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Retinal morphology and function in prematurely-born children at school age
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Preterm birth may lead to complications during the neonatal period that can cause visual dysfunctions. Retinopathy of prematurity (ROP) and neurological complications are well known reasons for visual dysfunctions, but preterm children with no or only mild ROP and no evident neurological problems may also be affected visually when they grow up. Retinal development starts early after gestation and continues long after birth. Major processes are underway during the second half of pregnancy when preterm children are born, and a preterm birth could possibly have a negative effect on normal retinal development.

The aims of the studies were to evaluate retinal morphology and function in former preterm children and compare the results with children born at term.

Former preterm children aged 5 to 17 years and born in a gestational age (GA) of 32 weeks or less were included in the different study groups. Children of similar ages who were born at term and with normal visual acuity (VA) acted as controls. Best corrected VA and refraction in cycloplegia were assessed in all children. Macular thickness and retinal nerve fiber layer (RNFL) thickness were measured with optical coherent tomography (OCT). Total retinal function was assessed with fullfield electroretinography (ffERG) and central macular function was assessed with multifocal electroretinography (mfERG).

Preterm children had thicker central maculae than controls. There was a positive correlation between central macular thickness and GA at birth. RNFL thickness was reduced in the preterm children with severe ROP and treated ROP, but children with mild or no ROP did not differ from the fullterm children. The photoreceptor function measured with ffERG and the macular function measured with mfERG were reduced in the preterm group compared to controls.

Preterm birth affects the retina both morphologically and functionally, and ROP has been suggested to be a reason for retinal changes. However, the results of this thesis indicate that children with no ROP also have retinal changes, suggesting an effect of prematurity itself. There were no correlations between any retinal changes and VA, but it is possible that larger studies using improved techniques may elucidate this further.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. , 42 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1088
Keyword [en]
Retinopathy of prematurity, Prematurity, Retinal development, OCT, Fullfield ERG, Multifocal ERG
National Category
Medical and Health Sciences
Research subject
Ophtalmology
Identifiers
URN: urn:nbn:se:uu:diva-247946ISBN: 978-91-554-9214-4 (print)OAI: oai:DiVA.org:uu-247946DiVA: diva2:798423
Public defence
2015-05-23, Gunnesalen, Ing. 10 Akademiska sjukhuset, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2015-04-28 Created: 2015-03-25 Last updated: 2015-07-07
List of papers
1. Central macular thickness is correlated with gestational age at birth in prematurely born children
Open this publication in new window or tab >>Central macular thickness is correlated with gestational age at birth in prematurely born children
2011 (English)In: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 95, no 6, 799-803 p.Article in journal (Refereed) Published
Abstract [en]

Background/aim Previous studies have revealed various subnormal visual functions in prematurely born children. The present study aimed to determine the retinal macular thickness in prematurely born children and compare with children born at term. Methods The eyes of 65 prematurely born children aged 5-16 years were examined with Stratus optical coherence tomography (OCT) 3, and the results were compared with those of 55 children born at term. The retinal macular thickness in the nine EDTRS macular areas (A1-A9), the foveal minimum and the total macular volume were determined. Results The central macular thickness (A1 and foveal minimum) was significantly thicker in the prematurely born children than in those born at term. There was no correlation between macular thickness and visual acuity or refraction. Children with previous retinopathy of prematurity (ROP) had significantly thicker central maculae than those without it. Prematurely born children without previous ROP had significantly thicker central maculae than the control group. Multiple regression analyses showed that gestational age at birth was the only risk factor for a thick central macula. Conclusion Prematurely born children had thicker central maculae than those born at term. Regardless of ROP, the degree of prematurity was the most important risk factor for abnormal foveal development.

