Vitreous Findings by Handheld Spectral-Domain OCT Correlate with Retinopathy of Prematurity Severity

Abstract

Objective: To evaluate the association between retinopathy of prematurity and vitreous findings in premature infants detected by handheld spectral-domain optical coherence tomography.Design: Prospective, observational cohort study.Participants: Consecutive sample of 92 premature infants requiring retinopathy of prematurity screening at two academic neonatal intensive care units, between July 2015 and March 2018. Methods:Infants underwent handheld spectral domain optical coherence tomography at the time of routine retinopathy of prematurity examinations. Two masked, trained graders analyzed right eye vitreoretinal findings including semi-automated quantification of punctate hyperreflective vitreous opacities within 5 foveal/parafoveal B-scans (Vitreous Opacity Ratio). Main Outcome Measures:Excluding post-treatment data, vitreous findings were compared to clinical retinopathy of prematurity diagnoses.Results: Agreement between image graders for all vitreoretinal findings was 91% (kappa=0.86 [95% confidence interval, 0.82-0.90], P<0.001). Among 92 infants undergoing 280 imaging sessions (52% male, mean gestational age 28.3±2.8 weeks, mean birthweight 1014.5±285.0 grams), 36/92 (39%) developed retinopathy of prematurity. Punctate hyperreflective vitreous opacities were identified in 61/92 (66%) infants. The presence of punctate hyperreflective vitreous opacities at least once was associated with a diagnosis of retinopathy of prematurity (62% vs. 29% without opacities, P=0.003), maximum retinopathy of prematurity stage (P=0.001), pre-plus or plus disease (24% vs. 5%, P=0.005), and type 1 disease (14% vs. 2%, P=0.03).

Choroidal Thickness by Handheld Swept-Source Optical Coherence Tomography in Term Newborns

“…[10][11][12] Vessel elevation, scalloped retinal layers, hyporeflective vessels, and retinal spaces were first described as markers of plus disease for infants with ROP 13 and may serve as general indicators of OCT retinal vascular characteristics. Punctate hyperreflective vitreous opacities 14 have also been associated with ROP in preterm infants and may relate to normal ocular development in full-term infants. 15 Structural abnormalities, including epiretinal membrane (ERM) 11 and cystoid macular edema (CME), 11 have been associated with both tractional and non-tractional vitreous bands in premature infants, 14,16 with unknown impact on choroidal thickness.…”

Quantitative Handheld Swept-Source Optical Coherence Tomography Angiography in Awake Preterm and Full-Term Infants

“…53 c Ratio of the length of the curve of a large-vessel segment over the distance between two ends of the curve. 54 OCT structural findings associated with ROP severity that have already been identified, 8,12 OCTA objective quantitative parameters should be explored to identify additional potential ROP severity biomarkers. Noncontact handheld SS-OCTA may therefore serve as a potential ROP screening tool.…”

“… 59 , 60 Both BIO and wide-field retinal photography are uncomfortable procedures involving an eyelid speculum and ocular contact, with high interobserver disagreement. 61 – 65 Along with several OCT structural findings associated with ROP severity that have already been identified, 8 , 12 OCTA objective quantitative parameters should be explored to identify additional potential ROP severity biomarkers. Noncontact handheld SS-OCTA may therefore serve as a potential ROP screening tool.…”

“…6,7 Subclinical morphologic findings in the retina and vitreous, such as punctate hyperreflective vitreous opacities, vitreous bands, preretinal tissue, epiretinal membrane, cystoid macular edema, retinoschisis, retinal detachment, and cross-sectional retinal vascular changes associated with plus disease, have been visualized using handheld OCT at the time of ROP screening. [8][9][10][11][12][13] To visualize the retinal vasculature, indirect ophthalmoscopy, retinal fundus photography, and fluorescein angiography are traditionally employed. However, these methods are variably limited by lack of microvascular detail, lack of objective measurements, and necessity for venous injection of fluorescein dye.…”

“… 6 , 7 Subclinical morphologic findings in the retina and vitreous, such as punctate hyperreflective vitreous opacities, vitreous bands, preretinal tissue, epiretinal membrane, cystoid macular edema, retinoschisis, retinal detachment, and cross-sectional retinal vascular changes associated with plus disease, have been visualized using handheld OCT at the time of ROP screening. 8 – 13 …”