Flying baby optical coherence tomography alters the staging and management of advanced retinopathy of prematurity

Abstract

Purpose To report the use of flying baby spectral domain optical coherence tomography (SD‐OCT) on infants with advanced retinopathy of prematurity (ROP), where clinical findings alone failed to differentiate between retinoschisis and retinal detachment. Methods Prospective, non‐interventional case‐series study of three premature infants with advanced ROP of clinically uncertain stage, after examination by indirect ophthalmoscopy. To confirm the diagnosis, table‐mounted SD‐OCT retinal imaging was performed with the infant held in the flying baby position under topical ocular anaesthesia only. Spectral domain optical coherence tomography (SD‐OCT) findings were correlated with clinical examination and ultra‐widefield scanning laser ophthalmoscopy to determine disease stage and appropriate management. Results The flying baby position was well tolerated, and SD‐OCT images of central and peripheral retina were successfully obtained in all three cases. Additional information provided by the SD‐OCT changed the ROP staging from 3 to 4 in one case, which subsequently required surgical treatment. In two other cases, clinical suspicion of stage 4 ROP was overruled as SD‐OCT revealed tractional retinoschisis rather than full‐thickness retinal detachment, thereby avoiding the need for immediate surgical intervention. Conclusions In this case‐series study, flying baby SD‐OCT provided a rapid and widely accessible imaging approach that overruled clinical findings and altered classification and management of infants with advanced ROP. The methodology was suitable for outpatient settings with no risks associated with systemic anaesthesia. The increased use of OCT imaging will make apparent how structural information is useful in management of ROP and may influence future classification of the disease.

Optical Coherence Tomography in Retinopathy of Prematurity

“…Likewise, the decision whether to intervene may be a great challenge. OCT has been shown the ability to assess the exact location of detachment, assess the degree of retinal elevation, estimate foveal involvement and distinguish retinal detachment from retinoschisis [10,[38][39][40]. Shallow retinal detachments that are not seen on indirect ophthalmoscopy also can be detected earlier on OCT imaging [41].…”

Optical Coherence Tomography and Optical Coherence Tomography Angiography in Pediatric Retinal Diseases

“…Their use in the pediatric age group has been limited due to issues with cooperation and positioning. Some pediatric retinal specialists have improvised and successfully imaged the pediatric fundus in the “flying baby position”, both for widefield color fundus imaging and OCT [ 6 , 7 ]. To achieve supine imaging, commercially available handheld portable OCT devices, such as Bioptigen (Bioptigen Inc., Research Triangle Park, NC, USA), and investigational armature-based portable systems, such as the Heidelberg Spectralis Flex module (Heidelberg Engineering, Heidelberg, Germany), were developed [ 2 ].…”

Commentary: The domain of optical coherence tomography in the spectrum of pediatric retinal disorders

“…Commercially available adaptations of the tabletop OCT such as the hand-held OCT (HH-OCT; Bioptigen; Leica Microsystems, Wetzlar, Germany/Morrisville, NC, USA), and the modified innovative techniques using the “flying baby position” made sure that we expanded its utility to pediatric retinal disorders as well. [ 1 2 ]…”

“…Cehajic-Kapetanovic et al . [ 2 ] extended the applications of OCT in premature babies by exhibiting its utility in decision making prior to surgical intervention; the child was held in the “flying baby position,” and the procedure was done under topical anesthesia. The decision for early surgical intervention could be taken and sight-threatening complications were prevented.…”