康柏西普治疗早产儿视网膜病变患儿屈光状态改变的临床研究

目的：观察玻璃体腔注射康柏西普（IVC）治疗早产儿视网膜病变（ROP）患儿后的屈光状态改变,探 讨ROP患儿屈光状态与注药次数、孕周、出生体质量、眼轴、视网膜血管发育情况之间的相关性。 方法：前瞻性临床研究。选取2017年4月至2021年6月就诊于潍坊眼科医院并诊断为“2型ROP阈值 前病变”的患儿64例（127眼）。根据其病情严重程度按需行IVC治疗,以治疗次数分为注药0次（A 组）共22例（43眼）、注药1次（B组）共30例（53眼）、注药2次（C组）共18例（31眼）,在其矫正胎龄3、 6、12个月时,观察屈光状态,记录等效球镜度（SE）、散光、眼轴、视网膜血管分区等情况。3组SE 比较采用单因素方差分析,散光比较采用Kruskal-Wallis非参数检验,SE与孕周、出生体质量、眼轴 及视网膜血管分区的关系采用Pearson及Spearman相关性分析。结果：矫正胎龄3个月和6个月时,3 组SE及散光差异均无统计学意义;矫正胎龄12个月时,3组SE及散光差异均有统计学意义（F=6.59, P=0.002; H=7.39, P=0.025）。进一步两两比较,A组与B组、A组与C组之间SE差异有统计学意义 （P=0.006; P=0.007）,A组与C组散光差异有统计学意义（P=0.020）。矫正胎龄12个月时,3组屈光不 正发生率、近视率差异无统计学意义,散光发生率差异有统计学意义（χ2 =8.96, P=0.011）。进一步两 两比较,A组与C组、B组与C组差异有统计学意义（χ2 =7.08, P=0.008; χ2 =6.82, P=0.009）。矫正胎龄 3个月时,SE与孕周（r=-0.18, P=0.043）、出生体质量（r=-0.19, P=0.032）、眼轴（r=-0.26, P=0.003）、 视网膜血管分区（r=-0.20, P=0.023）均呈负相关;矫正胎龄6个月、12个月时,SE与眼轴呈负相关 （r=-0.30, P=0.001）。结论：矫正胎龄12个月时,IVC治疗后ROP患儿远视储备低于自发消退的ROP 患儿,重复注药对ROP患儿短期屈光状态无显著影响。     

早产儿视网膜内外层厚度与视力的关系研究

目的　探讨早产儿视网膜内外各层厚度与视力的关系。方法　选取本院2007年1月至2009年1月出生的早产儿60例（120眼）作为早产组,另选取同期在本院出生的足月儿60例（120眼）作为足月组,早产组根据出生时是否有早产儿视网膜病变（retinopathy of prematurity,ROP）、是否接受治疗分为无ROP亚组（32例）、未治疗ROP亚组（20例）和治疗ROP亚组（8例）。测量各组最佳矫正视力（best corrected visualacuity,BCVA）和屈光度,频域光学相干断层扫描(spectral domain optical coherence tomography,SD-OCT)检测视网膜内外各层厚度。比较足月组和早产各亚组间 BCVA及视网膜内外各层厚度,分析早产儿视网膜内外各层厚度与BCVA的关系。结果　足月组BCVA明显优于早产组（P＜0.05）,早产组中治疗ROP亚组BCVA明显弱于未治疗ROP亚组和无ROP亚组（均为P＜0.05）。足月组与早产组年龄、屈光度比较,差异均无统计学意义（均为P>0.05）。早产组各亚组视网膜内层总厚度、视网膜神经纤维层（retinal nerve fiber layer,RNFL）、神经节细胞层（ganglion cell layer,GCL）、内网层（inner plexiform layer,IPL）及内核层（inner nuclear layer,INL）厚度均显著厚于足月组（均为P＜0.05）;未治疗ROP亚组和无ROP亚组视网膜内层总厚度、GCL厚度均显著薄于治疗ROP亚组（均为P＜0.05）。早产组各亚组视网膜外层总厚度、外网层（outer plexiform layer,OPL）和外核层（outer nuclear layer,ONL）、视网膜色素上皮（retinal pigment epithelium,RPE）层厚度均显著厚于足月组（均为P＜0.05）;未治疗ROP亚组和无ROP亚组视网膜外层总厚度、OPL、ONL厚度均显著薄于治疗ROP亚组（均为P＜0.05）。早产组儿童视网膜内层总厚度及GCL厚度与BCVA均呈正相关（均为P＜0.05）,视网膜外层厚度与BCVA无明显相关性（均为P＞0.05）;GCL是影响BCVA的独立危险因素（P＜0.05）。结论　与足月儿相比,早产儿视网膜内外层厚度增加,视力降低,且接受ROP治疗的早产儿视网膜各层厚度和视力所受影响更大,GCL厚度增厚是引起BCVA恶化的独立危险因素。     

