Subclinical macular findings in infants screened for retinopathy of prematurity with spectral-domain optical coherence tomography

Abstract

Objective: To evaluate subclinical macular findings in premature patients at risk of retinopathy of prematurity (ROP) with the use of handheld spectral-domain optical coherence tomography (SD-OCT).

Design: Prospective, observational case series.

Participants: Forty-nine prematurely born neonates.

Methods: Forty-nine infants were imaged using a handheld SD-OCT. Images were acquired in nonsedated infants in the neonatal intensive care unit (NICU). Some patients were followed and reimaged over the course of several weeks. A total of 300 total images were acquired and evaluated for cystoid macular edema (CME) and persistence of inner retinal layers.

Main outcome measures: In vivo determination of foveal retinal lamination, image analysis, and clinical observation.

Results: A total of 241 (80%) of the images from 46 patients were usable (defined as having scans passing through the fovea with clearly identifiable retinal layers). Persistence of 1 or more inner retinal layers was seen in 43 of the patients with usable images (93%). Of the patients with at least 1 persistent layer, 17, 4, 8, 12, and 1, had a maximum ROP stage of 0, 1, 2, 3, and 4A, respectively. Cystoid macular edema was seen in 25 of the 46 patients (54%) during 1 or more imaging sessions. Cystoid macular edema was present in 9, 1, 5, 9, and 1 patient with maximum ROP stage of 0, 1, 2, 3, and 4A, respectively.

Conclusions: Our data suggest there is persistence of inner retinal layers in premature infants regardless of maximal ROP stage. Subclinical CME is seen in premature infants; however, CME does not appear to be correlated with ROP stage. This suggests that there may be other causes for the CME seen in this patient population. Hand-held SD-OCT imaging is a viable technique for evaluating subclinical macular findings in premature infants, although larger datasets are needed from multiple centers to further evaluate the generalizability of these findings.

Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Figure 1

Repeatability of imaging in infants. Images from two different time points in patient DC_0840 (A–D), DC_0845 (B–E), and DC_0874 (C–F) demonstrate the ability to image the same retinal area during follow up. Retinal and choroidal vasculatures serve as landmarks to determine corresponding retinal locations.

Figure 2

Persistence of inner retinal layers at the foveal center. Some individuals exhibited complete excavation with no residual retinal layers present (A). Three patients had only the inner plexiform layer (1 layer) present (inner nuclear and ganglion cell and nerve fiber layers are absent) (B), while other subjects also had the inner plexiform and nuclear layer (2 layers) (C). Less developed retinas had residual ganglion cell, inner nuclear and inner plexiform layers (3 layers) (D). One subject had residual nerve fiber layer (additionally ganglion cell, inner nuclear and plexiform layers) over the macula (E).

Figure 3

Variability in cystoid macular edema (CME). Shown here are examples of optical coherence tomography (OCT) images with no CME (A), one single cyst at the fovea (B), a few parafoveal cysts (C), multiple cysts at the fovea with preserved foveal pit (D), and multiple cysts at the fovea with loss of foveal depression (E).

Figure 4

Cystoid macular edema (CME) in patients treated with bevacizumab. Shown here is imaging from a patient who had no CME on imaging prior to receiving bevacizumab (A). The patient received bevacizumab at 33 6/7 weeks postmenstrual age (PMA) and then developed CME by 34 6/7 weeks PMA (B).

Figure 5

Resolution of cystoid macular edema (CME) Three patients with CME had resolution of edema during the follow up period. Shown here is imaging from the right eye of patient DC_0450. CME was present on imaging at 35 2/7 weeks (wks) postmenstrual age (PMA) (A) but had resolved by 49 6/7weeks PMA (B).