Elsevier

Medical Hypotheses

Volume 85, Issue 5, November 2015, Pages 565-567
Medical Hypotheses

Ultrasonographic demonstration of the superior ophthalmic vein in the orbit of premature infants with and without retinopathy of prematurity

https://doi.org/10.1016/j.mehy.2015.07.024Get rights and content

Abstract

Retinopathy of prematurity (ROP), which develops due to abnormal retinal vascularization in premature babies, can lead to irreversible vision loss. B-scan ocular ultrasonography is a noninvasive examination which makes it possible to image the eye and orbit. Our purpose was to echographically assess the orbit of premature babies with and without retinopathy of prematurity (ROP), with a focus on the superior ophthalmic vein (SOV) which is normally not detected by orbital ultrasound. A prospective study design was used after approved by the local institutional review board. ROP was diagnosed by routine ophthalmoscopic exam. Orbital ultrasound was performed by a single experienced ophthalmologist and ultra-sonographer who was masked to the routine ROP screening results. The results of the ophthalmoscopic exam were compared to the orbital ultrasound findings. The study group was divided into those diagnosed with ROP and those not diagnosed with ROP and were found to be comparable by age and weight at the time of the US examination. The SOV was dilated in 21 of 22 eyes (95.4%) with ROP and in only 5 of 32 eyes (15.6%) without ROP.

The present study suggests an association between ROP and dilatation of the SOV.

Introduction

Retinopathy of prematurity (ROP), which develops due to abnormal retinal vascularization in premature babies, can lead to irreversible vision loss. It is classified according to stage of the ROP (stages 1–5), the area (zone) of retina involved and the presence or absence of plus disease. The reported incidence of ROP are rising with the increasing survival of younger and smaller babies [1]. Shorter gestation and lower birth weight are significantly associated with the severity of the disease [2]. Although most cases completely resolve, some may progress to retinal detachment and blindness [3]. Screening for ROP is mandatory in order to diagnose threshold ROP and to treat before irreversible damage occurs. Indirect ophthalmoscopy is considered by many to be the gold-standard modality for ROP screening and diagnosis, with high sensitivity, specificity and accuracy [4].

B-scan ocular ultrasonography is a noninvasive examination which makes it possible to image the eye and orbit without the need for mydriatic drops or a lid speculum. It is used in newborns to evaluate the posterior segment when the view is limited by corneal opacity, cataract, vitreous hemorrhage, or a nondilating pupil. Previous studies reported intraocular ultrasonographic findings in ROP. They showed moderate to good correlation using 10-MHz B-scan and 20-MHz ultrasound with the ophthalmoscopic examination in infants with ROP [5], [6].

The purpose of the present study was to echographically assess the orbit of premature babies with and without ROP using B scan ultrasound, with a focus on the superior ophthalmic vein (SOV).

Section snippets

Patients and methods

A prospective study design was used. The study protocol was approved by the local institutional review board, and informed consent was obtained from the legal guardians of the study participants.

The study group consisted of 27 premature infants (gestational age ⩽35 weeks and/or birth weight ⩽1500 g) born at a tertiary medical center from January 2011 to February 2013. We included only infants who were medically able to undergo ultrasound scan of the orbit and routine ophthalmoscopy. All babies

Results

The study group consisted of 15 female and 12 male patients of mean gestational age 27.6 (±2.9) weeks and mean birth weight, 1007.7 (±369) g. There were 12 singleton infants and 15 pairs of twins. All examinations were performed bilaterally. At the time of ultrasound examination, mean postnatal age of the whole cohort was 8.5 (±3.7) weeks, and mean corrected gestational age, 35.9 (±3.2) weeks; mean weight was 1766.5 (±549.9) g. By routine ophthalmoscopic examination, 32 eyes were not diagnosed with

Discussion

In the present study, B-scan ultrasound examinations was performed in premature infants with and without ROP in order to determine the presence of SOV dilatation. It was found to be dilated in almost all babies diagnosed with ROP compared with a significantly lower percentage among babies who were not diagnosed with ROP. Thus the significant difference in SOV dilatation between the group diagnosed with ROP and the group not diagnosed with ROP can suggest an association between the two

Conflict of interest

None.

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