National Category
Neurosciences
Identifiers
urn:nbn:se:uu:diva-154617 (URN)10.1136/bjo.2010.184747 (DOI)000290793600011 ()20974631 (PubMedID)
Available from: 2011-06-08 Created: 2011-06-08 Last updated: 2017-05-11Bibliographically approved
2. Retinal nerve fibre layer thickness in school-aged prematurely-born children compared to children born at term
Open this publication in new window or tab >>Retinal nerve fibre layer thickness in school-aged prematurely-born children compared to children born at term
2012 (English)In: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 96, no 7, 956-960 p.Article in journal (Refereed) Published
Abstract [en]

Aim To investigate the retinal nerve fibre layer (RNFL) with optical coherent tomography (OCT) in prematurely-born children. Methods 62 children born with a gestational age of <= 32 weeks, and a control group of 54 children born at term with normal birth weight (BW) were included in the study. 28 of the preterm children had retinopathy of prematurity (ROP) in the neonatal period; eight of them had severe ROP (stages 3-4). RNFL thickness was measured with Stratus OCT 3. Mean age at examination was 8.6 years in the preterm children and 10.1 years in the control group. Results There was a significant difference between the children born preterm and those born at term, regarding RNFL thickness in the superior (right eye (RE), p=0.043; left eye (LE), p=0.048) and the nasal quadrants (RE, p=0.006; LE, p<0.001), as well as average RNFL thickness (RE, p=0.016; LE, p=0.029). This difference was caused by the thinner RNFL in children with previous severe ROP (stages 3 and 4). Within the preterm group, the average RNFL thickness increased with larger BW (RE, p=0.050; LE, p=0.028), but there was no correlation with gestational age at birth. Conclusion The RNFL was reduced in prematurely-born children with severe ROP when compared to children born at term. It is hypothesised that severe retinopathy as well as ablation of the retina with laser treatment or cryotherapy may affect the axons of the ganglion cells and thus reduce RNFL thickness. Prematurely-born children with low BW had a thinner RNFL, suggesting a negative effect of low birth weight on neural development.

National Category
Neurosciences
Identifiers
urn:nbn:se:uu:diva-177561 (URN)10.1136/bjophthalmol-2011-301010 (DOI)000305579000008 ()
Available from: 2012-07-16 Created: 2012-07-16 Last updated: 2017-05-11Bibliographically approved
3. Photoreceptor Function in School-Aged Children is Affected by Preterm Birth
Open this publication in new window or tab >>Photoreceptor Function in School-Aged Children is Affected by Preterm Birth
2014 (English)In: Translational vision science & technology, ISSN 2164-2591, Vol. 3, no 6, 7Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Prematurely born children have affected visual functions at school age. Optical coherent tomography (OCT) has shown morphological changes in the retina, suggesting a disturbance in normal retinal development in these children. The aim of this study was to examine retinal function with fullfield electroretinogram (ffERG) in school-aged children born prematurely and compare with children born at term. A second aim was to correlate retinal function with visual acuity (VA), gestational age (GA), birth weight, and retinopathy of prematurity (ROP).

METHODS: The study group consisted of 35 former preterm children born before GA of 32 weeks. A group of 42 children born at term acted as controls. All children were between 5- and 18-years old. FfERG was performed in both eyes. Best-corrected VA and refraction in cycloplegia was determined.

RESULTS: The a-wave of the combined rod/cone responses was significantly reduced in the prematurely-born children compared with children born at term. There was a correlation between reduced a-wave amplitude in the combined rod/cone response and ROP and GA at birth.

CONCLUSION: Function of photoreceptors was affected in prematurely born children, possibly also in children without previous ROP. Whether immaturity per se affects the retinal function remains to be elucidated.

National Category
Ophthalmology
Research subject
Ophtalmology
Identifiers
urn:nbn:se:uu:diva-247881 (URN)10.1167/tvst.3.6.7 (DOI)25674356 (PubMedID)
Available from: 2015-03-24 Created: 2015-03-24 Last updated: 2015-07-07Bibliographically approved
4. Macular function in preterm children at school age.
Open this publication in new window or tab >>Macular function in preterm children at school age.
2014 (English)Manuscript (preprint) (Other academic)
National Category
Ophthalmology
Research subject
Ophtalmology
Identifiers
urn:nbn:se:uu:diva-240845 (URN)000345328000028 ()
Conference
Nordic Congress of Ophthalmology, 20–23 August 2014, Stockholm, Sweden
Available from: 2015-01-08 Created: 2015-01-08 Last updated: 2015-07-07

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