Evaluation of Strabismus and Refractive Status in Premature Infants at Risk for Retinopathy of Prematurity

Purpose: The aim of our study was to evaluate strabismus and refractive aspects in premature infants at risk of developing retinopathy of prematurity.
Material and method: All infants with gestational age less than 34 weeks and birth weight below 2000 g who were born or transferred to the Neonatology Intensive Care Unit or who were hospitalized in the Premature Neonatology Clinic of Tîrgu Mureș between January 2008 and March 2009, were enrolled in a prospective study regarding the development of strabismus and refractive errors. Patients were subdivided in three groups: group A – prematures without retinopathy of prematurity, group B – prematures with spontaneously regressed retinopathy of prematurity and group C – prematures with laser treated retinopathy. The first examination was performed at 4 to 6 weeks after birth, followed by others depending on eye fundus appearance, until complete vascularization of retina, or involution of retinopathy occurred. Complete ophthalmological assessment took place at 6 months, and 3 years.
Results: Of the 240 eyes of 120 premature infants included in our study, the incidence of retinopathy was recorded in 20%. At 3 years follow-up, the overall incidence of myopia was 6.3%, hyperopia was noticed in 85%, astigmatism in 8.75%, while strabismus appeared in 11.3% of the studied eyes. The incidence of myopia, astigmatism and strabismus was higher in eyes with retinopathy of prematurity, particularly in laser treated eyes, while higher hyperopia appeared in eyes without retinopathy.
Conclusions: Premature babies with retinopathy of prematurity have higher rates of strabismus and refractive errors, particularly myopia. Long-term follow-up of these babies is mandatory for early detection and treatment of these ocular problems.

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