Morphology and Vessel Density of the Macula in Preterm Children Using Optical Coherence Tomography Angiography

Abstract

Background: Retinal morphology changes may be associated with prematurity and can lead to visual impairment. Optical coherence tomography angiography may contribute to understanding the pathomechanism of structural and vascular retinal impairment in premature children. The aim of this study was to assess an influence of prematurity, neonatal clinical characteristics, and a history of retinopathy of prematurity (ROP) on the morphology and retinal vascularity of macula in children. Methods: A case–control study of 123 preterm children and 86 full-term children was performed. The age of the subjects was 10.45 years (IQR: 8.12–12.77), while the age of the control group was 11.78 years (IQR: 8.81–13.79). Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA, angio-OCT) were performed using RTVueXR Avanti (Optovue, Fremont, CA, USA). Ganglion cell complex (GCC), foveal thickness (FT), parafoveal thickness (PFT), size of foveal avascular zone (FAZ) in superficial plexus, superficial capillary vessel density (sVD), deep capillary vessel density (dVD), central choroidal thickness (CCT), and presence of macular hypoplasia were analyzed. The association between OCT/angio-OCT results and clinical characteristics including the degree of ROP and therapy requirements was assessed in preterm infants. Results: Foveal morphology was affected in preterm children with high incidence of foveal hypoplasia (24.77%). GCC was thinner in preterm children compared to controls: avgGG 93 μm vs. 100 μm, p < 0.001. No associations between GCC and gestational age (R = −0.085; p = 0.228) and birth weight (R = −0.054; p = 0.446) were found. FAZ in preterm group was smaller than in controls (0.13 ± 0.09 vs. 0.22 ± 0.09; p < 0.001). FAZ area correlated with gestational age (R = 0.456; p < 0.001) and birth weight (R = 0.472; p < 0.001). Deep vessel density in the fovea was higher in preterm children than in control group (p < 0.001). PFT was significantly lower in preterm children compared to control group. However, increased thickness in the fovea was noted in preterm children (p < 0.001). FT was inversely correlated with gestational age (R = −0.562; p < 0.001) and birth weight (R = −0.508, p < 0.001). CCT was lower in preterm children (312 μm vs. 337.5 μm, p < 0.001) Parameters of GCC and FT were higher in patients with ROP required treatment compared to patients without ROP and spontaneously regressed retinopathy. FAZ was smaller in patients with retinopathy than in preterm children without ROP. Conclusion: Prematurity has a significant negative impact on GCC, macular morphology, and vascularization. In premature children, decreased FAZ, increased FT, and vessel density were strongly associated with gestational age, birth weight, Apgar score, ROP stage, and treatment requirement. Optical coherence tomography angiography is a useful tool for detecting retinal changes in premature children.

Vascular imaging findings in retinopathy of prematurity

“…They also found the ROP group requiring treatment displayed significantly decreased whole VD and parafoveal VD in the SCP, and significantly increased foveal VD in the SCP in comparison to preterm infants without ROP. The ROP group not requiring treatment only displayed significantly increased foveal VD in the DCP versus preterm infants without ROP (Czeszyk et al., 2022). Contrarily, Lavric et al.…”

“…Vascular changes, as measured by OCTA, have also been investigated between ROP infants and preterm infants. Two studies have found that FAZ area was significantly smaller in ROP patients compared to preterm children (Czeszyk et al, 2022;Mataftsi et al, 2021). The study by Mataftsi et al further found that foveal VD in both the SCP and DCP was significantly higher in spontaneously regressed ROP patients in comparison to preterm patients (Mataftsi et al, 2021).…”

Ganglion cell complex thickness with spectral domain optical coherence tomography and correlations in a normative pediatric South Asian cohort

“…Evaluation of healthy children also differentiates their retinal structure from preterm children's retinas and several studies on the latter have come forward where a thinned GCC has been linked to prematurity and may be associated with their visual impairment (Czeszyk et al, 2022; Lee, Chang, et al, 2018; Ortueta‐Olartecoechea et al, 2021). However, the GCC is thicker in children with retinopathy of prematurity as noted in one study, and needs careful assessment and monitoring for glaucoma development in these children (Lee, Chang, et al, 2018).…”

Automated diagnosis of plus disease in retinopathy of prematurity using quantification of vessels characteristics

“…Since ROP is a proliferative retinal vascular disease and Plus disease is characterized by vascular tortuosity and dilation, it is hypothesized that the vessel density in Plus disease is greater than that of a healthy retina. The density of retinal vessels has been extensively discussed in the academic literature as a potential indicator of ROP 32 – 36 , particularly in relation to Plus disease 35 . Therefore, in our study, we investigated the density of vessels as a potential indicator of Plus disease, in addition to evaluating tortuosity and dilation.…”