早产对无早产儿视网膜病变的早产儿眼发育和发病的影响

目的调查无早产儿视网膜病变（ROP）的学龄前和学龄期早产儿的眼球发育和发病率。方法对26名5～7岁无ROP的早产儿童进行全面的眼科检查,包括矫正视力、散瞳验光、色觉以及眼前后段检查。测量数据包括前房深度、晶体厚度、玻璃体长度和眼轴长度。结果早产儿视力和屈光状态之间没有相关性。2名（7.7%）有斜视,2名（7.7%）有弱视,3名（11.5%）有屈光参差。眼轴长与胎龄（r=0.822,P〈0.001）和胎重（r=0.569,P=0.003）有相关性,玻璃体长度与胎龄（r=0.744,P〈0.001）和胎重（r=0.553,P=0.004）有相关性。讨论本研究显示眼球的增长是因为胎龄和胎重增加,但这种情况不会导致明显的屈光不正。通过文献对比,无ROP的早产儿童的斜视、弱视和屈光参差的发病率要明显高于同年龄段的正常儿童。     

近视性屈光参差性弱视患者视网膜黄斑中心凹及神经纤维层厚度的研究

背景弱视是一种从视网膜到视中枢的视觉传导系统及中枢全领域形态学及功能异常引起的临床表现,目前弱视眼的视网膜是否受累仍是争论的焦点。目的采用光学相干断层扫描（OCT）测量单眼近视性屈光参差性弱视患者的视网膜黄斑中心凹厚度及视网膜神经纤维层（RNFL）厚度,探讨单眼近视性屈光参差性弱视患者视网膜是否存在组织病理学改变。方法取近视性屈光参差性弱视患者22例44眼为弱视组;近视性屈光参差性弱视患者经治疗后视力达到正常者10例20眼为弱视治愈组;初诊为近视性屈光参差非弱视患者11例22眼为非弱视组。所有患者采用Model3000型OCT测量双眼视网膜黄斑中心凹厚度及视盘周围RNFL厚度,包括上方、下方、鼻侧、颞侧和平均厚度。采用配对t检验对各组受试者双眼间视网膜厚度的差异进行比较,用多元线性回归方法分析黄斑中心凹视网膜厚度及RNFL厚度与弱视眼眼轴长度、屈光度和年龄的关系。结果弱视组患者中弱视眼黄斑中心凹厚度明显比对侧眼增厚,差异有统计学意义（P=0．001）;弱视治愈组原弱视眼与对侧眼之间视网膜厚度的差异无统计学意义（P=0．778）,非弱视组高度数近视眼与低度数近视眼之间视网膜厚度的差异无统计学意义（P=0．943）;弱视组弱视眼颞侧RNFL厚度明显比对侧眼增厚,差异有统计学意义（P〈0．001）,弱视治愈组原弱视眼颞侧RNFL厚度比对侧眼厚,差异有统计学意义（P=0．003）,非弱视组高度数眼颞侧RNFL厚度比低度数眼厚,差异有统计学意义（P=0．046）,各组双眼视网膜上方、下方、颞侧及平均RNFL厚度的差异均无统计学意义（P〉0．05）。年龄与视盘下方RNFL厚度间呈负相关关系（r=-0．559,P=0．016）,其余各参数之间均无明显相关（P〉0．05）。结论近视性屈光参差性弱视患者的黄斑中心凹视网膜较正常眼增厚,而RNFL厚度与一般近视眼无明显差别;弱视的改善伴随着黄斑中心凹厚度的减小。     

