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BACKGROUND AND OBJECTIVES: Generalized convulsive seizures (GCSs) are the main risk factor of sudden unexpected death in epilepsy (SUDEP), which is likely due to peri-ictal cardiorespiratory dysfunction. The incidence of GCS-induced cardiac arrhythmias, their relationship to seizure severity markers, and their role in SUDEP physiopathology are unknown. The aim of this study was to analyze the incidence of seizure-induced cardiac arrhythmias, their association with electroclinical features and seizure severity biomarkers, as well as their specific occurrences in SUDEP cases. METHODS: This is an observational, prospective, multicenter study of patients with epilepsy aged 18 years and older with recorded GCS during inpatient video-EEG monitoring for epilepsy evaluation. Exclusion criteria were status epilepticus and an obscured video recording. We analyzed semiologic and cardiorespiratory features through video-EEG (VEEG), electrocardiogram, thoracoabdominal bands, and pulse oximetry. We investigated the presence of bradycardia, asystole, supraventricular tachyarrhythmias (SVTs), premature atrial beats, premature ventricular beats, nonsustained ventricular tachycardia (NSVT), atrial fibrillation (Afib), ventricular fibrillation (VF), atrioventricular block (AVB), exaggerated sinus arrhythmia (ESA), and exaggerated sinus arrhythmia with bradycardia (ESAWB). A board-certified cardiac electrophysiologist diagnosed and classified the arrhythmia types. Bradycardia, asystole, SVT, NSVT, Afib, VF, AVB, and ESAWB were classified as arrhythmias of interest because these were of SUDEP pathophysiology value. The main outcome was the occurrence of seizure-induced arrhythmias of interest during inpatient VEEG monitoring. Moreover, yearly follow-up was conducted to identify SUDEP cases. Binary logistic generalized estimating equations were used to determine clinical-demographic and peri-ictal variables that were predictive of the presence of seizure-induced arrhythmias of interest. The z-score test for 2 population proportions was used to test whether the proportion of seizures and patients with postconvulsive ESAWB or bradycardia differed between SUDEP cases and survivors. RESULTS: This study includes data from 249 patients (mean age 37.2 ± 23.5 years, 55% female) who had 455 seizures. The most common arrhythmia was ESA, with an incidence of 137 of 382 seizures (35.9%) (106/224 patients [47.3%]). There were 50 of 352 seizure-induced arrhythmias of interest (14.2%) in 41 of 204 patients (20.1%). ESAWB was the commonest in 22 of 394 seizures (5.6%) (18/225 patients [8%]), followed by SVT in 18 of 397 seizures (4.5%) (17/228 patients [7.5%]). During follow-up (48.36 ± 31.34 months), 8 SUDEPs occurred. Seizure-induced bradycardia (3.8% vs 12.5%, z = -16.66, p < 0.01) and ESAWB (6.6% vs 25%; z = -3.03, p < 0.01) were over-represented in patients who later died of SUDEP. There was no association between arrhythmias of interest and seizure severity biomarkers (p > 0.05). DISCUSSION: Markers of seizure severity are not related to seizure-induced arrhythmias of interest, suggesting that other factors such as occult cardiac abnormalities may be relevant for their occurrence. Seizure-induced ESAWB and bradycardia were more frequent in SUDEP cases, although this observation was based on a very limited number of SUDEP patients. Further case-control studies are needed to evaluate the yield of arrhythmias of interest along with respiratory changes as potential SUDEP biomarkers.
