Prematurely Born Infants And Its Ocular Motility Disorders: Relationship With Retinopathy Of Prematurity V. De Felice ,A. Segnalini, R.Malagola Sapienza Università di Roma
Abstract The purpose- The aim of this study is to examine the incidence of ROP and its features with the influence of birth weight and gestational age in a sample of premature infants. We also wanted to investigate the visual outcome of these patients by comparing the incidence of strabismus with a sample of term infants. Methods- With a total of 183 preterm with gestational age between 25 and 32 wk, born between 2005 and 2009, have been obtained from the percentage of eyes with ROP, classified for staging and localization, by relating the relative fundus oculi with birth weight (g) and the gestational age of the patients. The incidence of strabismus was evaluated on three 3 groups consisting of: 1°) preterm without ROP (n = 26), 2°) preterm with ROP (n = 26), and 3°) born at term (n = 26) . The orthoptic examination was made both within 12 months, and next 24 months. Finally we analyzed the characteristics and changes over time of the angle of deviation in all three groups. The results-ROP was found with a percentage of 14.2% (26/183): n = 18 eyes ROP stage I (n = 12 zone 3, n = 6 zone 2, n = 0, zone 1); n = 13 eyes ROP stage II (n = 4 zone 3, n = 8 zone 2, zone 1 n = 1); n = 21 eyes ROP stage III (n = 5 Zone 3, Zone 2 n = 7, n = 9 Zone 1). In stages ROP more serious it was found, in addition to a greater involvement of more posterior retinal areas (area 1 and 2), an extremely low gestational
age and birth weight. At the first orthoptic examination we found a strabismus incidence rate of 46%(n=12) in the 1° group: n=7 with intermittent exotropia, n=3 with exotropia, n=3 with intermittent esotropia, n=1 with esotropia; in the 2° group an incidence rate of 31%(n=8): n=5 with exotropia, n=2 with intermittent esotropia, n= 1with exotropia; in the 3° group an incidence rate of 8%(n=2): n=2 with esotropia. During the second orthoptic examination we found a strabismus incidence rate of 15%(n=4) in the 1° group, of 23%(n=6) in the 2°one and of 8%(n=2) in the 3°one. Conclusions- Premature patients with gestational age <32 wk are high-risk ROP. The severity of this pathology is inversely proportional both gestational age and the birth weight. The incidence of strabismus in preterm infants with gestational age < 32 wk with or without retinopathy of prematurity is higher than observed in full term infants both at the first orthoptic examination and to the second one. The percentage of esotropia in full term infants is more higher than those observed in preterm infants. In patients born prematurely without ROP there is a high percentage of intermittent exotropia , which tend to regress in time with the completion of oculomotor development. Therefore recommended always a ophthalmologic follow up during the first 3 years of life , especially for a child with EG < 32 wk ,in order to prevent and control further complications as amblyopia and low vision.