Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA.
Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA.
Am J Ophthalmol. 2021 Feb;222:41-53. doi: 10.1016/j.ajo.2020.08.043. Epub 2020 Sep 4.
To assess retinal nerve fiber layer (RNFL) thickness in preterm infants.
Prospective observational study.
We imaged 83 awake infants (159 eyes) at 36 ± 1 weeks postmenstrual age (defined as the time elapsed between the first day of the last maternal menstrual period and the time at imaging) using a handheld optical coherence tomography (OCT) system at the bedside. Blinded graders semi-automatically segmented RNFL in the papillomacular bundle (-15 to +15° relative to the fovea-optic nerve axis). We correlated RNFL thickness and 7 characteristics of interest (sex, race, ethnicity, gestational age, birth weight, stage of retinopathy at prematurity, and presence of pre-plus or plus disease) via univariable and multivariable regressions.
RNFL was 3.4 μm thicker in the right eyes than in the left eyes (P < .001). Among 7 characteristics, birth weight was the only independent predictor of RNFL thickness (P < .001). A 250-g increase in birth weight was associated with 5.2 μm (95% confidence interval: 3.3-7.0) increase in RNFL thickness. Compared with very preterm infants, extremely preterm infants had thinner RNFL (58.0 ± 10.7 μm vs 63.4 ± 10.7 μm, P = .03), but the statistical significance disappeared after adjustment for birth weight (P = .25). RNFL thickness was 11.2 μm thinner in extremely low birth weight infants than in very low birth weight infants (55.5 ± 8.3 μm vs. 66.7 ± 10.2 μm; P < .001). The difference remained statistically significant after adjustment for gestational age.
Birth weight is a significant independent predictor of RNFL thickness near birth, implying that the retinal ganglion cells reserve is affected by intrauterine processes that affect birth weight.
评估早产儿的视网膜神经纤维层（RNFL）厚度。
前瞻性观察性研究。
我们使用手持式光学相干断层扫描（OCT）系统在 36±1 周的胎龄（定义为从末次月经第一天到成像时的时间）时对 83 名清醒的婴儿（159 只眼）进行成像。盲法分级员在视乳头-黄斑束（相对于视乳头-视神经轴的-15 至+15°）中半自动分割 RNFL。我们通过单变量和多变量回归分析将 RNFL 厚度与 7 个感兴趣的特征（性别、种族、民族、胎龄、出生体重、早产儿视网膜病变分期和存在 Pre-plus 或 Plus 疾病）相关联。
右眼的 RNFL 比左眼厚 3.4μm（P<.001）。在 7 个特征中，出生体重是 RNFL 厚度的唯一独立预测因素（P<.001）。出生体重增加 250g，与 RNFL 厚度增加 5.2μm（95%置信区间：3.3-7.0）相关。与非常早产儿相比，极早产儿的 RNFL 更薄（58.0±10.7μm 与 63.4±10.7μm，P=.03），但调整出生体重后统计学意义消失（P=.25）。极低出生体重儿的 RNFL 比极低出生体重儿薄 11.2μm（55.5±8.3μm 与 66.7±10.2μm；P<.001）。调整胎龄后，差异仍具有统计学意义。
出生体重是出生时 RNFL 厚度的重要独立预测因素，这表明视网膜神经节细胞储备受到影响出生体重的宫内过程的影响。
