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Ocular sequelae in premature infants
J M Page1, S Schneeweiss, H E Whyte
1Department of Nursing, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Premature infants with low birth weight and retinopathy of prematurity (ROP) have a high risk of developing myopia and strabismus. Vision significantly deteriorates by 24 months, necessitating continued follow-up.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatrics
Background:
- Premature infants are at increased risk for ocular complications.
- Retinopathy of prematurity (ROP) is a significant concern in this population.
- Long-term visual outcomes require further investigation.
Purpose of the Study:
- To determine the incidence of myopia and strabismus in premature infants.
- To assess visual development at 12 and 24 months postterm.
- To identify risk factors associated with these conditions.
Main Methods:
- Retrospective review of eye charts from 190 premature infants (birth weight <1251 g).
- Assessment of retinopathy of prematurity (ROP) staging.
- Ophthalmological examinations at 12 and 24 months including refraction and motility tests.
Main Results:
- ROP was present in 53% of infants; 12% progressed to severe stages.
- Myopia incidence was 16% at 12 months, increasing to 38% by 24 months.
- Low birth weight, ROP severity, and intraventricular hemorrhage were linked to myopia and strabismus.
Conclusions:
- Low birth weight, ROP, and intraventricular hemorrhage are key factors in myopia and strabismus development.
- Deteriorating vision observed in over 80% of infants by 24 months.
- Extended follow-up to two years is crucial for monitoring visual health in premature infants.
Objective:
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.
Methods:
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.
Results:
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.
Conclusion:
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.