无视网膜病变早产儿生后早期的屈光状态研究

目的 了解早产儿生后早期的屈光发育.方法 横断面研究.收集生后4～6周进行早产儿视网膜病变筛查的无视网膜病变的早产儿253例,按矫正胎龄进行分组:A组(22只眼),矫正胎龄≤34周;B组(52只眼),矫正胎龄>34周且≤36周;C组(126只眼),矫正胎龄>36周且≤38周;D组(144只眼),矫正胎龄>38周且≤40周;E组(136只眼),矫正胎龄>40周且≤42周,F组(26只眼),矫正胎龄>42周且≤44周.行睫状肌麻痹检影验光确定屈光状态.其中38例在矫正胎龄40～44周时的屈光与同龄足月对照组比较.定量资料为非正态分布,使用Mann-Whitney U检验,相关性使用Spearman相关分析及回归分析.定性资料使用X2检验.结果 早产儿随出生体重的增加、孕龄和检查时矫正胎龄的增大,等效球镜远视程度增大.出生体重是等效球镜的显著影响因素.近视发生率14.43%,并随着矫正胎龄的增加而下降.散光发生率10.28%,各年龄组间差异无统计学意义.散光度中位数+1.00 DC,随着矫正胎龄的增加而增大,与出生孕龄和体重无关.散光轴向中位数90°,与矫正胎龄、出生孕龄和体重均无关.矫正胎龄40～44周的早产儿和足月儿比较,除等效球镜差异有统计学意义,前者有更大的近视趋势外,近视发生率、散光发生率、散光度、散光轴向的差异均无统计学意义.结论 早产儿屈光状态随发育向远视方向发展,但到矫正胎龄40～44周时仍较足月儿有较大的近视趋势,其潜在机制及随后的屈光发育有待进一步研究.(中华眼科杂志,2009,45:607-611)     

早产儿屈光状态和视力的调查研究

目的:观察和分析早产儿的屈光状态和视力发育情况。方法:对4～6岁早产儿156例312眼门诊进行视力和静态屈光检查并记录结果。结果:4～6岁早产儿156例312眼远视238眼(76.3%),近视15眼(4.8%),散光28眼(9.0%),正视眼31眼(9.9%),生理性远视所占的比例最大,各年龄远视比例有所不同,但都随着年龄的增长远视比例下降,正视和近视比例逐渐增加,视力正常率明显提高。结论:4～6岁早产儿屈光状态和视力发育与正常儿接近,随着年龄的增长,屈光状态有由远视向正视和近视发展的趋势。     

早产儿和足月儿屈光不正的分布和临床特点

目的:观察和分析儿童眼科门诊就诊的屈光不正3～7岁患儿,有早产史和足月产史的患儿的屈光不正的特点和差异.方法:屈光不正179例(358眼),分为2组:早产史者51人,足月产者128人.1%阿托品眼膏散瞳进行视网膜带状光剪影验光.结果:足月儿的屈光不正患儿中,以远视多见,占157/256眼(61.3%),对比有早产儿屈光不正的远视发病25/102(24.5%),差异有统计学意义(P<0.05).有早产儿屈光不正中,以散光发病为主,占81/102眼(79.4%),尤以高度散光、混合散光多见,相对与足月儿,其散光发病,高度散光发病和混合散光发病眼数的差异均有显著性(P<0.05).结论:散光,尤其是高度散光、复杂的混合散光是有早产儿童视力低下的重要原因.临床上散光与弱视的形成关系密切相关,因此不能忽略早产儿童视力发育.最早可提前到2岁即可进行屈光筛查.     

早产儿视网膜病变激光术后视力康复的观察分析

目的观察和分析早产儿视网膜病变(ROP)激光治疗术后的视力改变和视力发育情况。方法对ROP激光治疗术后3～5岁的儿童,共48例(96只眼)在门诊进行普通视力检查及阿托品散瞳验光,并对屈光结果进行统计分析。结果 ROP激光治疗后3～5岁儿童48例(96只眼)中,远视68只眼(70.8%),近视12只眼(12.5%),散光6只眼(6.3%),正视眼10只眼(10.4%),该组儿童中远视所占的比例最大,各年龄中远视所占比例有一定差异,但都随着年龄的增长远视比例有所下降,正视和近视比例逐渐增加,视力正常率明显提高,同时ROP激光治疗后的儿童弱视比例为10.4%,明显高于足月产儿童的平均发生率,且随着年龄的增加呈下降趋势。结论 ROP激光治疗术后的屈光状态和视力发育变化趋势与正常儿童大致相同,随着年龄的增长,屈光状态有由远视向正视和近视发展的趋势,ROP激光术后儿童弱视发病率高于足月产儿童的平均发生率,ROP激光术后的屈光情况应尽早进行视觉追踪和屈光筛查。     

