摘要目的 用闭路式强化优先注视(COPL)法检测早产儿6月龄前的条栅视力,探讨其发育情况.方法 前瞻性病例对照研究.符合筛选标准且能完成条栅视力检查,随访≥6个月的早产儿48名,用COPL法检测条栅视力,年龄7 d～8个月,体重(2233.4±448.0)g,分组段定期测试每一名早产儿单、双眼视力.另外筛选正常足月儿34名作为对照组,体重(3443.3±553.0)g,定期作检测.视力结果以5分法记录.数据采用独立样本t检验、配对t检验、单因素方差分析、Pearson相关、直线回归及Mann-Whitney检测进行分析.结果 早产儿出生2周内、校正孕周满38周、出生后14周、校正孕周满52周、出生后6个月、校正孕周满63周的右眼和左眼条栅视力分别为2.48±0.02和2.49±0.02,2.70±0.01和2.70±0.01,3.54±0.03和3.51±0.03,3.70±0.03和3.69±0.03,3.98±0.03和3.95±0.03,4.10±0.02和4.09±0.02,同一个体左右眼视力差异无统计学意义;各组段双眼条栅视力分别为2.51±0.02、2.70±0.01、3.55±0.03、3.69±0.03、3.96±0.03、4.18±0.02.早产儿的视力与月龄之间存在高度正相关关系(r=0.928,P＜0.01),视力((Y))与月龄(X)之间的直线回归方程为(Y)=0.248X+2.457(R2=0.861,F=1769.743,P＜O.01)；视力与孕周呈高度正相关(r=0.725,P＜0.01),视力((Y))与孕周(X)之间的直线回归方程为(Y)=0.017X+ 1.457(R2=0.261,F=11.743,P＜0.01).与出生体重、性别的相关性无统计学意义.足月儿出生后2周、出生后3个月、出生后6个月右眼和左眼视力分别为2.60±0.02和2.63±0.02,3.71±0.02和3.72±0.02,4.06±0.02和4.05±0.02,同一个体左右眼间视力差异无统计学意义;足月儿各组段双眼视力分别为2.60±0.02、3.72±0.02、4.14±0.02.比较同组段平均单双眼条栅视力,各月龄早产儿平均单双眼条栅视力与同组段正常足月儿相比,均较低,差异均有统计学意义(t=0.81、0.79、0.87,P＜0.05).结论 无眼底病变早产儿的单眼条栅视力与眼别无关,单、双眼条栅视力均低于同龄正常足月儿,条栅视力发育与月龄、孕周呈高度正相关,与性别、体重和屈光状态无相关性.电脑控制强化优先注视检测系统是检测0～6月龄早产儿视力的有效手段.

abstractsObjective To determine the grating acuity of healthy preterm infants by using the Closed-Circuit Operant Preferential Looking System (COPL) and to investigate visual development during the early 6-month period after birth.Methods In this prospective case-control study,the COPL was used to determine the monocular and binocular grating acuity of 48 preterm infants (25 males,23 females),who met the eligibility criteria of 7 days-8 months old,with birth weight from 1415 g to 2770 g (2233.4±448.0)g.The infants were measured periodically.The grating acuity of another 34 full-term infants,who were the controls,were measured periodically for six months at the same time points after birth.The data were analyzed statistically by independent samples t test, paired t test, ANOVA, Pearson correlation, linear regression and Mann-Whitney test. Results The mean values of monocular acuity (right and left) for the preterm infants were:2.48±0.02 and 2.49±0.02(2 weeks after birth),2.70±0.01 and 2.70±0.01 (gestational age,38 weeks),3.54±0.03 and 3.51±0.03 (14 weeks after birth),3.70±0.03 and 3.69±0.03 (gestational age,52 weeks),3.98±0.03 and 3.95±0.03(6 months after birth),4.10±0.02 and 4.09±0.02 (gestational age,63 weeks).There were positive correlation between visual acuity and months in the preterm infants [r=0.928,P＜0.01; (Y)=0.248X+2.457 (R2=0.861,F=1769.743,P＜0.01)].Also between visual acuity and weeks of gestational age [r=0.725,P＜0.01; (Y)=0.017X+1.457 (R2=0.261,F=11.743,P＜0.01)].Nor the weight or gender.The mean values of binocular acuity for the preterm infants at corresponding time points were 2.51±0.02,2.70±0.01,3.55±0.03,3.69±0.03,3.96±0.03,4.18±0.02.Mean values of monocular acuity for the full-term infants were 2.60±0.02 and 2.63±0.02 (2 weeks after birth),3.71±0.02 and 3.72±0.02(3 months after birth),4.06±0.02,and 4.05±0.02 (6 months after birth).There was no statistically significant difference between the two eyes. The binocular acuities of the full-term infants at corresponding time points were 2.60±0.02,3.72±0.02,4.14±0.02.Within the same age group, the acuities of the preterm infants was lower than those of the full-term infants (t=0.81,0.79,0.87,P＜0.05). Conclusion The grating acuities of the preterm infants are lower than those of full-term infants.Visual acuity of the preterm infant progressively increases with age and improves at a faster rate during 1 to 5 months after birth.There is no corr elation between visual acuity and gender.This study shows that the early measurement of visual acuity in preterm infants is necessary even if no retinopathy of premature is present.The COPL system is useful for assessing grating acuity in infants.