Ocular outcomes in low birth weight premature infants with intraventricular hemorrhage

PURPOSE: To study ocular outcomes in very low birth weight premature infants with intraventricular hemorrhage. METHODS: Parents of 490 consecutive very low birth weight (less than 1500 g) premature infants who were discharged from the neonatal intensive care unit of our hospital between 1994 and 1996 were asked to enroll their child/children in this cross-sectional study. Sixty infants (12%) were recruited and had complete masked ophthalmologic examinations at 12 months corrected gestational age. The medical records of each infant were reviewed after the eye examination was complete. The occurrence of intraventricular hemorrhage and other perinatal comorbidities was documented. Ocular outcomes of infants with no or low-grade (grades I-II) hemorrhages were compared with those of infants with high-grade (grades III-IV) intraventricular hemorrhage. RESULTS: Of the 60 infants examined, 17 (28%) had neonatal intraventricular hemorrhage. Eleven (18%) had high-grade intraventricular hemorrhage, and 49 (82%) had no or low-grade hemorrhage. Of the 11 infants with high-grade intraventricular hemorrhage, 8 (73%) had strabismus compared with 7 (14%) of 49 infants with no or low-grade hemorrhages who developed strabismus (P<0.001). The high-grade group also had a larger proportion of infants with ocular motility defects (P=0.008), nystagmus (P<0.001), optic nerve atrophy (P<0.001), and abnormal retinal findings (P=0.039). Additionally, these infants were more likely to have stage 3 or worse retinopathy of prematurity (P=0.003). CONCLUSIONS: These results confirm the findings of our earlier retrospective study, and suggest that the occurrence of high-grade intraventricular hemorrhage in the early postnatal period places these infants at significant risk for adverse ocular outcomes. These infants require close ophthalmologic surveillance.