早产儿与足月儿学龄期屈光状态的2年随访研究

目的　了解早产儿和足月儿学龄期时屈光发育的差异，分析早产儿屈光状态的影响因素。方法　纵向研究，随机选取2014年9月至2015年3月在本院进行健康体检的262名6~7岁一年级学生，跟踪随访2 a，收集相关资料并作对比。结果　最终完成2 a随访者早产儿81例（162眼）、足月儿138例（276眼）。基线时早产儿与足月儿屈光状态均以正视为主，随访2 a后，早产儿近视比例为30.9%（50/162），高于足月儿25.7%（71/276）。早产儿的基线等效球镜度数为（-0.04±0.85）D，小于足月儿的（0.15±0.59）D（t=-2.860，P=0.004），早产儿近视进展速度为每年-0.19 D，快于足月儿的-0.15 D（F=9.621，P<0.05），两组间基线时、随访1 a和随访2 a时的散光检出率差异均无统计学意义（均为P>0.05）。胎龄越小，学龄期早产儿的近视进展越快，其中胎龄≤30周、>30~33周、>33~36周时2 a等效球镜度数改变量分别为（-0.61±1.03）D、（-0.32±0.72）D和（-0.22±0.55）D（F=3.073，P=0.049）。较大的出生胎龄（OR=0.70）、较长的户外活动时间（OR=0.40）是早产儿近视发病的保护因素。结论　早产儿学龄期时的近视进展速度高于足月儿，且胎龄越小，近视发展速度越快。     

上海市区学龄前儿童屈光异常852例分析

目的:了解上海市区部分学龄前儿童屈光的异常状态及视力矫正情况。方法:视力异常学龄前儿童852例(1615眼)作散瞳验光检查,并对检查结果进行分析探讨。结果:单纯近视443眼(27.43%),复性近视散光255眼(15.79%),单纯远视287眼(17.77%),复性远视散光347眼(21.49%),混合性散光283眼(17.52%)。随着年龄的增长,就诊的学龄前近视患者逐渐增多;父母近视对学龄前儿童近视发生率的增加有影响;屈光不正大都以轻中度为主(82.43%),视力大多(80.40%)是可以矫正的。结论:学龄前儿童近视和近视散光的发生率有明显增加的趋势。     

学龄前儿童视力和屈光状态分析

目的:了解北京市通州区学龄前儿童的视力现况,并对其屈光状态进行分析。方法:横断面调查研究。于2021-12/2022-01采用整群随机抽样法选取北京市通州区9所幼儿园3～6岁儿童1 513人3 026眼,均进行视力和屈光度检查,并分析不同年龄段儿童视力和屈光度分布情况。结果:纳入儿童视力低常率为15.47%,屈光异常率为14.24%,且随着年龄增长,屈光异常检出率减少,而屈光异常类型以单纯近视性散光为主(11.46%),随着年龄增加,单纯性远视率逐渐降低,单纯性近视率逐渐增加。屈光度检查结果显示,纳入儿童球镜度为0.50(0.25,1.00)D,柱镜度为-0.25(-0.50,-0.25)D,等效球镜度为0.375(0,0.625)D。不同年龄段儿童球镜度和等效球镜度均无差异(P>0.05),但柱镜度有差异(P<0.001)。结论:3～5岁儿童视力低常率随年龄增加逐渐降低,6岁后又呈增加趋势。3～6岁儿童屈光异常以单纯近视性散光为主。学龄前儿童视力发育情况应重点关注,应定期进行视力和屈光状态检查。     

