Achim Fieß

Macular morphology in former preterm and full-term infants aged 4 to 10 years

ObjectiveTo analyse macular retinal and choroidal layer thickness in former preterm and full-term infants and to assess associated perinatal influence factors and functional correlation.MethodsThis prospective controlled, cross-sectional, hospital-based study in a tertiary center of maximum care examined former preterm infants with a gestational age (GA) ≤ 32 weeks and full-term neonates currently aged 4 to 10 years. We investigated data from 397 infants, analysing total foveal retinal thickness and six distinct macular retinal layer and choroidal layer measurements via spectral-domain optical coherence tomography. Multivariable linear regression analysis was performed to investigate associations of layer thickness with GA and retinopathy of prematurity (ROP).ResultsTotal retinal thickness in the fovea was thicker in former preterm infants with GA ≤ 28 weeks and in those with GA between 29–32 weeks compared to full-term infants independently of ROP. Occurrence of ROP was also associated with increased foveal thickness. Ganglion cell layer together with inner plexiform layer (GCL+IPL) was thinner in infants with GA ≤ 28 weeks than in full-term infants at 1000 and 2000μm distance from the fovea, but no association with ROP was present. Similar results were found for the photoreceptor layer. Total foveal retinal thickness was associated with low visual function.ConclusionThis study identified low gestational age and ROP occurrence as main determinants for foveal thickening. Furthermore, thinned GCL+IPL measurements were associated with lower gestational age. This study highlights the prognostic value of these maturity parameters influencing retinal morphology, which may affect visual function.

Axial Length and Anterior Segment Alterations in Former Preterm Infants and Full-term Neonates Analyzed With Scheimpflug Imaging

Purpose: To compare the axial length and anterior segment alterations in preterm infants with and without retinopathy of prematurity with those of full-term infants. Methods: The Wiesbaden Prematurity Study investigated 503 participants of former gestational age ⩽32 weeks and gestational age ≥37 weeks now being aged 4 to 10 years. This study included 485 participants in the prospective controlled cross-sectional, hospital-based study with successful Pentacam Scheimpflug imaging. Anterior segment parameters, axial length measurements, and associated factors were analyzed. Results: Corneal thickness did not differ between former preterm and full-term infants. Significant differences were found between preterm and full-term infants now aged ⩽7 years for spherical equivalent, astigmatism, corneal diameter, and axial length. In preterm infants aged ≥8 years compared with full terms of the same age, we found a significant difference only in the corneal diameter. In multivariable analysis of the corneal diameter, we detected an association with birth weight and perinatal adverse events. Astigmatism correlated with birth weight and laser treatment, anterior chamber depth with birth weight, laser treatment and age at examination, and axial length with birth weight and age at examination. Conclusions: This study demonstrated altered axial length and anterior segment morphology in former preterm infants, especially in the first years of life. In addition, we observed that preterm infants seemed to catch up, so that the differences in ocular growth in terms of spherical equivalent, astigmatism, and axial length decreased within the first 8 years of life.

Functional analysis and associated factors of the peripapillary retinal nerve fibre layer in former preterm and full-term infants

Purpose The aim of the study was to investigate peripapillary retinal nerve fibre layer thickness (RNFLT) in former preterm infants and full-term neonates using spectral-domain optical coherence tomography (SD-OCT). Methods The prospective, controlled, cross-sectional, hospital-based study in a tertiary centre with maximum care examined 503 infants with a former gestational age (GA) of ≥37 and ≤32 weeks now aged between 4 and 10 years. In total, we analysed 432 participants with successful circular peripapillary RNFLT OCT measurements. Main outcome measures were RNFLT correlations to GA, birth weight, occurrence of retinopathy of prematurity (ROP), perinatal adverse events as well as functional correlation. Results Global RNFLT was thinner in infants with GA ≤28 weeks compared with infants with GA between 29 and 32 weeks (p=0.024), and to full-term neonates (p=0.007) independent of the occurrence of ROP. Multivariable analysis revealed that RNFLT was positively associated with higher birth weight and GA. Furthermore, a decrease of RNFLT was related to reduced visual function in all peripapillary sectors. Conclusions The main factors for retinal nerve fibre layer thinning are low birth weight and low GA. In addition, decreased RNFLT was associated with reduced visual function. This demonstrates that preterm infants are at high risk for peripapillary RNFL damage associated with reduced visual function.

Association of birth weight with corneal power in early adolescence: Results from the National Health and Nutrition Examination Survey (NHANES) 1999-2008.

