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Mark S Dikopf, Iris S Kassem, Felix Yan-Fay Chau; Retinal Vascularization and Refractive Error in Premature Eyes at Risk for Retinopathy of Prematurity. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):966.
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Retinopathy of prematurity (ROP) is a potentially vision-threatening condition that necessitates screening in at-risk neonates to prevent retinal detachment. ROP also carries a risk for amblyogenic refractive error, of which the pathophysiology remains elusive. The goal of this study is to examine whether the timing or extent of retinal vascularization in untreated ROP, or whether type of ROP treatment, influence the development of refractive error.
Approval was obtained from the Institutional Review Board at the University of Illinois at Chicago (UIC). A retrospective chart review of all premature neonates (≤30 weeks gestational age (GA) or birth weight (BW) ≤1500grams) screened for ROP at UIC was performed; GA and BW, results of ROP screening examinations, and cycloplegic retinoscopy (CR) were recorded. Patients lost to follow-up prior to CR were excluded.
100 eyes from 50 patients were included in this study; mean GA and BW were 28.7 weeks and 1128g. For all eyes, final CR was performed at an average age of 11.1 months of age (SD=4.3 months). 53 eyes of 28 patients achieved full retinal vascularization at an average of 44 weeks corrected GA (CGA) (SD=8.6w), and had a mean CR spherical equivalent (SE) of +1.2 diopters (D) (SD=1.9, range -5.5 to +4.875D). 31 eyes of 17 patients had halted vasculature extending to Zone 3, and 16 eyes of 8 patients had halted vasculature extending to Zone 2. Subjects who did not vascularize past Zone 2 had a mean CR SE of -3.4 D (SD=3.5, range -12.25 to -0.25D) and were born at an average of 24.8 weeks and 709g, all of which are significantly lower than fully vascularized subjects (2-tailed t-test, p<0.0001). The results remained significant whether or not the subjects were treated for ROP. No eyes had halted vasculature within Zone 1 at final examination.
In this series, premature eyes that did not vascularize beyond Zone 2 were significantly more myopic and had a lower gestational age and lower birth weight. Eyes treated for ROP were also significantly more myopic, regardless of extent of final zone of vasculature. Close observation for the development of amblyogenic refractive error is therefore required in premature infants with halted zone 2 vasculature as well as those treated for ROP.
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