高龄老年人472眼屈光状态的临床分析

目的:探讨高龄老年人眼视力状况及屈光分布,做好高龄老年人的视力保健。方法:标准照明下查70岁以上高龄老年人472眼远视力,作仔细的眼部和屈光状态的检查并矫正其视力。结果:全组472眼中屈光不正468眼(99.2%),全组以近视居多,且随着年龄递增,近视所占比例逐渐增大。散光415眼(87.9%),70～80岁组以远视散光为主,80岁以上则以近视散光为主,全组散光以近视性逆规散光眼所占比例最大,共172眼(36.4%),远视散光眼散光度数集中在0.50～1.00D,近视散光和混合性散光眼度数集中在1.25～2.00D。全组裸眼视力随年龄增加而降低,各年龄组矫正视力均有明显提高。结论:高龄老年人由于眼睑和晶状体等的老年性改变,其屈光状态向近视性逆规散光发展,成为影响其视力的主要原因,尚未行白内障摘除之高龄老年人,定期检查其屈光状态并做必要的屈光矫正能明显提高高龄老年人的视力。     

无锡市滨湖区0～6岁儿童通过SureSight手持验光仪视力筛查结果分析

目的:了解无锡市滨湖区0~6岁儿童视力发育状况,为制定无锡市滨湖区儿童眼保健措施提供科学依据。方法:对无锡市滨湖区3695名0~6岁学龄前儿童运用SureSight手持验光仪视力快速检测眼屈光状态,参照由美国伟伦公司提供的各年龄段屈光筛查转诊标准来确定筛查结果。并且在筛查视力的同时完成全面的眼部检查。结果:视力筛查儿童总异常率为9.76%,可疑率为5.40%,我们发现随着幼儿年龄的增长异常和可疑检出率有上升趋势,并且各年龄段视力筛查结果有差异(χ²=15.913,P=0.014),但男孩和女孩之间无差异(χ²=7.200,P=0.066)。在各个年龄组中视力异常比例最高的是散光(13.89%、17.96%、17.62%、11.50%),其次是远视(0.35%、1.91%、3.60%、8.86%)和屈光参差(0.69%、0.67%、1.64%、2.07%)。五种类型在各年龄段中分布的比例如下:远视(4.38%)、近视(0.82%)、散光(15.65%)、屈光参差(1.42%)和其他屈光问题(0.466%)。0~3岁学龄前儿童散光患病率为6.94%(95%CI:4.90%~9.00%),3~4岁为8.98%(95%CI:7.80%~10.20%),4~5岁为8.81%(95%CI:7.70%~9.90%),5~6岁为5.75%(95%CI:4.80%~6.70%)。在不同年龄组中散光患病率无差异(χ²=0.872,P=0.929)。结论:从我们的筛查结果中发现散光是学龄前儿童最常见的屈光不正类型,其次是远视和屈光参差,但我们并没有发现近视,从而证实了先前的研究,即近视并没有在早期发展。最后我们强调应定期实施学龄前儿童视力筛查,倡导社会重视学龄前儿童视力保护及眼睛的健康管理。     

0~6岁早产儿和正常儿童屈光状态的比较研究

目的：探讨0~6岁早产儿和正常儿童的屈光发育情况。方法病例对照研究。回访自2011年9月至2012年9月在武汉大学人民医院进行早产儿视网膜病变(ROP)筛查的无视网膜病变的早产儿1164例,其中纳入研究1088例（2176只眼）,按矫正胎龄分组：<0.5岁（150例）,≥0.5岁且<1.0岁（118例）,≥1.0岁且<1.5岁（155例）,≥1.5岁且<2.0岁（137例）,≥2.0岁且<2.5岁（153例）,≥2.5岁且<3.0岁（95例）,≥3.0岁且<4.0岁（103例）,≥4.0岁且<5.0岁（89例）,≥5.0岁（88例）。同时收集来武汉大学人民医院门诊体检的正常足月儿1191例,纳入同龄随机对照组足月儿1102例（2204只眼）。所有儿童行睫状肌麻痹检影验光确定屈光状态。其中3~6岁早产儿采用相干光生物测量仪（IOL Master）测量眼轴和角膜曲率。定量资料组间差异使用t检验,定性资料组间差异采用卡方检验。相关性使用多元线性回归分析。结果0～6岁早产儿平均近视患病率为9.1%,足月儿为4.4%;0～6岁早产儿平均散光患病率为35.4%,足月儿为18.9%。2～6岁早产儿平均球镜度数为（1.15±0.87）D,平均柱镜度数为（0.84±0.71）D,平均等效球镜度数为（1.47±0.28）D,球镜、等效球镜度数以及柱镜均随年龄的增大而呈现下降趋势。3～6岁早产儿等效球镜度数与眼轴、角膜曲率、胎龄、出生体重及年龄相关（r=-0.232,0.112,0.117,0.254,-0.215;P=0.000,0.009,0.008,0.000,0.001）。结论早产儿近视及散光患病率高于足月儿;早产儿正视化过程要早于足月儿。（中华眼科杂志,2015,51：505-509）     

