Page J M, Schneeweiss S, Whyte H E, Harvey P
Department of Nursing, Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatrics. 1993 Dec;92(6):787-90.
The authors report on the incidence of myopia and strabismus at 12 and 24 months postterm in a cohort of 190 premature infants with birth weights of less than 1251 g born in 1986 and 1987.
The neonatal and follow-up eye charts of a cohort of 190 premature infants were retrospectively reviewed. All 138 children who survived the neonatal period had at least one eye examination between day 28 and 42 of life that documented the presence and staging of retinopathy of prematurity (ROP) according to the International Classification of ROP. No infants received cryotherapy. Eye examinations conducted at 12 and 24 months postterm included assessment of vision, fundus, ocular motility, anterior segment abnormality, and refractive error. Eyes were refracted using cycloplegic retinoscopy. Strabismus was detected using the Hirschberg and cover tests. Eye reports were available for 80% (n = 110) at 12 months and 36% (n = 50) at 24 months.
Fifty-three percent of the cohort exhibited ROP in the neonatal period; 12% of these progressed to stage 3 or 4 ROP. Myopia was observed in 16% (18/110) of the cohort at 12 months of age; 4.5% (5/110) measured more than 4.0 diopters of myopia. Children with birth weights of less than 751 g were 3.2 times more likely than those with birth weights between 751 and 1000 g and 10 times more likely than those with birth weights between 1001 and 1250 g to develop myopia in the first year of life. The likelihood of myopia at 12 months doubled with each increment in ROP stage. Of the 50 children reexamined at 24 months postterm, more than 80% demonstrated deteriorating vision. The incidence of myopia increased to 38% (19/50) overall, with 24% (12/50) of the cohort showing severe myopia. Astigmatism and anisometropia were highly correlated with severe myopia. Strabismus was seen with increasing frequency through the second year of life. All children with grade III or IV intraventricular hemorrhage in the neonatal period developed esotropia.
This study emphasizes the significant roles of low birth weight, ROP, and intraventricular hemorrhage in the development of myopia and strabismus. Follow-up to 2 years of life is recommended given the demonstrated deterioration in our cohort.
作者报告了1986年和1987年出生的190名出生体重小于1251g的早产婴儿在足月后12个月和24个月时近视和斜视的发生率。
对190名早产婴儿的新生儿期和随访眼部检查图表进行回顾性分析。所有138名度过新生儿期的儿童在出生后第28天至42天之间至少接受了一次眼部检查，根据国际早产儿视网膜病变（ROP）分类记录了ROP的存在和分期。没有婴儿接受冷冻疗法。在足月后12个月和24个月进行的眼部检查包括视力、眼底、眼球运动、眼前段异常和屈光不正的评估。使用睫状肌麻痹视网膜检影法进行验光。使用 Hirschberg 法和遮盖试验检测斜视。12个月时80%（n = 110）、24个月时36%（n = 50）有眼部检查报告。
该队列中有53%的婴儿在新生儿期出现ROP；其中12%进展为3期或4期ROP。12个月大时，该队列中有16%（18/110）的婴儿出现近视；4.5%（5/110）的近视度数超过4.0屈光度。出生体重小于751g的儿童在生命的第一年发生近视的可能性是出生体重在751至1000g之间儿童的3.2倍，是出生体重在1001至1250g之间儿童的10倍。ROP分期每增加一期，12个月时近视的可能性就增加一倍。在足月后24个月重新检查的50名儿童中，超过80%的儿童视力下降。总体近视发生率增至38%（19/50），该队列中有24%（12/50）表现为重度近视。散光和屈光参差与重度近视高度相关。斜视在生命的第二年出现频率增加。所有在新生儿期有III级或IV级脑室内出血的儿童均发生了内斜视。
本研究强调了低出生体重、ROP和脑室内出血在近视和斜视发生发展中的重要作用。鉴于我们队列中已证实的视力下降情况，建议随访至2岁。