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Arritmias Cardíacas , Electroencefalografía , Humanos , Femenino , Masculino , Adulto , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/fisiopatología , Arritmias Cardíacas/diagnóstico , Incidencia , Persona de Mediana Edad , Estudios Prospectivos , Muerte Súbita e Inesperada en la Epilepsia/epidemiología , Convulsiones/epidemiología , Convulsiones/fisiopatología , Epilepsia Generalizada/epidemiología , Epilepsia Generalizada/fisiopatología , Anciano , Adulto Joven , Electrocardiografía , AdolescenteRESUMEN
OBJECTIVE: The aim of this study was to develop a machine learning algorithm using an off-the-shelf digital watch, the Samsung watch (SM-R800), and evaluate its effectiveness for the detection of generalized convulsive seizures (GCS) in persons with epilepsy. METHODS: This multisite epilepsy monitoring unit (EMU) phase 2 study included 36 adult patients. Each patient wore a Samsung watch that contained accelerometer, gyroscope, and photoplethysmographic sensors. Sixty-eight time and frequency domain features were extracted from the sensor data and were used to train a random forest algorithm. A testing framework was developed that would better reflect the EMU setting, consisting of (1) leave-one-patient-out cross-validation (LOPO CV) on GCS patients, (2) false alarm rate (FAR) testing on nonseizure patients, and (3) "fixed-and-frozen" prospective testing on a prospective patient cohort. Balanced accuracy, precision, sensitivity, and FAR were used to quantify the performance of the algorithm. Seizure onsets and offsets were determined by using video-electroencephalographic (EEG) monitoring. Feature importance was calculated as the mean decrease in Gini impurity during the LOPO CV testing. RESULTS: LOPO CV results showed balanced accuracy of .93 (95% confidence interval [CI] = .8-.98), precision of .68 (95% CI = .46-.85), sensitivity of .87 (95% CI = .62-.96), and FAR of .21/24 h (interquartile range [IQR] = 0-.90). Testing the algorithm on patients without seizure resulted in an FAR of .28/24 h (IQR = 0-.61). During the "fixed-and-frozen" prospective testing, two patients had three GCS, which were detected by the algorithm, while generating an FAR of .25/24 h (IQR = 0-.89). Feature importance showed that heart rate-based features outperformed accelerometer/gyroscope-based features. SIGNIFICANCE: Commercially available wearable digital watches that reliably detect GCS, with minimum false alarm rates, may overcome usage adoption and other limitations of custom-built devices. Contingent on the outcomes of a prospective phase 3 study, such devices have the potential to provide non-EEG-based seizure surveillance and forecasting in the clinical setting.
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Electroencefalografía , Dispositivos Electrónicos Vestibles , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Electroencefalografía/métodos , Electroencefalografía/instrumentación , Convulsiones/diagnóstico , Convulsiones/fisiopatología , Algoritmos , Adulto Joven , Estudios Prospectivos , Aprendizaje Automático , Epilepsia Generalizada/diagnóstico , Epilepsia Generalizada/fisiopatología , Anciano , Reproducibilidad de los Resultados , Fotopletismografía/instrumentación , Fotopletismografía/métodosRESUMEN
Duplicated cystic ducts are a rare congenital malformation with less than 20 reported cases before 2019. This malformation is important to identify to reduce the risk of intraoperative complications such as bile duct injuries that can increase postoperative morbidity and mortality. We present the case of a 62-year-old male with duplicated cystic ducts that were ligated during laparoscopic cholecystectomy and subsequently complicated by postoperative biloma formation. Treatment options for biliary leak include endoscopic retrograde cholangiopancreatography (ERCP) with stenting, percutaneous drainage, and duct embolization. Each carries the risk of complications such as infection, duct perforation, and stent/drain displacement. Roux-en-Y hepaticojejunostomy (RHYJ) tends to be the last resort when other minimally invasive procedures fail. It is imperative to identify postoperative complications related to cystic duct anomalies and the various treatment options available should these complications occur.
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Objectives: Sudden unexpected death in epilepsy (SUDEP) is a catastrophic epilepsy outcome for which there are no reliable premortem imaging biomarkers of risk. Percival respiratory depression is seen in monitored SUDEP and near SUDEP cases, and abnormal chemosensing of raised blood carbon dioxide (CO2) is thought to contribute. Damage to brainstem respiratory control and chemosensing structures has been demonstrated in structural imaging and neuropathological studies of SUDEP. We hypothesized that functional MRI (fMRI) correlates of abnormal chemosensing are detectable in brainstems of persons with epilepsy (PWE) and are different from healthy controls (HC). Methods: We analyzed fMRI BOLD activation and brain connectivity in 10 PWE and 10 age- and sex-matched HCs during precisely metered iso-oxic, hypercapnic breathing challenges. Segmented brainstem responses were of particular interest, along with characterization of functional connectivity metrics between these structures. Regional BOLD activations during hypercapnic challenges were convolved with hemodynamic responses, and the resulting activation maps were passed on to group-level analyses. For the functional connectivity analysis, significant clusters from BOLD results were used as seeds. Each individual seed time-series activation map was extracted for bivariate correlation coefficient analyses to study changes in brain connectivity between PWE and HCs. Results: (1) Greater brainstem BOLD activations in PWE were observed compared to HC during hypercapnic challenges in several structures with respiratory/chemosensing properties. Group comparison between PWE vs. HC showed significantly greater activation in the dorsal raphe among PWE (p < 0.05) compared to HCs. (2) PWE had significantly greater seed-seed connectivity and recruited more structures during hypercapnia compared to HC. Significance: The results of this study show that BOLD responses to hypercapnia in human brainstem are detectable and different in PWE compared to HC. Increased dorsal raphe BOLD activation in PWE and increased seed-seed connectivity between brainstem and adjacent subcortical areas may indicate abnormal chemosensing in these individuals. Imaging investigation of brainstem respiratory centers involved in respiratory regulation in PWE is an important step toward identifying suspected dysfunction of brainstem breathing control that culminates in SUDEP and deserve further study as potential imaging SUDEP biomarkers.