早产儿眼球发育及屈光状态变化

目的:观察早产儿眼球生物学指标及屈光状态随年龄变化的规律。方法:早产儿218例、足月儿76例分别在出生后1,4,8和12mo进行A超检查,记录眼轴长度、前房深度、晶状体厚度、玻璃体腔长度;并在8和12mo进行睫状肌麻痹检影验光,记录球镜度;分析眼球生物学指标及屈光状态随年龄变化规律。结果:随年龄增长,无论早产儿及足月儿前房深度、玻璃体腔长度、眼轴长度均逐渐增大;晶状体厚度逐渐减小。出生初期,早产儿较正常儿前房深度浅,玻璃体腔长度及眼轴长度短。出生后随年龄增长,早产儿玻璃体腔长度和眼轴长度生长较足月儿快;但前房深度和晶状体厚度改变无明显差异。结论:出生时早产儿较正常儿眼球各项生物学指数发育差,随年龄增长,早产儿正视化较足月儿快,与眼轴生长有关。     

早产儿及足月儿早期眼球生物学指标变化规律

目的观察早产儿及足月儿眼球生物学指标随年龄变化的规律。方法对早产儿218例、足月儿76例分别在出生后1、4、8和12个月进行A超检查,记录眼轴长度、前房深度、晶状体厚度、玻璃体腔长度。分析眼球生物学指标随年龄变化的规律。结果随年龄增长,无论早产儿及足月儿前房深度、玻璃体腔长度、眼轴长度均逐渐增大,晶状体厚度逐渐减小。出生初期,早产儿较正常儿前房深度浅,玻璃体腔长度及眼轴长度短。随年龄增长,早产儿玻璃体腔长度和眼轴长度生长较足月儿快,但前房深度和晶体厚度改变无明显差异。结论出生时早产儿较足月儿眼球各项生物学指数发育差,随年龄增长,早产儿眼球发育较足月儿快。     

Emmetropisation following preterm birth

BACKGROUND/AIMS: Even in the absence of retinopathy of prematurity (ROP), premature birth signals increased risk for abnormal refractive development. The present study examined the relation between clinical risk factors and refractive development among preterm infants without ROP. METHODS: Cycloplegic refraction was measured at birth, term, 6, 12, and 48 months corrected age in a cohort of 59 preterm infants. Detailed perinatal history and cranial ultrasound data were collected. 40 full term (plus or minus 2 weeks) subjects were tested at birth, 6, and 12 months old. RESULTS: Myopia and anisometropia were associated with prematurity (p<0.05). More variation in astigmatic axis was found among preterm infants (p<0.05) and a trend for more astigmatism (p<0.1). Emmetropisation occurred in the preterm infants so that at term age they did not differ from the fullterm group in astigmatism or anisometropia. However, preterm infants remained more myopic (less hyperopic) than the fullterm group at term (p<0.05) and those infants born <1500 g remained more anisometropic than their peers until 6 months (p<0.05). Infants with abnormal cranial ultrasound were at risk for higher hyperopia (p<0.05). Other clinical risk factors were not associated with differences in refractive development. At 4 years of age 19% of the preterm group had clinically significant refractive errors. CONCLUSION: Preterm infants without ROP had high rates of refractive error. The early emmetropisation process differed from that of the fullterm group but neither clinical risk factors nor measures of early refractive error were predictive of refractive outcome at 4 years.     

Bell's phenomenon in newborns and premature babies.

