Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Ophthalmology. 2013 Nov;120(11):2278-85. doi: 10.1016/j.ophtha.2013.03.035. Epub 2013 May 30.
Ophthalmologic complications after preterm birth are common. Small studies show an association between retinopathy of prematurity and later retinal detachment. There are no population-based studies of preterm birth and risk of retinal detachment, which was the objective of the current investigation.
Nationwide Swedish cohort study based on population registries.
Of 3 423 697 subjects born in Sweden, 1 271 725 were born between 1973 and 1986 (i.e., before the national screening program for retinopathy of prematurity started), and 2 151 972 were born between 1987 and 2008. The participants were followed up from 1 year of age until 2009.
Unadjusted and adjusted hazard ratios (HRs) for retinal detachment were calculated using Cox proportional hazards regression.
Incident retinal detachment, as defined by a diagnosis in the Swedish Patient Register (both inpatient and hospital-based outpatient data).
During follow-up (median follow-up, 17.4 years), 1749 subjects were diagnosed with retinal detachment. Among the 188 852 subjects born prematurely (i.e., at <37 weeks of gestation), there were 124 cases of retinal detachment, of which 42 occurred in the 20 470 subjects born before 32 weeks of gestation. Compared with subjects born at term (37-41 weeks), the adjusted HR for retinal detachment after extremely preterm birth (<28 weeks of gestation) was 19.2 (95% confidence interval [CI], 10.3-35.8) for births between 1973 and 1986 and 8.95 (95% CI, 3.98-20.1) for births between 1987 and 2008. The corresponding HRs in subjects born very prematurely (28-31 weeks) were 4.32 (95% CI, 2.70-6.90) and 2.80 (95% CI, 1.38-5.69), respectively. Moderately preterm birth (32-36 weeks) was not associated with an increased risk of retinal detachment.
Birth before 32 weeks of gestation is associated with a substantially increased relative risk of retinal detachment. These findings may have implications for ophthalmologic follow-up of children and adults born very prematurely.
早产儿眼部并发症较为常见。一些小型研究表明，早产儿视网膜病变与随后发生视网膜脱离之间存在关联。目前还没有基于人群的早产儿出生与视网膜脱离风险的研究，本研究旨在探讨这一问题。
基于人群的全国性瑞典队列研究，利用人口登记系统。
在瑞典出生的 3423697 名受试者中，1271725 名受试者出生于 1973 年至 1986 年（即全国早产儿视网膜病变筛查项目开始之前），2151972 名受试者出生于 1987 年至 2008 年。受试者的随访时间从 1 岁开始，直至 2009 年。
采用 Cox 比例风险回归计算视网膜脱离的未调整和调整后危险比（HR）。
视网膜脱离的发生率，由瑞典患者登记处（包括住院和医院门诊数据）的诊断确定。
在随访期间（中位随访时间为 17.4 年），共有 1749 名受试者被诊断为视网膜脱离。在 188852 名早产儿（即妊娠 37 周前出生）中，有 124 例发生视网膜脱离，其中 42 例发生在 20470 名妊娠 32 周前出生的受试者中。与足月（37-41 周）出生的受试者相比，1973 年至 1986 年出生的极早产儿（<28 周）的视网膜脱离校正后 HR 为 19.2（95%置信区间[CI]，10.3-35.8），1987 年至 2008 年出生的校正后 HR 为 8.95（95%CI，3.98-20.1）。出生时极早产（28-31 周）的受试者的 HR 分别为 4.32（95%CI，2.70-6.90）和 2.80（95%CI，1.38-5.69）。中度早产（32-36 周）与视网膜脱离风险增加无关。
妊娠 32 周前出生与视网膜脱离的相对风险显著增加相关。这些发现可能对视科医生对早产儿及其成年后的随访产生影响。