早产儿出生后早期屈光系统发育及其影响因素

目的：探讨早产儿矫正胎龄32～40周的屈光系统发育情况,评估早产儿眼轴长度与出生体质量及出生孕龄的相关性。方法：系列病例研究。选取2018年3─12月在浙江大学医学院附属妇产科医院以及温州医科大学附属眼视光医院接受早产儿视网膜病变筛查的早产儿为研究对象,在矫正胎龄 32～40周时右眼行A超检查并记录,得到前房深度、晶状体厚度、玻璃体长度、眼轴长度等数据。 记录早产儿的出生体质量、出生孕龄及接受检查时的矫正胎龄。分别根据出生孕龄（出生孕龄<30周, 出生孕龄≥30周）及出生体质量（出生体质量<1 500 g,出生体质量≥1 500 g）对早产儿进行分组并 评估其与眼轴长度的相关性。采用Pearson相关性分析研究屈光系统参数与矫正胎龄的关系,2组间 眼轴长度的比较采用独立样本t检验。结果：共496例早产儿纳入研究,收集屈光系统参数1 385次。 前房深度（r=0.384,P<0.001）,晶状体厚度（r=0.295,P<0.001）,玻璃体长度（r=0.723,P<0.001）,眼轴长度（r=0.782,P<0.001）均与矫正胎龄呈正相关。出生孕龄<30周以及出生孕龄≥30周的早产儿眼轴差异无统计学意义。出生体质量<1 500 g的早产儿较出生体质量≥1 500 g的早产儿在矫正胎龄38～40周时眼轴更短,差异有统计学意义（t=2.195,P=0.030;t=2.504,P=0.015;t=1.989,P=0.048）。结论：早产儿出生后早期,出生孕龄对眼轴影响不大,极低出生体质量早产儿有较短的眼轴。     

严重活动期早产儿视网膜病变患儿氧疗情况及相关疾病分析

目的：分析处于严重活动期的早产儿视网膜病变（ROP）患儿氧疗情况和所患疾病的相关性。方法： 病例对照研究。收集2017年11月至2019年10月在青岛市妇女儿童医院新生儿医学中心出生的早产 儿,在生后4～6周或矫正胎龄32周开始对其进行眼底检查以及氧疗情况的记录,根据是否发病以及 发病的严重程度分为轻症组和重症组。2组间发病情况比较采用χ2 检验,组间计量资料的比较采用 t检验或Mann-Whitne U检验。结果：共纳入符合研究条件的早产儿464例,其中眼底正常或轻度活 动期ROP的轻症组426例（91.8%）,严重活动期ROP的重症组38例（8.2%）。在337例接受氧疗的早产 儿中,重症组的氧疗时间明显长于轻症组,差异有统计学意义（Z=-7.074,P<0.001）;吸氧浓度的比 较,2组差异无统计学意义;将吸氧方式按照单种与多种方式进行比较,2组差异无统计学意义,但是 重症组机械通气的使用更为频繁,差异有统计学意义（Z=4.114,P=0.043）。对所有早产儿所患疾病 进行分析,发现重症组发生新生儿呼吸窘迫综合征（NRDS）、新生儿支气管肺发育不良（NBPD）的 概率更多,差异有统计学意义（χ2 =14.515,P<0.001;χ2 =4.601,P=0.032）。多因素回归分析发现,氧 疗时间是影响严重活动期ROP的独立危险因素（χ2 =18.127,P<0.001）。结论：更长时间的氧疗和机械 通气的频繁使用增加了严重活动期ROP的发生。新生儿窒息、NRDS、NBPD在严重ROP患儿中更 多见。氧疗时间、给氧方式以及吸氧浓度是发生严重的活动期ROP的危险因素。     

