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Retinopathy of prematurity: a prospective study. Review at six months
1Birmingham and Midland Eye Hospital, UK.
Insights
Retinopathy of prematurity (ROP) significantly impacts infant vision, increasing strabismus and myopia. Early detection and intervention are crucial for managing visual impairments in premature infants.
Area of Science:
- Ophthalmology
- Neonatology
- Developmental Pediatrics
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Understanding the long-term visual consequences of ROP is crucial for early intervention.
Purpose of the Study:
- To investigate the relationship between the severity of retinopathy of prematurity (ROP) and visual outcomes in premature infants.
- To assess the incidence of strabismus, visual acuity, and refractive errors in relation to ROP severity.
Main Methods:
- Prospective cohort study of infants with birthweight ≤ 1700 g.
- Assessment at 6 months corrected age, including strabismus evaluation, binocular visual acuity, and cycloplegic refraction.
- Correlation of visual findings with neonatal data and ROP severity.
Main Results:
- Overall strabismus incidence was 6.4%, significantly higher in infants with stage 3 ROP (29.2%).
- Lower visual acuity and increased myopia, astigmatism, and anisometropia were associated with increasing ROP severity.
- Abnormal neonatal cranial ultrasound findings were also linked to strabismus and fusional ability.
Conclusions:
- ROP severity is a critical determinant of visual development in premature infants.
- Ophthalmic monitoring and management are essential for premature infants, particularly those with ROP.
- Findings highlight the need for comprehensive neuro-ophthalmic evaluation in this high-risk population.
Abstract:
A cohort of infants of birthweight < or = 1700 g studied prospectively for retinopathy of prematurity (ROP) has been reviewed at 6 months corrected age and the findings related to the neonatal data. The overall incidence of strabismus was 6.4% (30/468), rising from 3.1% (7/229) without ROP to 29.2% (7/24) with stage 3. Strabismus and fusional ability were significantly related to presence and severity of ROP, and abnormal neonatal cranial ultrasound findings. Binocular visual acuity was measured in 340 infants between 20 and 40 weeks corrected age. Eight were subnormal, all due to neurological problems. For the remainder, despite falling within the normal range, there was a significant trend (p < 0.001) for lower acuities with increasing ROP severity. Cycloplegic refraction on 387 infants revealed, with increasing ROP severity: 1, a significant trend towards myopia; 2, increased magnitude of astigmatism; 3, alteration of the astigmatic axis; 4, increased incidence of anisometropia. For the first three categories there was an insignificant trend between no ROP and stage 2, reaching significance only between stage 2 and 3. The predominant axis of astigmatism in infants without ROP was between 60 degrees and 120 degrees, but with ROP there was a significant trend away from this direction.