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Ocular Morbidity in Premature Children

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Ocular Morbidity in Premature Children

Mihir Kothari1, V. Narendran2, Parag K. Shah3.
1Director, Jyotirmay Eye Clinic and Pediatric Low Vision Center, Thane W, Maharashtra, India, 2Chief Medical Officer and Head of the Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore 641 014, Tamilnadu, India, 3Consultant, Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore 641 014, Tamilnadu, India.
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Kothari M, Narendran V, Shah P K. OCULAR MORBIDITY IN PREMATURE CHILDREN. Pediatr Oncall J. 2006;3: 40-46.

Email
drmihirkothari@yahoo.com
 
Other vision threatening ocular morbidity associated with Prematurity :

Myopia :

Low birth weight, prematurity and ROP all significantly impact the refractive state in the long term.27,28 At age 10-12 years children born preterm (even if there was no ROP) have an increased prevalence of all refractive errors.27 The prevalence of myopia in babies with Prethreshold ROP is 64.5%28 and does not change significantly with treatment. The severity and incidence of refractive error is inversely related to the gestational age and birth weight and directly related to the severity of the disease. Every premature child is recommended to have a routine eye evaluation between 4 - 6 months of age for the assessment of the refractive status of the eye and ocular alignment.

Squint :

The prevalence of strabismus in general population is 1 - 2% while at 9 months, 20 - 30% of infants with prethreshold ROP have strabismus.29 The presence of strabismus in child can be associated with 1) Lack of binocularity and stereo-acuity, 2) Amblyopia, 3) Reduced field of vision, 4) 50% increased chance of losing the good eye due to injury, 5) Reduced Self esteem. An early intervention as early as 4 months of age is usually recommended.

Amblyopia :

With an increased prevalence of squint and refractive errors a child who is prematurely born has a proportionately higher incidence of Amblyopia. It can affect one eye or both the eyes and can be treated if detected early. The treatment generally entails appropriate spectacle correction and/or occlusion therapy.

Cerebral Visual Impairment :

Pre-term newborns represent a high-risk population for brain damage, primarily affecting the white matter, and for related neurodevelopmental disabilities. 30 This can be associated with the damage to the anterior or the posterior visual pathways leading to severe to mild visual impairment. Nearly 19% Children have ophthalmic deficits while another 47% have both, neurological and ophthalmic deficits. 31 The associated ophthalmic deficits range from the strabismus in 37%, oculomotor apraxia or gaze palsy in 15%, nystagmus in 11%, optic atrophy in 17%, refractive errors in 9% and squint in 37%, These children need to have an early intervention by the vision stimulation, management of all other ocular comorbidities as mentioned above. A concurrent consultation with the occupational therapist, physiotherapist and pediatric neurologist is required in many.

Summary :

A pre-term child is at a high risk for developing various vision threatening ocular disorders that need an early referral to the ophthalmologist for the intervention.
 