早产儿视网膜病变的屈光状态

自发性退化早产儿视网膜病变（ROP）的屈光不正发生率较普通人群高,其近视发生率和近视度数随ROP严重程度上升而上升。行激光光凝治疗和冷冻治疗的ROP患眼近视发生率和度数均增加,但激光光凝治疗比冷冻治疗后的屈光状态好;保留晶状体的玻璃体切割手术后,患眼近视度数降低,视功能改善;巩膜扣带手术后,患眼可出现高度近视。随着年龄增加,ROP患儿的近视和散光发生率增加。ROP患眼屈光不正的发生率大,发生屈光不正性弱视、斜视等异常视觉症状的危险性高,需要定期检查,及时治疗需要干预的屈光不正。     

足月儿与早产儿双眼先天性白内障术后远期预后比较

目的：随访观察并比较足月和早产的双眼先天性白内障患儿于婴儿期行白内障手术治疗后的远期视功能和并发症。方法：前瞻性队列研究。对2002 年1 月至2012 年7 月在北京大学人民医院眼科收治的婴儿期双眼先天性白内障术后患儿进行跟踪随访。所有患儿均接受双眼同期白内障吸出、后囊切开及前部玻璃体切割术，术后进行屈光矫正、弱视训练并密切随访。按出生时胎龄将患儿分为早产儿组（胎龄≤36 周）和足月儿组（胎龄 > 36 周），对末次随访时2 组患儿的单眼和双眼最佳矫正视力（BCVA，LogMAR），术后远期并发症和合并症进行比较，数据采用Student's t 检验和卡方检验进行分析。结果：15例（30眼）足月患儿和36例（72眼）早产患儿纳入本研究。2组患儿的初次手术时月龄、性别构成、最长随访时间和末次随访时二期人工晶状体植入比例等方面比较差异无统计学意义。末次随访时，足月儿组单眼BCVA为0.66±0.28，双眼BCVA为0.54±0.25；早产儿组单眼BCVA为0.52±0.27，双眼BCVA为0.42±0.24。2 组患儿单眼BCVA间差异存在统计学意义（t =-2.316，P =0.023）。末次随访时早产儿组单眼BCVA（Snellen）≥30/50为14 眼（14/72），而足月儿组则为0 眼，2组患儿单眼BCVA分布差异存在统计学意义（χ2=11.229，P =0.022），但双眼BCVA分布差异无统计学意义（χ2=7.174，P =0.140）。足月儿和早产儿白内障术后长期并发症和合并症包括斜视（3/15和8/36）、眼球震颤（4/15和14/36）、后发性白内障（3/15和3/36）和高眼压症（1/15和1/36）等，2组间发生率比较差异均无统计学意义。结论：在生命更早期阶段即对双眼先天性白内障患儿进行积极治疗和干预对远期视功能预后存在影响。早产的双眼先天性白内障患儿应在全身情况允许的情况下尽早手术治疗。     

