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JAMA Ophthalmol. 2016 Mar 24. doi: 10.1001/jamaophthalmol.2016.0391. [Epub ahead of print]

Ophthalmologic Outcome of Extremely Preterm Infants at 6.5 Years of Age: Extremely Preterm Infants in Sweden Study (EXPRESS).

Author information

1
Department of Clinical Neuroscience, Karolinska Institutet, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
2
Department of Ophthalmology, Lund University Hospital, Lund, Sweden.
3
Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
4
Department of Ophthalmology, Umeå University, Umeå, Sweden.
5
Department of Ophthalmology, Örebro University, Örebro, Sweden.
6
Centre of Reproduction Epidemiology, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Lund, Lund, Sweden.
7
Section of Pediatrics, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
8
Section of Pediatric Ophthalmology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
9
Department of Neuroscience (Ophthalmology), Uppsala University Hospital, Uppsala, Sweden.

Abstract

Importance:

This follow-up study of extremely preterm (EPT) children (<27 weeks' gestational age [GA] at birth) revealed major eye and visual problems in 37.9% (147 of 388) of all EPT infants and in 55.4% (67 of 121) of the most immature subgroups at 6.5 years of age. These major eye and visual problems were strongly associated with treatment-requiring retinopathy of prematurity (ROP).

Objectives:

To investigate the ophthalmologic outcome of a national cohort of EPT children at 6.5 years of age and to evaluate the impact of prematurity and ROP.

Design, Setting, and Participants:

All surviving EPT children born in Sweden between April 1, 2004, and March 31, 2007, were included and compared with a matched term control group, as part of a prospective national follow-up study.

Main Outcomes and Measures:

Visual acuity, refraction in cycloplegia, and manifest strabismus were evaluated and compared with GA at birth and with treatment-requiring ROP.

Results:

The study cohort comprised 486 participants. The mean (SD) GA of the children who were included was 25 (1) weeks, and 45.7% (222 of 486) were female. At a median age of 6.6 years, 89.3% (434 of 486) of eligible EPT children were assessed and compared with 300 control group children. In the EPT group, 2.1% (9 of 434) were blind, 4.8% (21 of 434) were visually impaired according to the World Health Organization criteria, and 8.8% (38 of 434) were visually impaired according to the study criteria. Strabismus was found in 17.4% (68 of 390) and refractive errors in 29.7% (115 of 387) of the EPT children compared with 0% (0 of 299) and 5.9% (17 of 289), respectively, of the control children (P < .001). Altogether at 6.5 years of age, 37.9% (147 of 388) of the EPT children had some ophthalmologic abnormality compared with 6.2% (18 of 290) of the matched control group (95% CI of the difference, 26.1%-37.2%). When treatment-requiring ROP was adjusted for, no significant association between GA and visual impairment could be detected. For refractive errors, the association with GA remained after adjustment for treatment-requiring ROP (odds ratio, 0.72; 95% CI, 0.58-0.91 for each 1-week increment).

Conclusions and Relevance:

In a Swedish national cohort of EPT children at 6.5 years of age, major eye and visual problems were frequently found. Treatment-requiring ROP was a stronger impact factor than GA on visual impairment and strabismus, but not on refractive errors, as a whole. In modern neonatal intensive care settings, ophthalmologic problems continue to account for a high proportion of long-term sequelae of prematurity.

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