Visual-motor functions are affected in young adults who were born premature and screened for retinopathy of prematurity

Central macular morphology and optic nerve fibre layer thickness in young adults born premature and screened for retinopathy of prematurity

PURPOSE

To investigate central retinal morphology and optic retinal nerve fibre layer (RNFL) in prematurely born young adults and compare to term born controls.

MATERIALS AND METHODS

The participants were 59 prematurely born individuals, with a birthweight ≤1.500 g, and 44 term born controls, all 25-29 years of age. Visual acuity (VA) and contrast sensitivity (CS) were assessed. The retinal macular thickness, ganglion cell-inner plexiform layer (GC-IPL) thickness and RNFL thickness were assessed with Cirrus optical coherence tomography (OCT).

RESULTS

Central macular thickness was increased (mean 26.7 μm) in prematurely born individuals compared to controls. The macular GC-IPL was thinner (mean 3.84 μm), also when excluding those with previous retinopathy of prematurity (ROP) and those with neurological complications. Gestational age at birth and previous treatment of ROP were risk factors for a thicker macula, however, not for reduced GC-IPL. The average peripapillary RNFL was thinner (mean 4.61 μm) in the prematurely born individuals, also when excluding those with previous ROP and/or neurological complications. Within the prematurely born group, treated ROP was correlated with increased average RNFL. Further, both better VA and CS were associated with thinner optic nerve RNFL and thicker average GC-IPL.

CONCLUSION

Macular and optic nerve morphology were influenced by premature birth as assessed with OCT in adult individuals. Gestational age at birth and treatment for ROP seemed to affect central macular thickness, and treated ROP affected the peripapillary RNFL. Thus, retinal sequelae remained in adulthood.

Wide-field digital imaging system for assessing ocular anterior segment development in very preterm infants

Purpose

This study aims to longitudinally investigate developments of the anterior segment in very preterm infants who exhibit normal retinal development outcomes by utilizing a wide-field digital imaging system.

Methods

Between June 2021 and June 2022, neonates with a birth weight of <1500 g and/or a gestational age (GA) of less than 32 weeks were included in this study. The participants underwent regular ocular examinations, including sequential evaluations of the anterior segment and the retina, at intervals of 2-5 weeks, starting from birth and continuing until they reached a corrected GA of 48 weeks. Term neonates were selected as normal controls for the study. The study recorded the weight and GA of subjects at the time of examination, as well as indicators of abnormal development in the anterior segment.

Results

A total of 48 very preterm infants with normal retinal developmental outcomes were enrolled. The control group included 59 full-term infants. Common anterior segment eye abnormalities such as persistent hyperplasia of primary vitreous, persistent pupillary membranes, iris vessels, and anterior chamber angle vessels gradually subsided with the period in very preterm infants. The vascularity of the iris was substantially higher than in term controls (P < 0.05) at term gestation. The imaging of iris vessels and anterior chamber angle vessels in very preterm infants exhibited a decline at 46 and 47 weeks, respectively, which occurred slightly later compared to term infants.

Conclusion

In very preterm infant s with normal outcomes, although the developmental process is delayed, they may form a normal anterior segment structure similar to that of full-term infants in the late stages, which is followed up by the wide-field digital imaging system.

Strabismus, stereoacuity, accommodation and convergence in young adults born premature and screened for retinopathy of prematurity

PURPOSE

The aim of the study was to evaluate strabismus, stereoacuity, accommodation and convergence in prematurely born young adults; screened for retinopathy of prematurity in the neonatal period and compare with term-born individuals of the same age.

MATERIALS AND METHODS

The study participants included 59 prematurely born individuals with a birthweight of ≤1,500 grams and 44 term-born controls, all born during 1988-1990 in Stockholm County, Sweden. Ocular alignment was assessed with a cover test, stereoacuity with the TNO stereo test and the amplitude of accommodation and the near point of convergence with the Royal Air Force Rule.

RESULTS

Seven of 59 (12%) preterms had manifest strabismus, 4/59 (7%) had esotropia and 3/59 (5%) exotropia. One of 44 (2%) controls had esotropia; no other controls had manifest strabismus. Stereoacuity was within normal limits in 38/59 (64%) preterms and 43/44 (98%) controls, p < 0.01; the difference remained after excluding those with strabismus. A neurological complication at 2.5 years of age was the strongest risk factor for subnormal stereoacuity within the preterm group after excluding those with strabismus. The mean amplitude of accommodation was poorer in the preterms than the controls in better (p < 0.05) and worse eyes (p < 0.05). The preterms were more likely to have an amplitude of accommodation below the minimum, according to Hofstetter's equation. There were no differences between the groups regarding the near point of convergence.

CONCLUSION

Prematurely born young adults had a higher prevalence of strabismus, reduced stereoacuity and worse amplitude of accommodation than term-born controls.

Refraction and its development in young adults born prematurely and screened for retinopathy of prematurity

PURPOSE

To evaluate refraction and its development in young adults born prematurely, screened for retinopathy of prematurity, and to compare with individuals of the same age born at term.

MATERIALS AND METHODS

The participants were 59 preterms, with a birthweight of ≤ 1500 g, and 43 term-born controls, all born during 1988-1990. The refraction was measured in cycloplegia, and the spherical equivalent (SE) was calculated. The axial length (AL), anterior chamber depth and corneal radius (CR) were measured, and the AL/CR ratio was calculated.

RESULTS

The mean SE was -0.5 dioptres (D) (SD 2.5) in right eyes (REs) and -0.4 D (SD 2.3) in left eyes (LEs) of preterms, and -0.2 D (SD 1.5) in REs and -0.2 D (SD 1.5) in LEs of controls. The distribution of refraction was wider in the preterm group compared to the control group. In the preterm group, 12% had a SE ≥ 1.5 D, but none of the controls. Ten preterms, but none of the controls, had anisometropia ≥ 1.0 D. The prevalence of astigmatism ≥ 1.0 D was higher in preterms than controls. The SE decreased around 1 D in both preterms and controls from 10 to 25 years of age. The AL and CR were shorter in the preterms; however, the AL/CR ratio was similar in both groups. Within the preterm group, cryotherapy was correlated with astigmatism, but not with SE and anisometropia at this age.

CONCLUSION

Prematurely born individuals had higher prevalence of refractive errors in young adulthood compared to term-born controls.

Antenatal steroids and neurodevelopment in 12-year-old children born extremely preterm

AIM

To investigate neurodevelopmental outcome in 12-year-old children born very preterm in relation to perinatal, neonatal and socioeconomic variables. To examine whether previously described positive effects of antenatal steroids on cognition persist at 12 years.

METHODS

Prospective cohort, 78 children with gestational ages 22.7-31.9 weeks, born in 2004-2007 and examined at 12 years of age with cognitive, motor and visual motor integration tasks and compared to an age-matched control group (n = 50). Two preterm subgroups were studied: very preterm children (28-31 gestational weeks, n = 53) and extremely preterm children (22-27 gestational weeks, n = 25).

RESULTS

The preterm children had significantly lower scores on all cognitive, motor and visual motor integration tasks than the controls. Gestational age and maternal education influenced associations differently in the two preterm subgroups. Also, severe retinopathy of prematurity demonstrated strong associations to outcome. In the extremely preterm group, administration of antenatal steroids was associated with better cognition, basic attention, word generation and motor skills.

CONCLUSION

At 12 years of age, very preterm children born in the 2000s still have deficits across several neurodevelopmental domains compared to term-born peers. Administration of antenatal steroids has long-lasting associations to cognition and motor skills in extremely preterm-born children.