Objective: To explore the incidence and age distribution of fundus abnormalities in pediatric patients aged 0-3 years in northwest China. Methods: A retrospective study of the clinical data of 8808 pediatric patients aged 0-3 years who underwent fundus examination with a wide-filed digital retinal imaging system and an indirect ophthalmoscope in our hospital from January 2008 to December 2019 were performed. There were 5092 males and 3716 females, with a median age of 1 month (range, 3 days to 3 years), a mean gestational age of 34.32 (SD 2.92) weeks (range, 24 to 42 weeks) and a mean birth weight of 2006.92 (SD 709.23) g (range, 490 to 5500 g), from Shaanxi Province (7415 cases, 84.18%), Gansu Province (770 cases, 8.74%), Ningxia Hui Autonomous Region (94 cases, 1.07%), Qinghai Province (53 cases, 0.60%), Xinjiang Uygur Autonomous Region (14 cases, 0.16%) and other neighboring areas (462 cases, 5.25%). The fundus condition of the enrolled pediatric patients was documented to calculate the annual detection rate. The joinpoint regression model was drawn to estimate the annual percent change and average annual percent change. The constituent ratios and age distribution of different types of fundus abnormalities were finally analyzed. Results: Fundus abnormalities were detected in 2 531 cases (28.74%). During the 12 years, the number of pediatric patients undergoing fundus examination each year in our center increased rapidly in the first 7 years, and then kept almost stable, while the number of fundus abnormality cases increased year by year. The positive detection rate showed an overall upward trend with an average annual percent change of +7.2%, and it was +30.09% from 2016 to 2019. Among all the pediatric patients with fundus abnormalities, there were 1 678 cases with developmental diseases (66.30%), 232 cases with hereditary diseases (9.16%), 140 cases with ocular tumor (5.53%), 64 cases with ophthalmic manifestations of systemic diseases (2.53%), 31 cases with ocular trauma (1.23%), 12 cases with infectious diseases or inflammation (0.48%) and 438 cases with other ocular abnormalities (17.31%). The top 5 abnormalities were retinopathy of prematurity (ROP; 1477 cases, 58.36%), gray patchy retinopathy (225 cases, 8.89%), retinal hemorrhage (157 cases, 6.20%), retinoblastoma (137 cases, 5.41%) and familial exudative vitreoretinopathy (77 cases, 3.04%). Fundus abnormalities varied with age. ROP, developmental diseases other than ROP, hereditary diseases, ocular trauma and infectious diseases were mostly detected in pediatric patients at 0-6 months old, while tumors were mostly detected after 1 year old. Conclusions: The detection rate of fundus abnormalities in the Department of Ophthalmology of Xijing Hospital of Air Force Medical University, a tertiary referral center in northwest China, increased notably year by year. The abnormalities were mainly developmental and hereditary lesions as well as of certain age distribution. They occurred with the highest frequency between birth and 6 months of age, in which ROP was in the ascendancy. Meanwhile, the detection rate of other developmental, hereditary and neoplastic disorders increased with age. Therefore, a comprehensive and objective understanding of the fundus disease in infants is essential. (Chin J Ophthalmol, 2021, 57: 777-783).
目的： 探讨我国西北地区婴幼儿眼底各类眼底疾病的发病情况及年龄分布特征。 方法： 回顾性系列病例研究。对2008年1月至2019年12月于空军军医大学西京医院眼科进行眼底检查且资料完整的8 808例0~3岁婴幼儿的病例资料进行回顾性分析。其中男性5 092例，女性3 716例；初次就诊中位年龄1个月（3 d至3岁），出生孕周（34.32±2.92）周（24~42周）；出生体重（2 006.92±709.23）g（490~5 500 g）。受检婴幼儿来源地区为陕西省7 415例（84.18%），甘肃省770例（8.74%），宁夏回族自治区94例（1.07%），青海省53例（0.60%），新疆维吾尔自治区14例（0.16%），其他邻近地区462例（5.25%）。记录眼底疾病发生情况，比较不同年度检出率，采用Joinpoint回归模型分析年度变化百分比（APC）和平均年度变化百分比（AAPC）并检验变化趋势；分析不同类型眼底疾病的检出情况及构成比；将新生儿按初次就诊时年龄分为4组，比较不同年龄段中各类型眼底疾病的检出情况。 结果： 8 808例婴幼儿中，共有2 531例（28.74%）检出各类眼底疾病。12年中年检查总例数呈现快速升高后轻度波动的趋势，眼底疾病阳性检出率总体呈上升趋势，AAPC为+7.2%，尤其2016至2019年阳性检出率的年度增长率高达+30.09%。在所有眼底疾病中，发育性疾病1 678例（占66.3%），遗传性疾病232例（占9.16%），肿瘤类疾病140例（占5.53%），外伤性疾病31例（占1.23%），感染或炎性反应性疾病12例（占0.48%），其他异常438例（占17.31%）。前5位的眼底疾病依次为早产儿视网膜病变（ROP）1 477例（占58.36%）、灰白色点片状病变225例（占8.89%）、视网膜出血157例（占6.20%）、视网膜母细胞瘤137例（占5.41%）和家族性渗出性玻璃体视网膜病变77例（占3.04%）。不同眼底疾病的年龄分布也有所不同，ROP、非ROP的发育性疾病、遗传性疾病、外伤性疾病以及感染或炎性反应性疾病的患儿初次检出年龄均以0~6月龄最多；而肿瘤患儿的初次检出年龄主要是1岁以后。 结论： 空军军医大学西京医院眼科作为西北地区三级防治网中的三级单位，婴幼儿眼底疾病的检出率逐年增加；检出的眼底疾病主要以发育性和遗传性病变为主，且具有一定的年龄分布规律，即0~6月龄是各类型眼底疾病的高峰期，其中以ROP为首；而后随着就诊年龄的增长，非ROP的其他发育性、遗传性疾病和肿瘤的检出率则呈增高趋势。（中华眼科杂志，2021，57：777-783）.