|Year : 1972 | Volume
| Issue : 1 | Page : 11-15
The eye of the premature baby
Department of Ophthalmology, Lady Hardinge Medical College and Hospital, New Delhi-1, India
Department of Ophthalmology, Lady Hardinge Medical College and Hospital, New Delhi-1
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mathew M. The eye of the premature baby. Indian J Ophthalmol 1972;20:11-5
Very few have described ocular changes in premature infants. The reports are mostly on retrolental fibroplasia and myopia.
The persistence of pupillary membrane was taken as a sign of prematurity, (Gans  Leader  ). Pupillary remnants were first described by Weber  . The early authors did not think it occured frequently as Mooren  reported only 14 cases in 100,000 eyes examined.
Three types of persistent pupillary membrane are described by Duke-Elder  according to whether the remnants are adherent to (1) the cornea, (2) iris or (3) the lens.
If persistent membranes retain contact with iris, they are always attached at the lesser circle. collarette, or sometimes to the ciliary region.
Persistence of hyaloid vessels was studied by Brown  and Roper Hall  . Brown  stated that the entire length of hyaloid artery was visible in 28 weeks old infant, while remnants could be seen only posteriorly at 32 weeks. Roper Hall  found hyaloid remnants in ten out of eleven babies weighing between 2 and 3 lb. at birth; and in 58 per cent of 55 cases weighing between 3 and 4 lb. and in 36.5 per cent weighing between 4 and 5 lb. Forrester  rarely failed to see remnants in babies of less than 3 lb. weight, but found them uncommon in larger infants.
Three types of persistent hyaloid arteries may be seen, Duke Elder  .
1. The entire artery may persist from the optic disc to the lens.
2. The anterior end of the artery may persist attached to the posterior surface of lens.
3. The posterior end of the artery may persist atttached to the optic disc.
Szewizyk  examined permature babies' fundus in detail and found increased yellow tone of the fundus with yellowish white or yellowish grey periphery. He called it pale fundus and found it in 67% of the cases. He also observed attenuation of the blood vessels in 47% of cases and urged to take these signs as signs of prematurity.
Hosaka  examined the funds of premature babies and found the colour of the fundus to be of lighter hue than that of adults. There was increase in the pallor of the optic disc in premature babies and attenuation of the vessels.
The present study was undertaken to find out the above signs and their significance in premature Indian babies.
| Methods and Material|| |
100 premature babies born in Lady Hardinge Medical College and Hospital were examined. There were 37 males and 63 females in the series and their birth weight was taken as the guide to prematurity. [Table - 1]. All eyes were examined within 24 hours of the delivery. Pupils were dilated with 1% homatropine about one hour before examination. They were examined (1) for the presence of pupillary membrane, (2) persistence of hyaloid system and (3) appearance of the fundus. No difficulty was experienced in viewing the fundus after swathing the child's body tightly in a sheet, with extended arms.
| Results|| |
I Persistence of pupillary membrane :
85 cases (85%) presented pupillary membrane [Table - 2] In 55 cases it was unilateral and in 30 cases bilateral The membrane varied from a tag to fine fibrillary type of network across the pupil. The network was marked in babies having birth weight less than 1,335 gm. Only one or two tags were found in those cases weighing above 1,815 gms.
II. Persistent hyaloid artery
In 93 cases (93%) a definite remnant was seen in one or both eyes. Persistence of the entire hyaloid was seen in one case only and persistence of the anterior remnant in 10 cases [Table - 4].
Persistence of the posterior remnnat were further analysed according to the description given by Jones  [Table - 5]. The two main types of anterior remnants seen, were of filament and filament with broad base.
All these signs are seen more in babies having lower birth weight, out of the 10 cases weighing below 910 gms, 9 had pale or very pale optic disc, and yellowish grey or grey fundus in all.
| Discussion|| |
The present study proves that persistent pupillary membrane and persistent hyaloid artery are common in premature infants. Persistent pupillary membrane was seen in 56 out of 58 cases weighing below 1,785 gm. All the 48 cases between 910- 1,785 gm showed persistent pupillary membrane. Though only 85% of cases showed the persistent pupillary membrane, all infants (100%) in the weight group 910 gin - 1,785 gm showed this anomaly.
As Forrester , and Jones  noted the rarity of complete hyaloid vessel in their study, this series also showed only one case of complete hyaloid vessel; and that too only in one eye. However in majority, 93 cases (93%) hyaloid remnant was visible. The anterior and posterior remnants were studied and they were more common in babies, having low birth weight. These two findings should therefore be taken as the findings of premature babies.
Of the fundus examination findings, the pallor of the disc, yellowish grey or grey colour of the general fundus along with attenuation of the vessels should also be taken as signs of prematurity. These were commonly seen in babies with birth weight less than 1,785 gms. Of 58 cases weighing below 1,785 gm, 82.7% showed very pale or pale disc and 63.7% showed attenuation of vessels. 74% showed grey or yellowish grey fundus Myopia as a sign of prematurity was already reported by Mathew and Sawney  .
Szewizyk  and Hosaka  also pointed out these findings and they emphasised that these signs should be taken as signs of prematurity.
| Summary|| |
100 premature babies were studied for the presence of persistent tent pupillary membrane, persistent hyaloid artery, appearance of general fundus.
- 85% showed persistent pupillary membrane, varying from a delicate network to one or two strands across the pupil.
- 93% of cases showed persistent hyaloid artery. 82% were posterior remnant, 10% anterior remnant and 1 % entire artery.
- 60% of the premature babies showed pallor of disc 58% attenuation of blood vessels, and 65% yellowish grey or grey fundus.
- All these signs were predominantly seen in cases of lesser birth weight.
| Acknowledgement|| |
I am grateful to Dr. P. Madan, Professor of Obstitrics & Gynaecology for permitting study of the Premature new born babies, of Lady Hardinge Medical College and Hospital.
| References|| |
Brown C.A. : Prematurity by B. Corner. pp 461. et Seq Cassell. London (1960).
Duke Elder, S.: System of Ophthalmology Vol. III. P. 11, Pp 777, Henry Kimpton (1964)
Forrester, R. M.: Brit. Med. J., 2307 (1960).
Gans. B.: Arch. Disc. Child - 34:292 (1959).
Hosaka, A.: Jap. J. Ophth. 7.77, (1963).
Jones, H. E.: Brit. J. Ophthal 47:39, (1963).
Leader : Brit. Med. J. 2.45, (1960).
Mathew. M. Sawney B. K.:
Orient arch. Ophthal: 8:65 (1960).
Mooren: Ophthalmiatrische Beobachtungen Berlin 122, (1867) quoted from (2).
Roper Hall, M. J.: Brit. Med. J. 2:231. (1960)
Sessiger, J.: Arch Augenheilk; 100: 302. (1953).
Szewizyk, T. S.: Am. J. Ophth. 36: 1336, (1953)
Weber: U. Grafes Arch. Ophthal 8. (1) 337, (1861) quoted from (2)
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]