AIMS--To evaluate the development and course of Bell's phenomenon (BP) in premature and normal neonates. METHODS--Twenty seven preterm infants and 42 healthy full term infants were studied. Mean birth weight, gestational age, and head circumference were recorded. BP was graded from no response to full response. The premature group was examined in the first week of life, and then at 4 and 8 weeks after birth. The full term group was initially examined at the age of 3 days until a full response was observed. RESULTS--No preterm infants exhibited BP during the first week of life, while 8/28 (29.6%) exhibited a weak to full reflex at 8 weeks of age. In the full term group 15/42 neonates (35.7%) demonstrated a mature reflex at age of 3 days and 36/37 (97.3%) at age 16 weeks. A significant correlation was observed between BP, sex, and birth weight, as well as gestational age in the premature group. No such correlation was found in the full term infants. CONCLUSION--BP has a longitudinal course. It is an important clinical marker for evaluation and follow up of neuro-ophthalmic maturation in neonates.     

早产儿视网膜功能的全视野闪光视网膜电图检查

目的 观察早产儿视网膜功能变化特征。方法 对78例4～5个月婴儿在口服镇静 剂熟睡后进行全视野闪光视网膜电图（ERG)检查，测量各项反应的a波和b波的振幅和隐含期 ，以评价未成熟儿的视网膜功能。78例156只眼中，健康足月产儿33例66只眼，健康早产儿2 5例50只眼，早产儿视网膜病变（ROP）患儿20例40只眼。结果 所有足 月产儿和健康早产儿 都可以记录到明显的ERG波形。足月产儿的标准混合反应b波振幅为388.7 μV，健康早产儿 的标准混合反应b波振幅为336.7 μV，分别为正常成人混合反应b波振幅的64.4％和55.6 ％。ROP患儿中，20只眼记录不到波形，其余20只眼的标准混合反应b波振幅为183.8 μV，和足月产儿相比，隐含期也显著延迟。健康早产儿的ERG振幅较足月产儿 轻度降低， 差异有统计学意义。结论 出生后视网膜还处于不断成熟发育过程中， 健康足月产儿的ER G尚未达到正常成人的水平；早产儿视网膜发育程度较足月儿慢，不论是健康早产儿还是ROP 患儿，其ERG均不及健康足月产儿。因此ERG检查是评价早产儿视网膜功能的有效方法。     

矫正年龄6个月内无早产儿视网膜病变的早产儿眼部生物学参数分析

目的 探讨矫正年龄(PMA)6个月内的无早产儿视网膜病变(ROP)早产儿眼部生物学参数分布及与出生体重(BW)和PMA的关系。方法 纳入490例接受ROP筛查的早产儿并研究。根据PMA分为7组：0个月组(矫正胎龄40周±3 d)、1个月组、2个月组、3个月组、4个月组、5个月组和6个月组。采用RETCAM3检查眼底并排除ROP,角膜测厚仪测量中央角膜厚度(CCT),A超测量眼轴长度(AL)、前房深度(ACD)、晶状体厚度(LT)和玻璃体长度(VL)。利用自动屈光测量仪测量患儿PMA 3个月至6个月非睫状肌麻痹的屈光状态。采用t检验数据正态性,单因素方差分析患儿性别、眼别及组间眼部生物学参数差异性,多因素线性回归模型分析AL、ACD、LT、VL和CCT与BW和PMA的关系。结果 入组患儿的出生胎龄为(32.71±2.26)周,BW为(1802.46±480.83)g, ACD、LT、VL、AL、和CCT分别为(2.26±0.30)mm、(4.04±0.24)mm、(11.84±0.84)mm、(18.14±1.11)mm和(535.01±37.63)μm。PMA 3个月至6个月球镜度、柱...     

Central corneal thickness and corneal diameter in premature infants

BACKGROUND: Central corneal thickness is significantly greater in full-term infants than in adults. Very little is known about corneal thickness in premature infants. METHODS: Measurements of central corneal thickness and horizontal corneal diameter were carried out in 35 premature babies (70 eyes) undergoing screening for retinopathy of prematurity. Initial measurements were taken at approximately 31 weeks gestational age and at intervals until term was reached. RESULTS: Babies born at approximately 31 weeks have very thick corneas which show a progressive and statistically significant decrease to term. Conversely, horizontal corneal diameter shows a progressive significant increase to term. A very strong inverse correlation was found between these two parameters. CONCLUSION: We demonstrate that premature infants have thick corneas and small corneal diameters. Central corneal thickness decreases dramatically from approximately 31 weeks to term and is mirrored by a significant increase in corneal diameter.     

