One-third of infants were initially examined slightly earlier or later than the strict six to nine week limits, but all except three infants were examined between 35 and 42 weeks gestation. One infant born at 26 weeks gestation, was examined 'too late' in that she had stage 4 disease when first seen at 11 weeks of age. Recent information on the natural history of ROP, and confirmation of the efficacy of treatment with cyotherapy, suggested that the timing of an initial screening examination for ROP needed reassessment. From our experience and a review of the literature we recommended that infants of less than 1000 g birthweight or less than 28 weeks gestation have an initial examination at six weeks of age; for infants of 1000 to 1250 g birthweight or 28 to 30 weeks gestation examination continue to be at six to nine weeks of age; and for infants of more than 1250 g birthweight or 31 weeks gestation screening at six to nine weeks of age is only necessary if the infant has had an unstable course or prolonged oxygen requirements. Such a protocol would not place too great a burden on ophthalmological services and would direct efforts towards the group of infants most at risk of severe visual handicap.
近年来，推荐在极低出生体重儿出生6至9周时进行间接检眼镜检查以筛查早产儿视网膜病变（ROP）已成为标准做法。按照这一建议，我们在两年时间里检查了85名婴儿。29名（34%）发生了急性ROP，2名（2.4%）发展为瘢痕性病变。三分之一的婴儿最初检查时间略早或略晚于严格的6至9周界限，但除3名婴儿外，所有婴儿均在妊娠35至42周时接受了检查。一名妊娠26周出生的婴儿，在11周龄首次就诊时已处于4期疾病，检查“太晚”。关于ROP自然病史的最新信息以及冷冻疗法治疗效果的证实，表明ROP初次筛查检查的时间需要重新评估。根据我们的经验并回顾文献，我们建议出生体重低于1000g或妊娠少于28周的婴儿在6周龄时进行初次检查；出生体重在1000至1250g之间或妊娠28至30周的婴儿继续在6至9周龄时进行检查；出生体重超过1250g或妊娠31周的婴儿，仅在其病程不稳定或有长期吸氧需求时才需要在6至9周龄时进行筛查。这样的方案不会给眼科服务带来太大负担，并将把工作重点放在最有严重视力障碍风险的婴儿群体上。
