早产儿及早产儿视网膜病变患儿的屈光状态及视神经纤维层厚度分析

目的：评估8岁段早产儿及早产儿视网膜病变（ROP）患儿的屈光状态和视网膜神经纤维层（RNFL） 厚度，探讨早产及ROP对屈光状态和RNFL厚度的影响。方法：前瞻性研究。收集2009 年1月至 2011年2月在重庆医科大学附属儿童医院眼科行眼底筛查的早产儿，孕周（33.6±4.1）周，出生体质 量（2 099±779）g，按有无ROP分为ROP组和早产无ROP组（简称早产组），并将同龄足月儿作为对照， 共纳入112例（222眼），其中ROP组24例（47眼）、早产组55例（110眼）、足月组33例（65眼）。纳入研 究第8年行RNFL厚度、眼轴长度及睫状肌麻痹视网膜检影检查，比较屈光不正发生率及RNFL厚度 差异。采用卡方检验、单因素方差分析进行数据处理。结果：ROP组及早产组的近视发生率较足月 组高（χ2 =8.062，P=0.018；χ2 =3.671，P=0.036）；ROP组、早产组及足月组的远视发生率差异无统计学 意义（χ2 =4.910，P=0.250）；ROP组及早产组的散光发生率较足月组高（χ2 =7.758，P=0.023；χ2 =3.710， P=0.034）。ROP组及早产组眼轴均较足月组短（均P<0.001）。早产组视盘周围平均RNFL厚度较足月 组薄（P=0.030），早产组颞侧RNFL厚度较足月组（P<0.001）、ROP组（P<0.001）薄。结论：8岁段早 产儿及ROP患儿眼轴较足月儿短，更易发生近视和散光，ROP和早产共同影响其屈光状态，其中早 产起主要作用。早产与ROP对RNFL厚度影响不同，尤其是颞侧象限，在随访中需与其他疾病所致 的RNFL厚度异常鉴别。

Analysis of Refractive Status and Thickness of Retinal Nerve Fiber Layer in Children with or without Retinopathy of Prematurity

Objective: To compare the refractive status and retinal nerve fiber layer thickness (RNFLT) in pre-term children with or without retinopathy of prematurity (ROP) at 8 years old, and to investigate the effects ofpre-term birth and ROP on refractive status and RNFLT. Methods: This was a prospective study. From January 2009 to February 2011, premature babies (average gestational age: 33.6±4.1 weeks, average birth weight: 2 099±779 g) who underwent fundus screening in the Department of Ophthalmology, Children's Hospital of Chongqing Medical University, were divided into an ROP group and pre-term ROP group (pre-term group), and full-term babies of the same age were used as controls. A total of 112 children (222 eyes) were enrolled, including 24 in the ROP group (47 eyes), 55 in the pre-term group (110 eyes), and 33 in the full-term group (65 eyes). The RNFLT, axial length (AL), and retinoscopy were examined in the three groups at the age of 8. The incidence of refractive error and the difference in RNFLT were compared. Data were analyzed using Chi-squsure test and ANOVA. Results: The incidence of myopia (χ2 =8.062, P=0.018; χ2 =3.671, P=0.036) and astigmatism (χ2 =7.758, P=0.023; χ2 =3.710, P=0.034) in the ROP group and pre-term group were higher than those in the full-term group. There was no significant difference in the incidence of hyperopia (χ2 =4.910, P=0.250). The AL of the ROP group and pre-term group was shorter than that of the full-term group (both P<0.001). The average RNFLT of the pre-term group was thinner than that of the full-term group (F=2.593, P=0.030). The temporal quadrant RNFLT of the pre-term group was thinner than that of both the full-term group (P<0.001) and ROP group (P<0.001). Conclusions: The pre-term children and children with ROP have a shorter AL at 8 years of age, and are more prone to myopia and astigmatism. ROP and prematurity affect their refractive status, but prematurity plays a major role. Prematurity and ROP have different effects on RNFLT, especially in the temporal quadrant. The abnormalities of RNFLT caused by other diseases need to be identified during the follow-up period.