Elsevier

Ophthalmology

Volume 121, Issue 6, June 2014, Pages 1289-1296
Ophthalmology

Original article
Three-Dimensional Assessment of Vascular and Perivascular Characteristics in Subjects with Retinopathy of Prematurity

Preliminary data presented at: the American Association of Pediatric Ophthalmology and Strabismus, April 10–11, 2013, Boston, MA; and the Association for Research in Vision, May 5–9, 2013, Seattle, Washington.
https://doi.org/10.1016/j.ophtha.2013.12.004Get rights and content

Purpose

To study vascular features detected with spectral domain optical coherence tomography (SD-OCT) in subjects undergoing retinopathy of prematurity (ROP) screening.

Design

Cross-sectional study.

Participants and Controls

Fifty-seven premature neonates, 10 with plus disease in at least 1 eye and 47 without plus disease.

Methods

Bedside noncontact SD-OCT imaging was performed after obtaining parental consent on 97 consecutive infants between January 2009 and September 2012. Fifty-seven subjects (31–49 weeks' post-menstrual age) who had an SD-OCT scan in at least 1 eye showing the edge of the optic nerve and at least 1 major retinal vascular arcade were included. One eye per subject was randomly selected for analysis. Two masked graders evaluated scans for (1) retinal vessel elevation, (2) scalloped retinal layers, (3) hyporeflective vessels, and (4) retinal spaces. To coalesce the weight of these features, a Vascular Abnormality Score by OCT (VASO) was created. For quantitative assessment of vessel elevation, retinal surface maps were created.

Main Outcome Measures

Prevalence of SD-OCT vascular abnormalities, the VASO, intergrader agreement, and presence of elevation on surface maps.

Results

From among 67 SD-OCT characteristics that were recorded, the most common characteristics found were vessel elevation (44%), hyporeflective vessels (40%), scalloped layers (22%), and retinal spaces (11%). Features significantly associated with plus disease were vessel elevation (P = 0.01), hyporeflective vessels (P = 0.04), and scalloped retinal layers (P = 0.006). Intragrader agreement was between 74% and 90% for all features. The VASO was significantly higher in subjects with plus disease (P = 0.0013). On 3-dimensional SD-OCT volumes, eyes with plus disease had greater retinal surface elevation that more often matched en face retinal vascular patterns.

Conclusions

We present a novel 3-dimensional analysis of vascular and perivascular abnormalities identified in SD-OCT images of eyes with ROP. The SD-OCT characteristics that are more common in eyes with plus disease provide the first in vivo demonstration of the effects of vascular dilation and tortuosity on perivascular tissue. The VASO and surface maps also delineate the severity of vascular pathology in plus disease. Further studies evaluating these findings in eyes with pre-plus versus normal posterior pole vessels may determine the usefulness of SD-OCT in the early detection of vascular abnormalities in ROP.

Section snippets

Methods

Between January 2009 and September 2012, 96 prematurely born neonates undergoing conventional ROP screening were imaged by SD-OCT after institutional review board–approved consent was obtained from parents or legal guardians. Subjects underwent SD-OCT imaging immediately after scheduled ophthalmoscopic examination for ROP screening. Spectral domain OCT was performed using a portable handheld SD-OCT system (Bioptigen Inc., Durham, NC) in the nonsedated neonate following an age-specific imaging

Baseline Characteristics of Study Participants

The mean gestational age for the study participants was 26±2.1 weeks, and the mean birth weight was 872 ± 267 g (Table 2, available at www.aaojournal.org). The mean age at imaging (for the scans included in the study) was 37 ± 4.4 weeks. The percentages of female and male subjects and Caucasians and African-Americans were equal. Sex, race, and birth weight were similar in both cases and controls (P > 0.05). The plus group had an expected lower gestational age when compared with the controls (

Discussion

This is the first SD-OCT study specifically investigating the retinal vasculature characteristics in prematurely born subjects undergoing ROP screening (PubMed search for terms retinopathy of prematurity, plus disease, and optical coherence tomography from 1981 to date). In this study, we present unique information of vascular changes occurring in neonates with ROP that cannot be appreciated with any other imaging modality. This information can help us to understand the characteristics of

Acknowledgments

The authors thank Dr. Joseph Izatt and Dr. Hansford Hendargo for insightful comments on the interpretation of vascular blood flow on OCT.

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Supplementary material available at www.aaojournal.org

Financial Disclosure(s): The author(s) have made the following disclosure(s): C.A.T. receives Bioptigen and Genentech research support through Duke University and royalties from Alcon for surgical technologies.

This research was made possible by the following grants: The Hartwell Foundation; The Andrew Family Foundation; Grant Number 1UL1 RR024128-01 from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources or the NIH.

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