Related Experiment Video
Updated: Jun 11, 2025
Monitoring Dynamic Growth of Retinal Vessels in Oxygen-Induced Retinopathy Mouse Model
Published on: April 2, 2021
Cerebral injury and retinopathy as risk factors for blindness in extremely preterm infants
Benjamin M Honan1, Scott A McDonald2, Colm P Travers3
1Heersink School of Medicine, UAB, Birmingham, Alabama, USA bmhonan@uab.edu.
Insights
Cerebral injury and severe retinopathy of prematurity (ROP) are equally significant risk factors for blindness in extremely preterm infants. Clinicians should consider both conditions when assessing vision loss in this vulnerable population.
Area of Science:
- Neonatal ophthalmology
- Pediatric neurology
- Perinatal medicine
Background:
- Retinopathy of prematurity (ROP) is a primary cause of blindness in extremely preterm infants.
- The role of cerebral injury as a cause of blindness in this population is less understood.
- This study addresses the association between cerebral injury and bilateral blindness in extremely preterm infants.
Purpose of the Study:
- To investigate the association between cerebral injury and bilateral blindness in extremely preterm infants.
- To determine the extent to which cerebral injury contributes to blindness, independent of or in conjunction with severe ROP.
- To highlight cerebral injury as a potential cause of blindness in this cohort.
Main Methods:
- Multicenter analysis of infants born between 22 0/7 and 28 6/7 weeks gestational age.
- Follow-up examinations were conducted at 18-26 months corrected age.
- Logistic regression was used to analyze the adjusted association of bilateral blindness with severe ROP and/or cerebral injury.
Main Results:
- A total of 19,863 infants were included, with 1% experiencing bilateral blindness.
- Both severe ROP and cerebral injury were independently associated with an 8-fold increased odds of blindness.
- The combined presence of severe ROP and cerebral injury resulted in a 28.7-fold increased odds of blindness, indicating a significant additive risk.
Conclusions:
- Severe ROP and cerebral injury are equally important risk factors for blindness in extremely preterm infants.
- Cerebral injury should be considered a significant cause of blindness in extremely preterm infants, alongside ROP.
- Comprehensive neuroimaging and ophthalmologic evaluations are crucial for managing vision impairment in this population.
Objective:
This study investigates whether and to what extent cerebral injury is associated with bilateral blindness in extremely preterm infants, which has been attributed mainly to retinopathy of prematurity (ROP).
Design:
Multicentre analysis of children born from 1994 to 2021 at gestational age 22 0/7 to 28 6/7 weeks with follow-up at 18-26 months. Logistic regression examined the adjusted association of bilateral blindness with severe ROP and/or cerebral injury among extremely preterm infants.
Exposures:
Severe ROP and cerebral injury, the latter defined as any of the following on cranial imaging: ventriculomegaly; blood/increased echogenicity in the parenchyma; cystic periventricular leukomalacia.
Main Outcome Measures:
Bilateral blindness, defined as a follow-up examination meeting criteria of 'blind-some functional vision' or 'blind-no useful vision' in both eyes.
Results:
The 19 863 children included had a mean gestational age of 25.6±1.7 weeks, mean birth weight of 782±158 g and 213 (1%) had bilateral blindness. Multiplicative interaction between ROP and cerebral injury was statistically significant. For infants with only severe ROP (n=3130), odds of blindness were 8.14 times higher (95% CI 4.52 to 14.65), and for those with only cerebral injury (n=2836), odds were 8.38 times higher (95% CI 5.28 to 13.28), compared with the reference group without either condition. Risks were not synergistic for infants with both severe ROP and cerebral injury (n=1438, adjusted OR=28.7, 95% CI 16.0 to 51.7, p<0.0001).
Conclusions:
In a group of extremely preterm infants, severe ROP and cerebral injury were equally important risk factors for blindness. Besides ROP, clinicians should consider cerebral injury as a cause of blindness in children born extremely preterm.
Trial Registration Number:
NCT00063063.
