Aims:To determine the refractive status and ocular dimensions of a cohort of children at age 10-12 years with birth weight below 1701 g,and also the relation between the neonatal ophthalmic findings and subsequent ref...Aims:To determine the refractive status and ocular dimensions of a cohort of children at age 10-12 years with birth weight below 1701 g,and also the relation between the neonatal ophthalmic findings and subsequent refractive state.Methods:293 low birth weight children who had been examined in the neonatal period were assessed at 10-12 years of age.The examination consisted of autorefraction,keratometry,and A-scan.Results of right eyes were compared with published normative data.Results:293 of the birth cohort of 572 children consented to participate.The average mean spherical equivalent(MSE)in the low birth weight cohort was+ 0.691 dioptre,significantly higher than the control data(+ 0.30D,p=0.02).The average change in MSE over the 10-12 year period was-1.00 dioptre(n=256),but only 62.1% of cases showed a shift in refractive error of the appropriate magnitude and direction.The presence of any retinopathy of prematurity(ROP)increases the risk of developing anisometropia sixfold.Conclusions:Low birth weight and ROP both significantly impact the refractive state in the long term.At age 10-12 years children born preterm have an increased prevalence of all refractive errors.In low birth weight children refractive state is relatively stable over the first decade of life with a shift towards myopia of 1 dioptre.展开更多
Background: The relative risks and benefits of starting or withholding antiep ileptic drug treatment in patients with few or infrequent seizures are unclear. We sought to compare policies of immediate versus deferred ...Background: The relative risks and benefits of starting or withholding antiep ileptic drug treatment in patients with few or infrequent seizures are unclear. We sought to compare policies of immediate versus deferred treatment in such pat ients and to assess the effects of these policies on short- term recurrence and long- term outcomes. Methods: We undertook an unmasked, multicentre, randomise d study of immediate and deferred antiepileptic drug treatment in 1847 patients with single seizures and early epilepsy. Outcomes comprised time to first, secon d, and fifth seizures; time to 2- year remission; no seizures between years 1 a nd 3 and between years 3 and 5 after randomisation; and quality of life. Analysi s was by intention to treat. Findings: 404 patients invited to join the trial di d not consent to randomisation; 722 were subsequently assigned immediate treatme nt with antiepileptic drugs and 721 were assigned deferred treatment. Immediate treatment increased time to first seizure (hazard ratio 1.4 [95% CI 1.2 to 1.7 ]), second seizure (1.3 [1.1 to 1.6]), and first tonic- clonic seizure (1.5 [1. 2 to 1.8]). It also reduced the time to achieve 2- year remission of seizures ( p=0.023). At 5- years follow- up, 76% of patients in the immediate treatment group and 77% of those in the deferred treatment group were seizure free betw een 3 and 5 years after randomisation (difference - 0.2% [95% CI - 5.8% to 5.5% ]). The two policies did not differ with respect to quality of life out comes or serious complications. Interpretation: Immediate antiepileptic drug tre atment reduces the occurrence of seizures in the next 1- 2 years, but does not affect long- term remission in individuals with single or infrequent seizures.展开更多
文摘Aims:To determine the refractive status and ocular dimensions of a cohort of children at age 10-12 years with birth weight below 1701 g,and also the relation between the neonatal ophthalmic findings and subsequent refractive state.Methods:293 low birth weight children who had been examined in the neonatal period were assessed at 10-12 years of age.The examination consisted of autorefraction,keratometry,and A-scan.Results of right eyes were compared with published normative data.Results:293 of the birth cohort of 572 children consented to participate.The average mean spherical equivalent(MSE)in the low birth weight cohort was+ 0.691 dioptre,significantly higher than the control data(+ 0.30D,p=0.02).The average change in MSE over the 10-12 year period was-1.00 dioptre(n=256),but only 62.1% of cases showed a shift in refractive error of the appropriate magnitude and direction.The presence of any retinopathy of prematurity(ROP)increases the risk of developing anisometropia sixfold.Conclusions:Low birth weight and ROP both significantly impact the refractive state in the long term.At age 10-12 years children born preterm have an increased prevalence of all refractive errors.In low birth weight children refractive state is relatively stable over the first decade of life with a shift towards myopia of 1 dioptre.
文摘Background: The relative risks and benefits of starting or withholding antiep ileptic drug treatment in patients with few or infrequent seizures are unclear. We sought to compare policies of immediate versus deferred treatment in such pat ients and to assess the effects of these policies on short- term recurrence and long- term outcomes. Methods: We undertook an unmasked, multicentre, randomise d study of immediate and deferred antiepileptic drug treatment in 1847 patients with single seizures and early epilepsy. Outcomes comprised time to first, secon d, and fifth seizures; time to 2- year remission; no seizures between years 1 a nd 3 and between years 3 and 5 after randomisation; and quality of life. Analysi s was by intention to treat. Findings: 404 patients invited to join the trial di d not consent to randomisation; 722 were subsequently assigned immediate treatme nt with antiepileptic drugs and 721 were assigned deferred treatment. Immediate treatment increased time to first seizure (hazard ratio 1.4 [95% CI 1.2 to 1.7 ]), second seizure (1.3 [1.1 to 1.6]), and first tonic- clonic seizure (1.5 [1. 2 to 1.8]). It also reduced the time to achieve 2- year remission of seizures ( p=0.023). At 5- years follow- up, 76% of patients in the immediate treatment group and 77% of those in the deferred treatment group were seizure free betw een 3 and 5 years after randomisation (difference - 0.2% [95% CI - 5.8% to 5.5% ]). The two policies did not differ with respect to quality of life out comes or serious complications. Interpretation: Immediate antiepileptic drug tre atment reduces the occurrence of seizures in the next 1- 2 years, but does not affect long- term remission in individuals with single or infrequent seizures.
