目的 了解早产儿生后早期的屈光发育.方法 横断面研究.收集生后4～6周进行早产儿视网膜病变筛查的无视网膜病变的早产儿253例,按矫正胎龄进行分组:A组(22只眼),矫正胎龄≤34周;B组(52只眼),矫正胎龄>34周且≤36周;C组(126只眼),矫正胎龄>36周且≤38周;D组(144只眼),矫正胎龄>38周且≤40周;E组(136只眼),矫正胎龄>40周且≤42周,F组(26只眼),矫正胎龄>42周且≤44周.行睫状肌麻痹检影验光确定屈光状态.其中38例在矫正胎龄40～44周时的屈光与同龄足月对照组比较.定量资料为非正态分布,使用Mann-Whitney U检验,相关性使用Spearman相关分析及回归分析.定性资料使用X2检验.结果 早产儿随出生体重的增加、孕龄和检查时矫正胎龄的增大,等效球镜远视程度增大.出生体重是等效球镜的显著影响因素.近视发生率14.43%,并随着矫正胎龄的增加而下降.散光发生率10.28%,各年龄组间差异无统计学意义.散光度中位数+1.00 DC,随着矫正胎龄的增加而增大,与出生孕龄和体重无关.散光轴向中位数90°,与矫正胎龄、出生孕龄和体重均无关.矫正胎龄40～44周的早产儿和足月儿比较,除等效球镜差异有统计学意义,前者有更大的近视趋势外,近视发生率、散光发生率、散光度、散光轴向的差异均无统计学意义.结论 早产儿屈光状态随发育向远视方向发展,但到矫正胎龄40～44周时仍较足月儿有较大的近视趋势,其潜在机制及随后的屈光发育有待进一步研究.(中华眼科杂志,2009,45:607-611)%Objective To understand the development of the refractive status in premature infants during their early life. Methods It was a cross-sectional study. Two hundred fifty-three premature infants without retinopathy of prematurity (BOP) were screened for BOP at 4-6 weeks after born. Refraction with cycloplegic retinoscopy was determined. The refractions of 38 infants were compared with those of mature infants at 40-44 weeks' correct gestational age (CGA). Results The spherical equivalent (SE) increased progressively (become more hypermetropic) along with increasing gestational age (GA), birth weight (BW) and CGA at test. BW was the main factor for SE. The incidence of myopia and astigmatism was 14. 43% (73eyes) and 10. 28% (52eyes). The former decreased and the latter did not change along with increasing CGA. The median of astigmatism was 1.00DC, while Percentile 25 (P25) and Percentile 75 (P75) were 0. 50DC and 1.13DC, respectively. The degree of astigrnatism increased along with increasing CGA and did not change along with GA or BW. The median of axis of astigmatism (AX) was 90°, while P25 and P75 were 90°and 100° ,respectively. The AX was not correlated with CGA, GA or BW. Five observations, including SE, incidence of myopia and astigmastism, the degree and axis of astigmatism between premature and mature infants at 40 to 44 weeks' CGA, were compared. It shows that there was no statistical difference between the two groups in all items mentiond above but SE, which indicating that there was more myopic in premature infants. Conclusions The refraction of premature infants shifts towards hypermetropia along with development, but is still more myopic than mature infants at 40 to 44 weeks' CGA. Further studies on the underlying mechanisms of myopia and the subsequent refractive development are needed. (Chin J Ophthalmol , 2009,45:507-511)
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