Purpose To analyze the effect of birth weight on ocular morphology, refraction and visual function in early adolescents aged 12–15 years. Material and methods We conducted a secondary data analysis using the public use files from the National Health and Nutrition Examination Survey of the period from 1999 to 2008. Study participants aged 12 to 15 years were included with data on birth weight and ophthalmic parameters including presenting distance visual acuity, objective refraction and keratometry. Visual acuity, sphere, astigmatism in power vectors J0 and J45, corneal power and corneal astigmatism were evaluated for an association with birth weight. Linear and logistic regression with adjustment for age, sex, ethnicity, survey cycle and birth weight as independent variable were calculated. Results Linear regression analysis revealed an association between corneal power and birth weight (per 100g: beta = -0.04, p<0.001) in the univariate analysis, and in the model adjusted for age, sex, ethnicity and NHANES survey cycle (per 100g: beta = -0.04, p<0.001). A lower birth weight was associated with higher corneal power. We found no evidence for an association of visual acuity, sphere, spherical equivalent, J0-vector and J45-vector of astigmatism, corneal J0- or corneal J45-vector with birth weight. Conclusion Our data demonstrate that low BW is linked to alterations in keratometric power even in early adolescents aged 12–15 years whereas visual acuity and refractive error showed no association.

Trabeculectomy or Transscleral Cyclophotocoagulation as Initial Treatment of Secondary Childhood Glaucoma in Northern Tanzania

Purpose: The purpose is to describe the outcome of trabeculectomy with transscleral cyclophotocoagulation (TSCPC) as an initial intervention for secondary childhood glaucoma in Northern Tanzania. Methods: A retrospective, consecutive case series was analyzed of all children with secondary childhood glaucoma who underwent initial trabeculectomy or TSCPC between 2000 and 2013 at a referral eye unit in Northern Tanzania. Retrospective data were collected on causes of glaucoma, intraocular pressure (IOP), visual acuity, complications, and subsequent interventions. Outcomes were evaluated using Kaplan-Meier survival analysis and compared with Cox regression analysis. The main outcome measure was failure (IOP>21 mm Hg). Results: Thirty-six eyes of 27 children (male, 21; median age, 9 y; range, 0.3 to 15 y) with secondary childhood glaucoma underwent trabeculectomy (19 eyes, 53%) or TSCPC (17 eyes, 47%). Causes included ocular trauma (13, 36%), previous cataract surgery (12, 33%), congenital aniridia (5, 14%), Sturge-Weber syndrome (2, 6%), steroid-induced glaucoma (2, 6%), uveitis (1, 3%), and unspecified leucoma (1, 3%). After 12 months, success was achieved in 48% after trabeculectomy and 18% after TSCPC, with visual acuity remaining unchanged in 11 of 14 (79%) and 4 of 5 eyes (80%), respectively. One third of the children did not return for follow-up after 1 year. Distance to the hospital (>100 km) was a significant risk factor for trabeculectomy failure (P=0.031). Conclusions: A high proportion of secondary childhood glaucoma in Northern Tanzania was caused by trauma and previous cataract surgery. Trabeculectomy was associated with better IOP control but also a higher complication rate. The ability to maintain visual function was comparable after both interventions. Failure was associated with a journey to the eye hospital (>100 km) possibly leading to late presentation with advanced disease and erratic follow-up.

Outcomes of surgical interventions for primary childhood glaucoma in Northern Tanzania

Aim To evaluate goniotomy, trabeculotomy, transscleral cyclophotocoagulation (TSCPC) and trabeculectomy as initial procedures in children with primary childhood glaucoma from Northern Tanzania. Methods A retrospective analysis of consecutive interventions for primary childhood glaucoma from 2000 to 2013 was conducted at the Kilimanjaro Christian Medical Centre. Success was defined as postoperative intraocular pressure (IOP) below 22 mmHg. Success rates, IOP, visual acuity (VA), subsequent interventions and potential risk factors for failure were reported for the respective interventions. Results The study included 116 eyes of 70 children (age 4.6±5.9 years) with primary childhood glaucoma; 46 (65.7%) children were male. The preoperative IOP was 33.1±10.2 mmHg, the preoperative cup/disc (CD) ratio 0.71±0.3 and the corneal diameter 13.3±1.4 mm. As a primary intervention, 61 (52.6%) eyes underwent goniotomy, 10 (8.6%) eyes trabeculotomy, 12 (10.3%) TSCPC and 33 (28.4%) trabeculectomy. Follow-up data after 12 months were available for 63 (54.3%) eyes. Success rates at 12 months were 38% (goniotomy), 30% (trabeculotomy), 17% (TSCPC) and 64% (trabeculectomy). All interventions achieved a statistically significant IOP reduction at 3, 6 and 12 months, except for trabeculotomy after 6 months and TSCPC at all time points. Postoperative endophthalmitis occurred in one child treated with trabeculectomy. VA in 82% of all eyes was maintained or had improved after 12 months. Conclusions Based on the success rates of this retrospective analysis, goniotomy or trabeculotomy for younger and trabeculectomy for older children can be recommended in our setting to reduce IOP. Late presentation in combination with advanced glaucomatous damage as well as erratic postoperative follow-up and treatment were likely factors that compromised overall success rates. More efforts are necessary to detect the blinding disease earlier and improve adherence to follow-up.