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）     

早产儿视网膜病变近视患儿的屈光参数分析

目的研究学龄前早产儿视网膜病变（ROP）近视患儿晶状体参数变化,并探讨晶状体参数与ROP近视的关系。方法病例对照研究。收集2014年1月至2015年12月在湖南省儿童医院眼科门诊随访的1～6岁ROP患儿,所有入选者未行手术,分为1～3岁和4～6岁2个年龄段。根据屈光状态分为ROP近视组（36例68眼,MOR组）、ROP非近视组（30例58眼,Non-MOR组）。对2组病例采用带状检影镜检测屈光度数并以等效球镜度（SE）记录,采用角膜曲率仪测量角膜曲率（CR）,A超测量前房深度（ACD）、玻璃体腔深度（VITR）、眼轴长度（AL）及散瞳前后晶状体厚度（LT）。通过比较MOR组与Non-MOR组屈光参数差异及散瞳前后的LT变化,来分析2组屈光参数的差异及晶状体参数的改变与ROP近视关系,2组间CR、ACD、AL等参数比较采用独立样本t检验。结果①1～3岁患儿MOR组较Non-MOR组CR更陡（t=2.916,P＜0.01）,LT更厚（t=3.227,P＜0.01）;而2组间ACD、VITR及AL差异无统计学意义。②4～6岁患儿MOR组较Non-MOR组LT更厚（t=2.257,P＜0.05）;而2组间CR、ACD、VITR及AL差异无统计学意义。③散瞳前MOR组较Non-MOR组LT更厚（t=3.152,P＜0.01）,散瞳前后MOR组LT变化较小（t=2.045,P＜0.05）。结论①1～3岁ROP近视患儿屈光参数特点主要表现为角膜较陡,晶状体较厚;而4～6岁ROP近视患儿屈光参数特点主要表现为晶状体较厚,说明学龄前期ROP患者近视主要来源于晶状体屈光力的增加。②ROP近视患儿晶状体厚,散瞳前后的LT变化小,提示ROP可能影响晶状体的弹性和调节。③晶状体的调节功能和屈光参数匹配可能是影响ROP近视的重要因素之一。     

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.     

A comparison of macular structure imaged by optical coherence tomography in preterm and full-term children

PURPOSE: Macular anatomic abnormalities were examined by optical coherence tomography (OCT) imaging in premature children and compared with those of full-term children. METHODS: In a prospective case-control study, premature patients 7 to 14 years of age were divided into three groups (group I, laser-treated retinopathy of prematurity [ROP]; group II, spontaneously regressed ROP; group III, no ROP), and age-matched children (group IV). All the eligible 74 eyes had normal-appearing posterior pole, myopia < or =3 D, and best corrected visual acuity 1.0. When both eyes of a subject were eligible for the study, one eye was randomly selected (10 eyes of 10 children in each group). Retinal thicknesses of the macula measured by OCT3 were compared. The correlation between central foveal thickness and prematurity (gestational age at birth < or = 30 weeks; birth weight < or = 1250 g) or ROP was determined. RESULTS: The mean foveal and central retinal thicknesses decreased significantly in group I (laser-treated ROP) and group IV (term birth). Significant differences in central retinal thickness were found between the premature groups and full-term children (Mann-Whitney U test). The cutoff point of central retinal thickness, determined by receiver operating characteristic curve was 209 microm. The general estimating equation model statistics found a significant effect of ROP severity (P = 0.003), P value for the category of prematurity was 0.063. CONCLUSIONS: The central retinal thickness was significantly higher in the preterm groups than in the full-term group. This subtle macular modification may be related mainly to ROP. Prematurity had only a marginally significant role.     

Myopia in adults with retinopathy of prematurity

PURPOSE: To evaluate myopia in adults with retinopathy of prematurity (ROP). DESIGN: Observational case series. METHODS: Axial length (AL), corneal radius (CR), and AL/CR ratio were measured in myopic adults with ROP using ultrasound A-scan biometry and keratometry, respectively. RESULTS: Twenty-five eyes of 18 patients (mean age, 48 years) were studied. Mean gestational age at birth was 29 weeks. The average refraction was -5.23 diopters, AL 24.43 mm, CR 7.45 mm, and AL/CR ratio 3.28. On average, myopic adults with ROP had a shorter AL and decreased CR (increased corneal curvature), but a similar AL/CR ratio, relative to adults with the same degree of myopia who were born full-term. Myopic adults with ROP also had increased lens thickness (LT) and shallow anterior chamber depth (ACD). CONCLUSIONS: Myopic adults with ROP had a shorter AL and smaller CR than expected for their degree of myopia. However, AL/CR ratios for these patients were similar to the values of adults who were born full-term. These results suggest that the refractive element most responsible for myopia in adults with ROP is higher corneal curvature (decreased CR), whereas the predominant factor in adult myopic individuals who were born full-term is increased AL. We believe that increased LT and shallow ACD make a lesser contribution to myopia in adults with ROP.     