The evolution of refractive status in Chinese infants during the first year of life and its affected factors

AIM: To study the evolution of the refractive status and examine the affected factors in infants during the first year of life in a large sample size in China. METHODS: A total of 1258 babies (2516 eyes) aged 32wk gestational age to 1y participated in the study, including 766 premature and 492 full-term infants. First, each baby received an orthoptic examination, slit-lamp checking and fundus imaging. Patients with diseases which might affect refractive status were excluded from the cohort. The cycloplegia retinoscopy was performed. Their neonatal histories were reviewed. Each measurement contained the refractive status and calculation of the spherical equivalent (SE). RESULTS: Refractive state showed an average hyperopia of +0.94±1.63 D at early ages, followed by a trend toward more hyperopia. The refractive state reached the top (+2.43±1.46 D) at the age of one to two months. Then gliding till one year old when the refractive state reached +0.59±1.41 D. The prevalence of astigmatism was 42.17% in the study, being 2.82% myopic astigmatism and 39.35% hyperopic astigmatism. The 94.1% of hyperopic astigmatism was with-the-rule astigmatism and 71.83% of myopic astigmatism was with-the-rule astigmatism. Refractive state between boys and girls was different. The mean SE of boys was +1.97±1.57 D, while that of girls was +1.79±1.46 D, and the difference was significant. CONCLUSION: Before one year old, the change of refractive status is associated with checking age and sex. At the age of one to two months, the degree of hyperopia reaches the top. Boys have more hyperopic degree than girls, and with-the-rule astigmatism is predominant. Excluding premature infants with advanced retinopathy of prematurity, premature and full-term children have same refraction status.     

Ocular growth and refractive error development in premature infants without retinopathy of prematurity

PURPOSE: This investigation studied the factors involved in the development of refractive error (RE) in premature infants unaffected by retinopathy of prematurity (ROP). METHODS: Premature infants enrolled in the national ROP screening program were recruited and examined at 32, 36, 40, 44, and 52 weeks' postmenstrual age. At each examination, axial length (AXL), anterior chamber depth (ACD), and lens thickness (LT) were measured on the A-scan biometer. Corneal curvature (CC) was recorded with a video-ophthalmophakometer, and refractive state was determined with routine cycloplegic refraction. Multilevel modeling techniques were used to determine the relationships between all the variables throughout the study period, as well as individual growth rates. RESULTS: Sixty-eight premature infants were included. AXL and ACD showed linear patterns of growth, whereas LT changed little over the study period. CC showed a quadratic growth pattern, and unlike the previous variables, correlated well with refractive state. Premature infants were myopes at the start of the study, with refraction becoming emmetropic as they neared full term and then hypermetropic toward the end of the study. CONCLUSIONS: Most of the components of refractive status showed linear patterns of growth during this early phase of ocular development. CC displayed a more complex pattern of growth, which correlated well with refractive state. Compared with full-term infants examined around term, this group has shorter AXLs, shallower anterior chambers, and more highly curved corneas. In addition, less of the expected hypermetropia developed in the premature group, which seems mainly due to the differences in ACD and corneal curvature.     

早产儿视网膜病变的筛查与高危因素分析

目的 研究早产儿视网膜病变(ROP)发病情况及相关的危险因素,探讨其合理的筛查标准.方法 对出生体重≤2500g,胎龄≤37周患儿进行ROP筛查,并行相关因素分析.结果 共筛查275例符合条件的早产儿,发现ROP38例(13.82%);出生体重≤1500g组,～2000g组,～2500g组患病百分比有显著性差异(P<0.05);出生胎龄≤30周组,～32周组,≥33周组间ROP患病百分比有显著性差异(P<0.05);ROP早产儿的吸氧时间明显高于无ROP组(Z=5.292,P=0.000),需要机械辅助呼吸的早产儿发生ROP者较多(x2=30.597,P=0.000),多胎与单胎间发生ROP的差异无统计学意义(x2=0.748,P=0.387),ROP发病与出生胎龄、出生体重、吸氧时间、机械辅助呼口等因素相关.结论 出生体重越低,出生胎龄越小,吸氧时间较长,需要机械辅助呼吸的早产儿,ROP患病率越高.早产儿应及时检查眼底,尽早发现ROP.