Repka M X, Summers C G, Palmer E A, Dobson V, Tung B, Davis B
Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Ophthalmology. 1998 Sep;105(9):1621-7. doi: 10.1016/s0161-6420(98)99028-5.
This study aimed to report the frequency of ophthalmologic surgical and medical therapies provided to children with birth weights less than 1251 g who had all stages of retinopathy of prematurity (ROP). In addition, this study aimed to report the initial age at which such procedures are provided and to report the frequency of cerebrospinal fluid shunts.
Observational case series with prospective data collection.
Children from the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) with birth weights less than 1251 g served as subjects. Group A included 257 children from all 23 CRYO-ROP study centers who had threshold ROP, who had participated in the randomized trial of cryotherapy, and who had survived to age 1 year. Group B included 1208 children from 5 of the 23 study centers who had varying severity of ROP (69 had threshold ROP) and who had participated in a 5 1/2-year study of the natural history of ROP.
Investigators documented medical and surgical ophthalmologic interventions through age 5 1/2 years as well as cerebrospinal fluid shunting surgery for hydrocephalus through age 2 years.
Group A was composed of 257 children with threshold ROP who underwent 226 ocular interventions in addition to cryotherapy (0.9 intervention per child). The most common treatments performed on the randomized cohort of children were vitrectomy (26% of patients), lensectomy (18%), amblyopia therapy (20%), and strabismus surgery (10%). Cataract surgery not associated with vitrectomy was performed infrequently (2%) and was performed equally often in treated and control eyes. Amblyopia therapy was prescribed as often for treated as for control eyes. Cerebrospinal fluid shunts were placed in 11% of these children. Group B was composed of 1208 natural history patients who underwent 239 ophthalmologic interventions (0.4 intervention per child). Strabismus surgery was the most commonly performed procedure for the natural history cohort of children (6% of the children). Amblyopia therapy was prescribed for 7% of the natural history patients. Cerebrospinal fluid shunts were required by 3% of the natural history infants, more often in children with more severe ROP.
These premature infants underwent a large number of ophthalmologic treatments during the first 5 1/2 years of life. The long-term costs of both extreme prematurity and ROP include not only the initial ablative therapy for ROP and societal loss due to blindness that still occurs in some cases, but also the ongoing costs of caring for eye problems.
本研究旨在报告为出生体重低于1251克且患有各阶段早产儿视网膜病变（ROP）的儿童提供眼科手术和药物治疗的频率。此外，本研究旨在报告进行此类手术的初始年龄，并报告脑脊液分流术的频率。
前瞻性数据收集的观察性病例系列研究。
来自早产儿视网膜病变冷冻疗法多中心试验（CRYO-ROP）、出生体重低于1251克的儿童作为研究对象。A组包括来自所有23个CRYO-ROP研究中心的257名儿童，这些儿童患有阈值ROP，参与了冷冻疗法随机试验，且存活至1岁。B组包括来自23个研究中心中5个中心的1208名儿童，这些儿童患有不同严重程度的ROP（69名患有阈值ROP），并参与了一项为期5年半的ROP自然病程研究。
研究人员记录了5岁半之前的眼科药物和手术干预，以及2岁之前因脑积水进行的脑脊液分流手术。
A组由257名患有阈值ROP的儿童组成，除冷冻疗法外，他们还接受了226次眼部干预（每名儿童0.9次干预）。在随机分组的儿童队列中，最常见的治疗方法是玻璃体切除术（26%的患者）、晶状体切除术（18%）、弱视治疗（20%）和斜视手术（10%）。与玻璃体切除术无关的白内障手术很少进行（2%），在治疗眼和对照眼中的实施频率相同。弱视治疗在治疗眼和对照眼中的处方频率相同。11%的这些儿童接受了脑脊液分流术。B组由1208名自然病程患者组成，他们接受了239次眼科干预（每名儿童0.4次干预）。斜视手术是自然病程儿童队列中最常进行的手术（6%的儿童）。7%的自然病程患者接受了弱视治疗。3%的自然病程婴儿需要进行脑脊液分流术，在ROP更严重的儿童中更常见。
这些早产儿在生命的前5岁半期间接受了大量眼科治疗。极早早产和ROP的长期成本不仅包括ROP的初始消融治疗以及某些情况下仍会发生的因失明导致的社会损失，还包括持续的眼部问题护理成本。