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Conflict of Interest
None
 
References :
  1. Agarwal KN, Agarwal DK, Agarwal A, Rai S, Prasad R, Agarwal S, Singh TB. Impact of the integrated child development services (ICDS) on maternal nutrition and birth weight in rural Varanasi. Indian Pediatr 2000;37:1321-7.  [PubMed]
  2. Repka MX. Ophthalmological problems of the premature infant. Rtard Dev Disabil Res Rev 2002;8:249-57.  [CrossRef]
  3. Leo SW, Cheong PYY. Incidence of retinopathy of prematurity in Singapore. Singapore Med J 1997;38:54-7.  [PubMed]
  4. Arroe M, Peitersen B. Retinopathy of prematurity: review of a seven-year period in a Danish neonatal intensive care unit. Acta Paediatr 1994;83:501-5.  [CrossRef]  [PubMed]
  5. Seiberth V, Linderkamp O. Risk factors in retinopathy of prematurity. A multivariate statistical analysis. Ophthalmologica 2000;214:131-5.  [CrossRef]  [PubMed]
  6. McKibbin M, Dabbs TR. Assisted conception and retinopathy of prematurity. Eye 1996;10:476-8.  [CrossRef]  [PubMed]
  7. Bergh T, Ericson A, Hillensjo T, et al. Deliveries and children born after in-vitro fertilisation in Sweden 1982-95: a retrospective cohort study. Lancet 1999;354:1579-85.  [CrossRef]
  8. Watts P, Adams GG. In vitro fertilisation and stage 3 retinopathy of prematurity. Eye 2000;14:330-3.  [CrossRef]  [PubMed]
  9. Pennefather PM, Tin W. Ocular abnormalities associated with cerebral palsy after preterm birth. Eye 2000;14:78-81.  [CrossRef]  [PubMed]
  10. Englert JA, Saunders RA, Purohit D, et al. The effect of anemia on retinopathy of prematurity in extremely low birth weight infants. J Perinatol 2001;21:21-6.  [CrossRef]  [PubMed]
  11. Dutta S, Narang S, Narang A, Dogra M, Gupta A. Risk factors of threshold retinopathy of prematurity. Indian Pediatr 2004;41:665-71.  [PubMed]
  12. Wallace DK, Kylstra JA, Phillips SJ, et al. Poor postnatal weight gain: a risk factor for severe retinopathy of prematurity. J AAPOS 2000;4:343-7.  [CrossRef]  [PubMed]
  13. Nair PM, Ganesh A, Mitra S, Ganguly SS. Retinopathy of prematurity in VLBW and extreme LBW babies. Indian J Pediatr 2003;70:303-6.  [CrossRef]  [PubMed]
  14. Reynolds JD, Hardy RJ, Kennedy KA, et al. Lack of efficacy of light reduction in preventing retinopathy of prematurity. Light Reduction in Retinopathy of Prematurity (LIGHT-ROP).
  15. Hosono S, Ohno T, Kimoto H, Shimizu M, Nozawa M, Genkawa R, Yoshida T, Wada S, Harada K. No clinical correlation between bilirubin levels and severity of retinopathy of prematurity. J Pediatr Ophthalmol Strabismus 2002;39:151-6.  [CrossRef]  [PubMed]
  16. Hughes S, Yang H, Chan-Ling T. Vascularization of the human fetal retina: roles of vasculogenesis and angiogenesis. Invest Ophthalmol Vis Sci 2000;41:1217-28.  [PubMed]
  17. Ashton N. Oxygen and the growth and development of retinal vessels. In vivo and in vitro studies. The XX Francis I. Proctor Lecture. Am J Ophthalmol 1966;62:412-35.  [CrossRef]
  18. Tripathi B, Knight G, Ashton N. Effect of oxygen on the developing retinal vessels of the rabbit. IV. Effect of hyperoxia on rabbit retinal vessels in tissue culture. Exp Eye Res 1974;19:449-75.  [CrossRef]
  19. Kissun RD , Garner A. Vasoformative properties of normal and hypoxic retinal tissue. Br J Ophthalmol 1977;61:394-8.  [CrossRef]
  20. An international classification of retinopathy of prematurity. The Committee for the Classification of Retinopathy of Prematurity. Arch Ophthalmol 1984;102:1130-4.  [CrossRef]  [PubMed]
  21. Shah PK, Narendran V, Saravanan VR, Raghuram A, Chattopadhyay A, Kashyap M, Devraj S. Fulminate type of retinopathy of prematurity. Indian J Ophthalmol 2004;52:319-20.  [PubMed]
  22. Shah PK, Narendran V, Saravanan VR, Raghuram A, Chattopadhyay A, Kashyap M. Morris RJ, Vijay N, Raghuraman V, Shah V. Fulminate retinopathy of prematurity - clinical characteristics and laser outcome. Indian J Ophthalmol 2005;53:261-5.  [CrossRef]  [PubMed]
  23. Good WV; Early Treatment for Retinopathy of Prematurity Cooperative Group. Final results of the Early Treatment for Retinopathy of Prematurity (ETROP) randomized trial. Trans Am Ophthalmol Soc 2004;102:233-48.  [PubMed]  [PMC free article]
  24. Jalali S, Anand R, Kumar H, Dogra MR, Azad R, Gopal L. Programme planning and screening strategy in retinopathy of prematurity. Indian J Ophthalmol 2003;51:89-99.  [PubMed]
  25. McGregor ML, Bremer DL, Cole C, McClead RE, Phelps DL, Fellows RR, Oden N; HOPE-ROP Multicenter Group. High Oxygen Percentage in Retinopathy of Prematurity study. Retinopathy of prematurity outcome in infants with prethreshold retinopathy of prematurity and oxygen saturation >94% in room air: the high oxygen percentage in retinopathy of prematurity study. Pediatrics 2002;110:540-4.  [CrossRef]
  26. Supplemental Therapeutic Oxygen for Prethreshold Retinopathy Of Prematurity (STOP-ROP), a randomized, controlled trial. I: primary outcomes. Pediatrics 2000;105:295-310.  [CrossRef]  [PubMed]
  27. O'Connor AR, Stephenson TJ, Johnson A, Tobin MJ, Ratib S, Fielder AR. Change of refractive state and eye size in children of birth weight less than 1701 g. Br J Ophthalmol 2006;90:456-60.  [CrossRef]  [PubMed]  [PMC free article]
  28. Davitt BV, Dobson V, Good WV, Hardy RJ, Quinn GE, Siatkowski RM, Summers CG, Tung B; Early Treatment for Retinopathy of Prematurity Cooperative Group. Prevalence of myopia at 9 months in infants with high-risk prethreshold retinopathy of prematurity. Ophthalmology 2005;112:1564-8  [CrossRef]  [PubMed]
  29. VanderVeen DK, Coats DK, Dobson V, Fredrick D, Gordon RA, Hardy RJ, Neely DE, Palmer EA, Steidl SM, Tung B, Good WV; Early Treatment for Retinopathy of Prematurity Cooperative Group. Prevalence and course of strabismus in the first year of life for infants with prethreshold retinopathy of prematurity: findings from the Early Treatment for Retinopathy of Prematurity study. Arch Ophthalmol 2006;124:766-73.  [CrossRef]  [PubMed]
  30. Arpino C, D'Argenzio L, Ticconi C, Di Paolo A, Stellin V, Lopez L, Curatolo P. Brain damage in preterm infants: etiological pathways. Ann Ist Super Sanita 2005;41:229-37.  [PubMed]
  31. Huo R, Burden SK, Hoyt CS, Good WV. Chronic cortical visual impairment in children: aetiology, prognosis, and associated neurological deficits. Br J Ophthalmol 1999;83:670-5.  [CrossRef]  [PubMed]  [PMC free article]

Last Updated : 01 September 2006 Vol 3 Issue 9 Art #31

Cite this article as: :
Kothari M, Narendran V, Shah P K. OCULAR MORBIDITY IN PREMATURE CHILDREN. Pediatr Oncall J. 2006;3: 40-46.
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