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OBJECTIVE: Increased understanding of the role of cortical structures in respiratory control may help the understanding of seizure-induced respiratory dysfunction that leads to sudden unexpected death in epilepsy (SUDEP). The aim of this study was to characterize respiratory responses to electrical stimulation (ES), including inhibition and enhancement of respiration. METHODS: We prospectively recruited 19 consecutive patients with intractable epilepsy undergoing stereotactic electroencephalography (EEG) evaluation from June 2015 to June 2018. Inclusion criteria were patients ≥18 years in whom ES was indicated for clinical mapping of ictal onset or eloquent cortex as part of the presurgical evaluation. ES was carried out at 50 Hz, 0.2 msec, and 1-10 mA current intensity. Common brain regions sampled across all patients were amygdala (AMY), hippocampus (HG), anterior cingulate gyrus (CING), orbitofrontal cortex (OrbF), temporal neocortex (TNC), temporal pole (TP), and entorhinal cortex (ERC). Seven hundred fifty-five stimulations were conducted. Quantitative analysis of breathing signal, that is, changes in breathing rate (BR), depth (TV), and minute ventilation (MV), was carried out during ES using the BreathMetrics breathing waveform analysis toolbox. Electrocardiography, arterial oxygen saturation, end-tidal and transcutaneous carbon dioxide, nasal airflow, and abdominal and thoracic plethysmography were monitored continuously during stimulations. RESULTS: Electrical stimulation of TP and CING (at lower current strengths <3 mA) increased TV and MV. At >7-10 mA, CING decreased TV and MV. On the other hand, decreased TV and MV occurred with stimulation of mesial temporal structures such as AMY and HG. Breathing changes were dependent on stimulation intensity. Lateral temporal, entorhinal, and orbitofrontal cortices did not affect breathing either way. SIGNIFICANCE: These findings suggest that breathing responses other than apnea can be induced by ES. Identification of two regions-the temporal pole and anterior cingulate gyrus-for enhancement of breathing may be important in paving the way to future development of strategies for prevention of SUDEP.
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Neocórtex , Muerte Súbita e Inesperada en la Epilepsia , Amígdala del Cerebelo , Electroencefalografía , Humanos , Lóbulo TemporalRESUMEN
OBJECTIVE: To analyze the association between peri-ictal brainstem posturing semiologies with postictal generalized electroencephalographic suppression (PGES) and breathing dysfunction in generalized convulsive seizures (GCS). METHODS: In this prospective, multicenter analysis of GCS, ictal brainstem semiology was classified as (1) decerebration (bilateral symmetric tonic arm extension), (2) decortication (bilateral symmetric tonic arm flexion only), (3) hemi-decerebration (unilateral tonic arm extension with contralateral flexion) and (4) absence of ictal tonic phase. Postictal posturing was also assessed. Respiration was monitored with thoracoabdominal belts, video, and pulse oximetry. RESULTS: Two hundred ninety-five seizures (180 patients) were analyzed. Ictal decerebration was observed in 122 of 295 (41.4%), decortication in 47 of 295 (15.9%), and hemi-decerebration in 28 of 295 (9.5%) seizures. Tonic phase was absent in 98 of 295 (33.2%) seizures. Postictal posturing occurred in 18 of 295 (6.1%) seizures. PGES risk increased with ictal decerebration (odds ratio [OR] 14.79, 95% confidence interval [CI] 6.18-35.39, p < 0.001), decortication (OR 11.26, 95% CI 2.96-42.93, p < 0.001), or hemi-decerebration (OR 48.56, 95% CI 6.07-388.78, p < 0.001). Ictal decerebration was associated with longer PGES (p = 0.011). Postictal posturing was associated with postconvulsive central apnea (PCCA) (p = 0.004), longer hypoxemia (p < 0.001), and Spo2 recovery (p = 0.035). CONCLUSIONS: Ictal brainstem semiology is associated with increased PGES risk. Ictal decerebration is associated with longer PGES. Postictal posturing is associated with a 6-fold increased risk of PCCA, longer hypoxemia, and Spo2 recovery. Peri-ictal brainstem posturing may be a surrogate biomarker for GCS severity identifiable without in-hospital monitoring. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that peri-ictal brainstem posturing is associated with the GCS with more prolonged PGES and more severe breathing dysfunction.