Peripapillary Choroidal Thickness in Former Preterm and Full-Term Infants Aged From 4 to 10 Years

Purpose The aim of the study was to investigate peripapillary choroidal thickness in former preterm and full-term infants with spectral-domain optical coherence tomography (SD-OCT). Methods Subanalysis of infants with successful peripapillary choroidal thickness measurements of a prospective, controlled, cross-sectional, hospital-based study in a tertiary center of maximum care. The study examined 503 infants aged 4 to 10 years at the time of examination. Infants were divided into different groups: group 1 born with gestational age (GA) ≥37 weeks, group 2 born with GA between 29 and 32 weeks without ROP (retinopathy of prematurity), group 3 born with GA ≤28 weeks without ROP, and group 4 born with GA ≤32 weeks and presence of ROP. Results Peripapillary choroidal measurements were available for 388 of 503 participants. No significant differences were found among the four groups for global peripapillary choroidal thickness. Multivariable analysis revealed no association with low GA, birth weight, ROP occurrence, perinatal adverse events, and logMAR visual acuity. Only infants born small for GA (SGA) revealed peripapillary choroidal thinning in the superior (P = 0.033) and nasal (P = 0.024) sectors compared with infants born appropriate for GA (AGA). Infants SGA had lower visual acuity than AGA infants (0.03 ± 0.07 logMAR SGA versus 0.01 ± 0.05 logMAR AGA; P = 0.029). Conclusions Our results indicate that prematurity itself does not affect choroidal thickness in the peripapillary region. Only infants born SGA revealed peripapillary choroidal thinning compared with AGA infants. Our data indicate that fetal growth restriction leads to choroidal long-term alterations in the peripapillary region.

Association of low birth weight with myopic refractive error and lower visual acuity in adulthood: results from the population-based Gutenberg Health Study (GHS)

Purpose Low birth weight (BW) is linked to impaired organ development in childhood, including altered ocular morphological and functional development. The aim of this study was to evaluate whether low BW has long-term effects on visual acuity and refraction in adulthood. Methods The Gutenberg Health Study is a population-based, observational cohort study in Germany, including 15 010 participants aged between 35 and 74 years. These participants were divided into three different BW groups (low: <2500 g; normal: between 2500 and 4000 g; and high: >4000 g). Best-corrected visual acuity and objective refraction were examined. We used multivariable linear regression models with adjustment for age, sex, socioeconomic status and self-reported glaucoma, age-related macular degeneration, corneal disease and cataract to assess associations between BW and the main outcome measures, best-corrected visual acuity, spherical equivalent and astigmatism. Results Overall, 8369 participants reported their BW. In a multivariable analysis, an association for low BW with spherical equivalent (B=−0.28 per dioptre, P=0.005) and best-corrected visual acuity (B=0.02 logarithm of the minimum angle of resolution, P=0.006) compared with normal BW was observed. For participants with high BW, an association was observed with spherical equivalent (B=0.29 per dioptre, P<0.001), while none with visual acuity. Conclusions Our data demonstrated that low BW is linked to visual acuity and refractive long-term outcomes long after childhood. Individuals with low BW are more likely to have lower visual acuity and a higher myopic refractive error in adulthood. Adults with high BW are more likely to have a more hyperopic refractive error.

Correlation of morphological parameters and visual acuity with neurological development in former preterm children aged 4-10 years

The objective of this study was to investigate the relationship between visual acuity, peripapillary retinal nerve fibre layer (pRNFL), retinal thickness at the fovea and other factors with the neurologic status of former preterm children.

Corneal Aberrations in Former Preterm Infants: Results From The Wiesbaden Prematurity Study

Purpose To compare corneal aberrations in former preterm infants to that of full-term infants. Methods A prospective cross-sectional study was carried out measuring the corneal shape with Scheimpflug imaging in former preterm infants of gestational age (GA) ≤32 weeks and full-term infants with GA ≥37 weeks now being aged between 4 to 10 years. The main outcome measures were corneal aberrations including astigmatism (Zernike: Z2-2; Z22), coma (Z3-1; Z31), trefoil (Z3-3; Z33), spherical aberration (Z40) and root-mean square of higher-order aberrations (RMS HOA). Multivariable analysis was performed to assess independent associations of gestational age groups and of retinopathy of prematurity (ROP) occurrence with corneal aberrations adjusting for sex and age at examination. Results A total of 259 former full-term and 226 preterm infants with a mean age of 7.2 ± 2.0 years were included in this study. Statistical analysis revealed an association of extreme prematurity (GA ≤28 weeks) with higher-order and lower-order aberrations of the total cornea. Vertical coma was higher in extreme prematurity (P < 0.001), due to the shape of the anterior corneal surface, while there was no association with trefoil and spherical aberration. ROP was not associated with higher-order aberrations when adjusted for gestational age group. Conclusions This study demonstrated that specific corneal aberrations were associated with extreme prematurity rather than with ROP occurrence.