Hellgren Kerstin M, Tornqvist Kristina, Jakobsson Peter G, Lundgren Pia, Carlsson Birgitta, Källén Karin, Serenius Fredrik, Hellström Ann, Holmström Gerd
Department of Clinical Neuroscience, Karolinska Institutet, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
Department of Ophthalmology, Lund University Hospital, Lund, Sweden.
JAMA Ophthalmol. 2016 May 1;134(5):555-562. doi: 10.1001/jamaophthalmol.2016.0391.
This follow-up study of extremely preterm (EPT) children (<27 weeks' gestational age [GA] at birth) revealed major eye and visual problems in 37.9% (147 of 388) of all EPT infants and in 55.4% (67 of 121) of the most immature subgroups at 6.5 years of age. These major eye and visual problems were strongly associated with treatment-requiring retinopathy of prematurity (ROP).
To investigate the ophthalmologic outcome of a national cohort of EPT children at 6.5 years of age and to evaluate the impact of prematurity and ROP.
DESIGN, SETTING, AND PARTICIPANTS: All surviving EPT children born in Sweden between April 1, 2004, and March 31, 2007, were included and compared with a matched term control group, as part of a prospective national follow-up study.
Visual acuity, refraction in cycloplegia, and manifest strabismus were evaluated and compared with GA at birth and with treatment-requiring ROP.
The study cohort comprised 486 participants. The mean (SD) GA of the children who were included was 25 (1) weeks, and 45.7% (222 of 486) were female. At a median age of 6.6 years, 89.3% (434 of 486) of eligible EPT children were assessed and compared with 300 control group children. In the EPT group, 2.1% (9 of 434) were blind, 4.8% (21 of 434) were visually impaired according to the World Health Organization criteria, and 8.8% (38 of 434) were visually impaired according to the study criteria. Strabismus was found in 17.4% (68 of 390) and refractive errors in 29.7% (115 of 387) of the EPT children compared with 0% (0 of 299) and 5.9% (17 of 289), respectively, of the control children (P < .001). Altogether at 6.5 years of age, 37.9% (147 of 388) of the EPT children had some ophthalmologic abnormality compared with 6.2% (18 of 290) of the matched control group (95% CI of the difference, 26.1%-37.2%). When treatment-requiring ROP was adjusted for, no significant association between GA and visual impairment could be detected. For refractive errors, the association with GA remained after adjustment for treatment-requiring ROP (odds ratio, 0.72; 95% CI, 0.58-0.91 for each 1-week increment).
In a Swedish national cohort of EPT children at 6.5 years of age, major eye and visual problems were frequently found. Treatment-requiring ROP was a stronger impact factor than GA on visual impairment and strabismus, but not on refractive errors, as a whole. In modern neonatal intensive care settings, ophthalmologic problems continue to account for a high proportion of long-term sequelae of prematurity.
这项对极早产儿（出生时胎龄<27周）的随访研究显示，在所有极早产儿中，37.9%（388例中的147例）在6.5岁时存在严重的眼部和视力问题；在最不成熟的亚组中，这一比例为55.4%（121例中的67例）。这些严重的眼部和视力问题与需要治疗的早产儿视网膜病变（ROP）密切相关。
调查全国队列中极早产儿在6.5岁时的眼科结局，并评估早产和ROP的影响。
设计、背景和参与者：作为一项全国前瞻性随访研究的一部分，纳入了2004年4月1日至2007年3月31日在瑞典出生的所有存活极早产儿，并与匹配的足月儿对照组进行比较。
评估视力、睫状肌麻痹验光和明显斜视，并与出生时的胎龄以及需要治疗的ROP进行比较。
研究队列包括486名参与者。纳入儿童的平均（标准差）胎龄为25（1）周，45.7%（486例中的222例）为女性。在中位年龄6.6岁时，对486例符合条件的极早产儿中的89.3%（434例）进行了评估，并与300例对照组儿童进行比较。在极早产儿组中，2.1%（434例中的9例）失明，根据世界卫生组织标准，4.8%（434例中的21例）视力受损，根据研究标准，8.8%（434例中的38例）视力受损。极早产儿中斜视的发生率为17.4%（390例中的68例），屈光不正的发生率为29.7%（387例中的115例），而对照组儿童的这两个比例分别为0%（299例中的0例）和5.9%（289例中的17例）（P<0.001）。在6.5岁时，总共37.9%（388例中的147例）的极早产儿存在某种眼科异常，而匹配对照组的这一比例为6.2%（290例中的18例）（差异的95%置信区间为26.1%-37.2%）。在对需要治疗的ROP进行调整后，未发现胎龄与视力损害之间存在显著关联。对于屈光不正，在对需要治疗的ROP进行调整后，与胎龄的关联仍然存在（优势比为0.72；每增加1周的95%置信区间为0.58-0.91）。
在瑞典全国队列中，6.5岁的极早产儿经常出现严重的眼部和视力问题。总体而言，需要治疗的ROP对视力损害和斜视的影响比胎龄更大，但对屈光不正的影响并非如此。在现代新生儿重症监护环境中，眼科问题在早产的长期后遗症中仍占很高比例。