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Tronco Encefálico/fisiopatología , Epilepsia Generalizada/fisiopatología , Postura/fisiología , Respiración , Convulsiones/fisiopatología , Adolescente , Adulto , Anciano , Electroencefalografía , Epilepsia Generalizada/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Convulsiones/diagnóstico , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
OBJECTIVES: Hypoxia, or abnormally low blood-oxygen levels, often accompanies seizures and may elicit brain structural changes in people with epilepsy which contribute to central processes underlying sudden unexpected death in epilepsy (SUDEP). The extent to which hypoxia may be related to brain structural alterations in this patient group remains unexplored. METHODS: We analyzed high-resolution T1-weighted magnetic resonance imaging (MRI) to determine brain morphometric and volumetric alterations in people with generalized tonic-clonic seizures (GTCS) recorded during long-term video-electroencephalography (VEEG), recruited from two sites (n = 22), together with data from age- and sex-matched healthy controls (n = 43). Subjects were sub-divided into those with mild/moderate (GTCS-hypox-mild/moderate, n = 12) and severe (GTCS-hypox-severe, n = 10) hypoxia, measured by peripheral oxygen saturation (SpO2 ) during VEEG. Whole-brain voxel-based morphometry (VBM) and regional volumetry were used to assess group comparisons and correlations between brain structural measurements as well as the duration and extent of hypoxia during GTCS. RESULTS: Morphometric and volumetric alterations appeared in association with peri-GTCS hypoxia, including volume loss in the periaqueductal gray (PAG), thalamus, hypothalamus, vermis, cerebellum, parabrachial pons, and medulla. Thalamic and PAG volume was significantly reduced in GTCS patients with severe hypoxia compared with GTCS patients with mild/moderate hypoxia. Brainstem volume loss appeared in both hypoxia groups, although it was more extensive in those with severe hypoxia. Significant negative partial correlations emerged between thalamic and hippocampal volume and extent of hypoxia, whereas vermis and accumbens volumes declined with increasing hypoxia duration. SIGNIFICANCE: Brain structural alterations in patients with GTCS are related to the extent of hypoxia in brain sites that serve vital functions. Although the changes are associative only, they provide evidence of injury to regulatory brain sites related to respiratory manifestations of seizures.
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Encéfalo/diagnóstico por imagen , Epilepsia Tónico-Clónica/metabolismo , Hipoxia/metabolismo , Muerte Súbita e Inesperada en la Epilepsia , Adulto , Encéfalo/patología , Encéfalo/fisiopatología , Estudios de Casos y Controles , Electroencefalografía , Epilepsia Tónico-Clónica/diagnóstico por imagen , Epilepsia Tónico-Clónica/fisiopatología , Femenino , Sustancia Gris/diagnóstico por imagen , Sustancia Gris/patología , Humanos , Imagenología Tridimensional , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Estudios Prospectivos , Sueño , Factores de Tiempo , Grabación en Video , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/patología , Adulto JovenRESUMEN
OBJECTIVE: Ictal (ICA) and postconvulsive central apnea (PCCA) have been implicated in sudden unexpected death in epilepsy (SUDEP) pathomechanisms. Previous studies suggest that serotonin reuptake inhibitors (SRIs) and benzodiazepines (BZDs) may influence breathing. The aim of this study was to investigate if chronic use of these drugs alters central apnea occurrence in patients with epilepsy. METHODS: Patients with epilepsy admitted to epilepsy monitoring units (EMUs) in nine centers participating in a SUDEP study were consented. Polygraphic physiological parameters were analyzed, including video-electroencephalography (VEEG), thoracoabdominal excursions, and pulse oximetry. Outpatient medication details were collected. Patients and seizures were divided into SRI, BZD, and control (no SRI or BZD) groups. Ictal central apnea and PCCA, hypoxemia, and electroclinical features were assessed for each group. RESULTS: Four hundred and seventy-six seizures were analyzed (204 patients). The relative risk (RR) for ICA in the SRI group was half that of the control group (pâ¯=â¯0.02). In the BZD group, ICA duration was significantly shorter than in the control group (pâ¯=â¯0.02), as was postictal generalized EEG suppression (PGES) duration (pâ¯=â¯0.021). Both SRI and BZD groups were associated with smaller seizure-associated oxygen desaturation (pâ¯=â¯0.009; pâ¯âªâ¯0.001). Neither presence nor duration of PCCA was significantly associated with SRI or BZD (pâ¯â«â¯0.05). CONCLUSIONS: Seizures in patients taking SRIs have lower occurrence of ICA, and patients on chronic treatment with BZDs have shorter ICA and PGES durations. Preventing or shortening ICA duration by using SRIs and/or BZD in patients with epilepsy may play a possible role in SUDEP risk reduction.
