Early angiographic signs of retinopathy of prematurity requiring treatment

Abstract

Background/objectives: Fluorescein angiography (FA) has been a pivotal tool to study the pathophysiology of retinopathy of prematurity (ROP) in vivo. We examined the course of ROP using FA in order to assess the predictive value of angiographic features.

Subjects/methods: This is an observational retrospective cohort multi-center study of eyes screened for ROP with binocular indirect ophthalmoscope and with FA. All infants undergoing screening examination for ROP who had retinal vasculature limited to Zone I and posterior Zone II vascularization underwent FA between 31 and 34 weeks postmenstrual age. RetCam fundus imaging and video digital fluorescein angiography were performed in the neonatal intensive care units. Masked grading of the FA images was retrospectively conducted by two ROP expert ophthalmologists. Ten criteria that describe retinovascular and choroidal features on FA were used to assess their predictive value for development of treatment-requiring ROP.

Results: A total of 98 eyes of 56 patients were included for this study. FAs of eyes of premature infants show a wide range of features either at the junction between the vascular and avascular retina and posteriorly to that. Among the angiographic features evaluated, leakage, shunts and hyperfluorescent lesions at the junction between vascular and avascular zone were predictive of the development of treatment-requiring ROP (p < 0.05), but findings in the posterior vascularized retina were not.

Conclusions: FA can add to our understanding of the evolution of vascular abnormalities in the course of ROP and can help predict which eyes will go on to treatment.

Fig. 1. FA abnormalities within the vascularized retina.

a Absence of foveal avascular zone, b Presence of foveal avascular zone, c Linear pattern of the choroidal vascular circulation, d Lobular pattern of the choroidal vascular circulation, e Hypofluorescent area surrounded by hyperfluorescence, f Hypofluorescent area without surrounding hyperfluorescence.

Fig. 2. FA abnormalities at the junction between vascular and avascular retina.

a Finger-like vascular branching pattern, b Naked arteriovenous shunt, c Capillary tangles, d Hyperfluorescent lesions, e Perivascular dye leakage, f capillary obliteration.