• Deborah K VanderVeen, David K Coats, Velma Dobson, Douglas Fredrick, Robert A Gordon, Robert J Hardy, Daniel E Neely, Earl A Palmer, Scott M Steidl, Betty Tung, William V Good, and Early Treatment for Retinopathy of Prematurity Cooperative Group.
• Department of Ophthalmology, Children's Hospital Boston, Harvard Medical School, Boston, Mass 02115, USA. deborah.vanderveen@childrens.harvard.edu
• Arch Ophthalmol Chic. 2006 Jun 1; 124 (6): 766-73.

ObjectiveTo present strabismus data for premature infants with prethreshold retinopathy of prematurity (ROP) enrolled in the Early Treatment for Retinopathy of Prematurity study.DesignThe prevalence of strabismus was tabulated for all of the infants with high-risk prethreshold disease who participated in the randomized trial of the Early Treatment for Retinopathy of Prematurity study and were examined at 6 and/or 9 months' corrected age as well as for all of the infants with low-risk prethreshold disease who were examined at 6 months' corrected age.Main Outcome MeasuresPresence or absence of strabismus at 6 and 9 months' corrected age.ResultsThe prevalence of strabismus at 6 months was higher for infants with high-risk prethreshold ROP than for those with low-risk prethreshold ROP (20.3% vs 9.6%, respectively; P<.001). Risk factors associated with the development of strabismus at 9 months include abnormal fixation behavior, presence of amblyopia, and outborn birth status (ie, born outside of a study-affiliated hospital). At 9 months, 30% of infants with high-risk prethreshold ROP had strabismus, although only 42% showed strabismus at 6 months. Thirty percent of infants with strabismus at 6 months showed normal alignment at 9 months.ConclusionsInfants with high-risk prethreshold ROP show significant variability in the presence vs absence of strabismus in the first year of life; thus, conservative management is recommended.Application To Clinical PracticeOphthalmologists managing strabismus in infants who have high-risk prethreshold ROP should be aware of the significant variability in ocular alignment during the first year of life.

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