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Benzodiazepinas/uso terapéutico , Epilepsia/tratamiento farmacológico , Hipoxia/tratamiento farmacológico , Convulsiones/tratamiento farmacológico , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Apnea Central del Sueño/tratamiento farmacológico , Adolescente , Adulto , Anciano , Estudios de Cohortes , Electroencefalografía/métodos , Epilepsia/fisiopatología , Femenino , Humanos , Hipoxia/fisiopatología , Masculino , Persona de Mediana Edad , Oximetría/métodos , Estudios Prospectivos , Convulsiones/fisiopatología , Apnea Central del Sueño/fisiopatología , Muerte Súbita e Inesperada en la Epilepsia/prevención & control , Adulto JovenRESUMEN
Herbal preparations used to treat human ailments globally can be contaminated with various heavy metals (HMs) originating from the raw materials or from the manufacturing processes. Therefore, we assessed 22 medicinal plants growing naturally on tannery pollutant contaminated (Site-C) and non-contaminated (Site-NC) sites for their ability to accumulate chromium (Cr). The Cr contents in soil and various plant parts were estimated using an atomic absorption spectrophotometer. Translocation and bioconcentration factors were calculated. The soil at Site-C had 27-fold higher concentration of total Cr than at Site-NC. Chromium accumulation is reported for the first time in 50 % of the medicinal plants examined and varied significantly among the sites. Shoots of Ricinus communis and Amaranthus viridis had maximum concentrations of Cr at Site-C, whereas in Site-NC, none of the plants had Cr accumulation >30 ppm. Ricinus communis, Amaranthus viridis, and Amaranthus spinosus had translocation factor (TF) greater than the one in the Site-C and Lantana camara had TF >1 in Site-NC. The bioconcentration factor (BCF) was >1 only for Ricinus communis at both the sites. The majority of the medicinal plants at Site-NC had Cr content exceeding the permissible limit of 2 ppm suggested for herbal raw material. The results of the study clearly emphasize the need for screening plants of therapeutic value for the presence of HMs even when collected from non-contaminated soils. Moreover, proportional allocation of Cr in different plant parts provided an insight on the safety of these parts when specifically used in herbal preparations.
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Amaranthus/metabolismo , Cromo/metabolismo , Brotes de la Planta/metabolismo , Plantas Medicinales/metabolismo , Ricinus/metabolismo , Contaminantes del Suelo/metabolismo , HumanosRESUMEN
Cryptosporidium parvum is a significant cause of diarrheal disease worldwide. The specific molecules that mediate C. parvum-host cell interactions and the molecular mechanisms involved in the pathogenesis of cryptosporidiosis are unknown. In this study we have shown that gp40, a mucin-like glycoprotein, is localized to the surface and apical region of invasive stages of the parasite and is shed from its surface. gp40-specific antibodies neutralize infection in vitro, and native gp40 binds specifically to host cells, implicating this glycoprotein in C. parvum attachment to and invasion of host cells. We have cloned and sequenced a gene designated Cpgp40/15 that encodes gp40 as well as gp15, an antigenically distinct, surface glycoprotein also implicated in C. parvum-host cell interactions. Analysis of the deduced amino acid sequence of the 981-bp Cpgp40/15 revealed the presence of an N-terminal signal peptide, a polyserine domain, multiple predicted O-glycosylation sites, a single potential N-glycosylation site, and a hydrophobic region at the C terminus, a finding consistent with what is required for the addition of a GPI anchor. There is a single copy of Cpgp40/15 in the C. parvum genome, and this gene does not contain introns. Our data indicate that the two Cpgp40/15-encoded proteins, gp40 and gp15, are products of proteolytic cleavage of a 49-kDa precursor protein which is expressed in intracellular stages of the parasite. The surface localization of gp40 and gp15 and their involvement in the host-parasite interaction suggest that either or both of these glycoproteins may serve as effective targets for specific preventive or therapeutic measures for cryptosporidiosis.