早产儿视网膜病变激光光凝术后角膜地形图状况

目的：:观察早产儿视网膜病变（ROP）激光光凝术后儿童角膜地形图的改变。方法：:病例对照研究。收集2015年9月至2018年4月于深圳市眼科医院行激光光凝术后的ROP儿童25例（50眼）为ROP组,同时收集年龄匹配的足月儿童23例（46眼）为对照组。2组儿童均行最佳矫正视力（BCVA）检查,统计分析时转换为LogMAR...     

Astigmatism and biometric optic components of diode laser-treated threshold retinopathy of prematurity at 9 years of age

Purpose

To assess the prevalence of astigmatism and its relationship with biometric optic components in preterm school children with diode laser-treated threshold retinopathy of prematurity (ROP).

Methods

A prospective, cross-sectional study in which cycloplegic keratometry, refraction, and ultrasound biometric measurement of optic components were performed on 24 consecutive preterm children with diode laser-treated threshold ROP at the age of 9 years. The study results were compared with data on 1021 age-matched full-term control children from a national survey.

Results

The laser-treated eyes had a mean astigmatism of 3.47 D, with a mean spherical equivalent of −4.49 D. Of the 46 eyes studied, 98% of eyes showed astigmatism ≥0.5 D and 50% had high astigmatism (>3.0 D). Most astigmatic eyes (97.7%) showed with-the-rule astigmatism, with the mean plus cylinder axis at 89.30^o. Further correlation analysis showed the astigmatism in refraction was highly correlated with the corneal astigmatism (r=0.921, P<0.001) and the vertical corneal curvature (r=0.405, P=0.005). There was significantly steeper vertical corneal curvature (P=0.003) and flatter horizontal corneal curvature (P=0.031) in eyes with laser-treated ROP when compared with age-matched full-term controls. The eyes with laser-treated ROP also show significantly thicker lens (3.93 mm) and shallower anterior chamber depth (ACD; 2.92 mm) than full-term controls (P<0.001).

Conclusions

There is significantly higher prevalence and greater magnitude of astigmatism in eyes with laser-treated threshold ROP compared with full-term controls. The steeper vertical corneal curvature component contributes to the increased astigmatism in eyes with laser-treated ROP.     

康柏西普和雷珠单抗治疗早产儿视网膜病变的疗效分析

目的：比较康柏西普和雷珠单抗治疗阈值前期1型早产儿视网膜病变（ROP）的疗效。方法：回顾性病例对照研究。选择2017年1月至2019年6月在解放军总医院第七医学中心儿科医学部住院治疗的阈值前期1型ROP且行抗血管内皮生长因子治疗的患儿107例（208眼），其中行康柏西普治疗（IVC）45例（86眼）作为IVC组，雷珠单抗治疗（IVR）62例（122眼）作为IVR组。IVC组中I区病变16例（32眼），II区病变29例（54眼）；IVR组中I区病变23例（46眼），II区病变39例（76眼）。术后定期随诊观察眼内炎症反应、ROP病变消退情况、ROP病变复发再治疗率和复发再治疗间隔时间。组间数据比较采用t检验和卡方检验。结果：2组间性别、出生胎龄、出生体质量、治疗时矫正胎龄、病变分区、急进型ROP构成差异均无统计学意义。IVR组和IVC组的复发再治疗率分别为45%和35%，其中I区为61%、63%，II区为37%、19%，2组间II区病变复发再治疗率差异有统计学意义（χ2=5.214，P=0.024）。IVR组和IVC组II区复发再治疗时间分别为注药后（8.8±2.5）周和（11.2±3.1）周，差异无统计学意义。结论：玻璃体腔注射雷珠单抗和康柏西普治疗ROP均有效，治疗后复发与病变分区有关，且康柏西普治疗II区病变复发再治疗率低于雷珠单抗的治疗。     

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.     

