Refractive Errors, Amblyopia and Strabismus in 3-year-old Premature Children

Ji Hyun Bae; Dong Gyu Choi

doi:10.3341/jkos.2010.51.10.1385

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Bae and Choi: Refractive Errors, Amblyopia and Strabismus in 3-year-old Premature Children

Original Article

J Korean Ophthalmol Soc 2010;51(10):1385-1391.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.10.1385

Refractive Errors, Amblyopia and Strabismus in 3-year-old Premature Children

Ji Hyun Bae, MD, Dong Gyu Choi, MD, PhD

Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

Address reprint requests to Dong Gyu Choi, MD, PhD Department of Ophthalmology, Kangnam Sacred Heart Hospital #948-1 Daerim 1-dong, Yeongdeungpo-gu, Seoul 150-950, Korea Tel: 82-2-829-5193, Fax: 82-2-848-4638, E-mail: eyechoi@dreamwiz.com

Received 8 March 2010 Accepted 17 June 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the refractive status, anisometropia, amblyopia and strabismus in 3-year-old premature children.

Methods

A total of 161 eyes from 82 premature infants were retrospectively reviewed and divided into three groups according to the presence of retinopathy of prematurity (ROP) and treatment; Group 1 (68 eyes): without ROP, Group 2-1 (32 eyes): spontaneously regressed ROP, and Group 2–2 (61 eyes): regressed ROP with treatment. The incidences and clinical features of refractive errors, anisometropia, amblyopia and strabismus at the age of three years were compared among the three groups.

Results

The incidences of myopia, astigmatism, anisometropia and the severity of myopia increased according to the presence of ROP and treatment (p = 0.03, 0.02, 0.001, and 0.04, respectively). There were no significant differences in the incidences of hyperopia among the three groups; however, the severity of hyperopia in Group 2–2 was higher than those in the other two groups (p = 0.01). Patients in Group 1 had better best corrected visual acuity (BCVA) compared with those of the other two groups (p < 0.001). However, no significant differences in the incidences of strabismus or amblyopia among the three groups (p = 0.80 and 0.85, respectively) were found, and the ratio of esotropia: exotropia was 1:1.3.

Conclusions

Regular ocular examination should be required in children who were born prematurely in order to detect and treat ophthalmologic problems such as refractive errors, amblyopia and strabismus.

Keywords: Amblyopia, Premature infant, Refractive error, Retinopathy of prematurity, Strabismus

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Table 1.

Characteristics of study population

		Group 1 (N = 34)		Group 2–1 (N =15)		Group 2–2 (N =33)		p value^*
		No	(%)	No	(%)	No	(%)	p value^*
Gestational age (wk)	<27	0	(0.0)	1	(6.7)	9	(27.3)	0.002
Gestational age (wk)	≥27	34	(100.0)	14	(93.3)	24	(72.7)	0.002
Birth weight (g)	<750	0	(0.0)	0	(0.0)	4	(12.1)	<0.001
	750≤ <1000	0	(0.0)	3	(20.0)	7	(21.2)
	1000≤<1500	8	(23.5)	8	(53.3)	14	(42.4)
	1500≤	26	(76.5)	4	(26.7)	8	(24.2)
Gender	M	19	(55.9)	12	(80.0)	19	(57.6)	0.25
Gender	F	15	(44.1)	3	(20.0)	14	(42.4)	0.25

^* Pearson's chi-square test. Group 1: without ROP; Group 2-1: spontaneously regressed ROP; Group 2–2: regressed ROP with treatment.

Table 2.

Incidence of refractive error, anisometropia and strabismus in 3-year-old premature children

		Group 1		Group 2–1		Group 2–2		p value^*
		No	(%)	No	(%)	No	(%)	p value^*
Refractive error^†		35	(51.5)	19	(59.4)	49	(80.3)	0.002
Anisometropia		2	(5.9)	6	(40.0)	14	(46.7)	0.001
Strabismus	exodeviation	6	(17.6)	2	(13.3)	9	(27.3)	0.80
	esodeviation	5	(14.7)	4	(26.7)	4	(12.1)	

^* Pearson's chi-square test

^† Refractive error is defined as myopia, hyperopia and/or astigmatism. Group 1: without ROP; Group 2-1: spontaneously regressed ROP; Group 2–2: regressed ROP with treatment.

Table 3.

Incidence and distribution of refractive error in 3-year-old premature children

	Group 1		Group 2–1		Group 2–2		p value^*
	No	(%)	No	(%)	No	(%)	p value^*
Myopia	16	(23.5)	11	(34.4)	31	(50.8)	0.03
Emmetropia	44	(64.7)	18	(56.3)	24	(39.3)	0.02
Hyperopia	5	(11.4)	3	(16.7)	6	(25.0)	0.872
Astigmatism	22	(32.4)	14	(43.8)	35	(57.4)	0.02

^* Pearson's chi-square test. Group 1: without ROP; Group 2-1: spontaneously regressed ROP; Group 2–2: regressed ROP with treatment.

Table 4.

Degree of refractive errors in 3-year-old premature children

	Group 1	Group 2–1	Group 2–2	p value
	Mean ± SD^* (D^†)	Mean ± SD (D)	Mean ± SD (D)	p value
Myopia	−1.39 ± 1.74	−1.78 ± 1.74	−2.73 ± 1.86	0.04^‡
Emmetropia	+0.59 ± 0.57	+0.87 ± 0.74	+0.75 ± 0.62	0.25^‡
Hyperopia	+4.05 ± 0.87	+3.33 ± 0.29	+6.17 ± 1.03	0.01^§
Astigmatism	1.93 ± 0.78	1.61 ± 0.81	2.17 ± 0.88	0.10^‡

^* SD=standard deviation

^† D=diopter

^‡ ANOVA

^§ Kruskal-Wallis test. Group 1: without ROP; Group 2-1: spontaneously regressed ROP; Group 2–2: regressed ROP with treatment.

Table 5.

Best corrected visual acuity (BCVA) and incidence of amblyopia in 3-year-old premature children

	Group 1	Group 2–1	Group 2–2	p value
BCVA (logMAR)	0.14 ± 0.08	0.16 ± 0.07	0.27 ± 0.18	< 0.001^*
Amblyopia No (%)	3 (15)	1 (14.3)	5 (20.8)	0.85^†

^* ANOVA

^† Pearson's chi-square test.

Group 1: without ROP; Group 2-1: spontaneously regressed ROP; Group 2–2: regressed ROP with treatment.

Table 6.

Previous studies of refractive errors in preterm population compared to term population²⁸

Study		Age (yr)	Mypoia (%)(<0 diopter)	Hyperopia (%)(>+3 diopter)	Astigmatism (%)(≥ 1 diopter)	Anisometropia (%)(≥ 1 diopter)
Larsson et al⁹	term	10	11.1	0.9	4.1	0.9
Larsson et al⁹	preterm	10	15.2	4.2	44.0	8.9
O'Connor and Stephenson²⁶		10–12	18.9	6.6	13.7	9.0
Holmström and Larsson²⁷		2.5	10.0	4.0	26.0	8.4

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