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Cryptosporidium parvum/genética , Genes Protozoarios , Glicoproteínas/genética , Proteínas Protozoarias/genética , Secuencia de Aminoácidos , Animales , Anticuerpos Monoclonales , Secuencia de Bases , Células CACO-2 , Adhesión Celular , Clonación Molecular , Criptosporidiosis/prevención & control , Criptosporidiosis/terapia , Cryptosporidium parvum/crecimiento & desarrollo , Cryptosporidium parvum/metabolismo , Cartilla de ADN/genética , Expresión Génica , Glicoproteínas/inmunología , Glicoproteínas/metabolismo , Humanos , Ratones , Datos de Secuencia Molecular , Pruebas de Neutralización , Procesamiento Proteico-Postraduccional , Proteínas Protozoarias/inmunología , Proteínas Protozoarias/metabolismoAsunto(s)
Miastenia Gravis/etiología , Blefaroptosis/tratamiento farmacológico , Blefaroptosis/etiología , Inhibidores de la Colinesterasa/uso terapéutico , Femenino , Humanos , Lactante , Miastenia Gravis/diagnóstico , Miastenia Gravis/tratamiento farmacológico , Neostigmina/uso terapéutico , Oftalmoplejía/tratamiento farmacológico , Oftalmoplejía/etiologíaRESUMEN
A retrospective study of perforating ocular injuries in children below the age of fifteen years was conducted. Eighty patients (eighty-nine eyes) were included in this study. Male children were more susceptible to ocular injury as compared to females (p = < 0.01). Children of the school-going age were the most affected (73.8%). Majority of the injuries occurred in the sports field (p = < 0.01). Playing with bow and arrow, and gillidanda* accounted for majority of the sport injuries (47.2%). Sixty-eight percent of the perforated eyes had no light perception at the end of treatment. Health education on the preventive aspects of ocular injuries in schools as well as through mass media should reduce the incidence of visual loss due to ocular injuries.
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Lesiones Oculares Penetrantes/epidemiología , Admisión del Paciente/estadística & datos numéricos , Adolescente , Niño , Preescolar , Lesiones Oculares Penetrantes/cirugía , Femenino , Humanos , India/epidemiología , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Factores de Riesgo , Agudeza VisualRESUMEN
Fifty preterm neonates were followed up at the age of 6 months and 1 year. In addition to developmental assessment, a complete ophthalmological examination was done on both visits. The largest (62%) gestational age group was of 34-36 weeks. At 6 months, none of the infants had normal vision. At 1 year of age, 64% of the babies had normal vision while incidence of myopia and hypermetropia was 16% and 20%, respectively. There was an inverse relationship noted between gestation and incidence of refractive errors. It was also noted that with decreasing weight, the incidence of myopia increased. Myopia was seen exclusively among infants of birth weight of 2000 g or less. Birth weight had a significant positive correlation with astigmatism. No correlation of asphyxia with refractive errors was observed. It is recommended that all preterm babies should have an ophthalmological examination at one year of age with follow up later on.
PIP: An ophthalmologist conducted a complete ocular examination of 50 premature infants at 6 months and 1 year to assess their refraction status. 52% of the infants weighed 1501-2000 g at birth. 62% were born between 34 and 36 weeks gestation. At 6 months, none of the 50 infants had normal vision. 66.6% of the infants born at 31-33 weeks gestation and 70% of those born at 34-36 weeks gestation were farsighted. The only infant born at 28 weeks gestation was nearsighted. 26% of all infants had different refractive power in the two eyes. The incidence of nearsightedness increased as gestational age decreased. At 12 weeks, 64% of all infants, all of whom were born at 31-33 and 34-36 weeks gestation, had normal vision. The 28-week infant still suffered from different refractive power in the two eyes. Nearsightedness incidence at 1 year was less than it was at 6 months (16% vs. 32%; p 0.05), while the incidence of farsightedness decreased (34 vs. 10 infants; p 0.05). Nearsightedness was inversely related to gestational age and birth weight (p 0.05). Nearsightedness and different refractive power in the two eyes existed only in infants weighing no more than 2000 g at birth. Different refractive power in the two eyes was also inversely related to gestational age. Astigmatism at 6 and 12 months was associated with low birth weight (p 0.05). There was no correlation between refractive errors and asphyxia. These findings show that refractive errors are common in premature infants. An ophthalmological examination at 1 year and later can prevent substantial visual handicap.