早产儿视网膜病变患儿激光光凝术后视功能和屈光状态

目的　研究早产儿视网膜病变（retinopathy of prematurity,ROP）患儿激光光凝术后视功能和屈光状态。方法　回顾性队列研究。收集我院行二极管激光光凝术治愈的ROP患儿44 例（88眼）,远期随访3 a以上,观察其视力、眼位及屈光状态情况。术后最佳矫正视力（best corrected visual acuity,BCVA）<0.3定义为低视力,术后低视力与出生体质量、孕周、治疗时矫正胎龄、病变区域和激光次数的相关性行Logistic多因素回归分析。结果　44例（88眼）患儿年龄为（4.2±0.8）岁,BCVA≤0.1者2眼,>0.1~0.3者 9眼,>0.3~0.5者14眼,>0.5者63眼。Logistic多因素回归分析显示,术后低视力与出生体质量、孕周、矫正胎龄和激光治疗次数均无相关性（均为P>0.05）,与病变区域有关（P=0.049）。近视性屈光不正29眼,近视度数为-0.25~-10.50 D,其中高度近视（SE≥-5.00 D）8眼;合并散光者44眼,散光度-1.00~-5.00 DC,其中高度散光（≥-2.00 DC）20眼;10例患有斜视,1例有眼球震颤。结论　ROP激光术后大部分患儿有较好的视力,高度近视和斜视是视力损伤的主要原因。     

Analysis of Oxygen Therapy and Related Diseases in Severe Active Retinopathy of Prematurity

Objective: To analyze the oxygen therapy and neonatal-related diseases in severe, active retinopathy of prematurity (ROP). Methods: This was a case control study. Preterm infants born in the neonatal medical center of Qingdao Women and Children's Hospital from November 2017 to October 2019 were enrolled, and their fundus examination and oxygen therapy were recorded at 4-6 weeks after birth or 32 weeks of corrected gestational age. Patients were divided into a mild group and severe group based on the severity of the disease. A χ2 test was used to compare the incidence between the two groups, and a t test or MannWhitney U test was used to compare the measurement data between the two groups. Results: A total of 464 preterm infants were included in the study; 426 infants (91.8%) were in the mild group with normalor mildly active ROP, and 38 infants (8.2%) were in the severe group with severely active ROP. In the 337 premature infants receiving oxygen therapy, the duration of oxygen therapy in the severe group was significantly longer than that in mild group (Z=-7.074, P<0.001). There was no significant difference in oxygen concentration or oxygen inhalation mode between the two groups. However, the use of mechanical ventilation was more frequent in the severe group (Z=4.114, P=0.043). By analyzing the diseases of all premature infants, we found that the incidence of neonatal respiratory distress syndrome (NRDS), and neonatal bronchopulmonary dysplasia (NBPD) was higher in the severe group (χ2 =14.515, P<0.001; χ2 =4.601, P<0.032). Multivariate regression analysis showed that the duration of oxygen therapy was an independent risk factor (χ2 =18.127, P<0.001). Conclusions: A longer duration of oxygen therapy and frequent use of mechanical ventilation increased the incidence of severe, active ROP. Neonatal asphyxia, NRDS and NBPD were more common in severe ROP. The duration of oxygen therapy, oxygen supply mode and oxygen concentration were the risk factors for serious, active ROP.