Angiographic Review of Choroidal Involution in Eyes with Retinopathy of Prematurity Treated with Bevacizumab

Abstract

Purpose: Retinopathy of prematurity (ROP) is considered a disease of the inner retina; however, there is increasing evidence that demonstrates choroidal vasculature loss in ROP, leading to degeneration of outer retinal function and visual deterioration. Central choroidal thinning is noted in children with history of ROP using optical coherence tomography (OCT) imaging. This study characterizes the presence and persistence of choroidal loss angiographically in eyes of infants treated with intravitreal bevacizumab (IVB) for stage 3 ROP. Methods: Retrospectively reviewed the fluorescein angiography (FA) images of 62 eyes of 31 infants treated with IVB monotherapy. The eyes with good quality early-, mid-, and late-phase imaging were included in this study. The presence of choroidal hypofluoresence involving the central and or peripheral retina were noted. In infants with multiple FAs, serial FAs were analyzed for persistence of choroidal hypofluorescence. Results: The mean age and birth weight of infants was 24.4 weeks PMA and 683 grams, respectively. All infants received IVB monotherapy. 24 of 62 angiography images of sufficient quality reviewed showed the presence of choroidal hypofluorescence involving central and peripheral lobular loss in the early phase and its persistence into mid and late phases. 12 eyes demonstrated persistent choroidal loss on sequential FA until three years chronological age. Conclusions: The study demonstrates the presence of choroidal vascular loss angiographically both central and peripheral fundus in infants with ROP. It highlights the critical role of choroidal involution in outer retinal function that could affect visual outcomes.

Choroidal Measurements in Decision Making for Retinopathy of Prematurity: A Decision Tree Analysis

“…al., the presence of choroidal hypo uorescence in the central and or peripheral retina of ROP patients was demonstrated(19).Consistent with previous studies, we found that choroidal involution is associated with the presence of pre-plus/plus, not with the ROP stage.According to our data, the choroidal vascularity index (CVI) and choroidal stromal index (CSI) weren't signi cantly different in the treatment and untreated groups. CVI is a novel means of choroidal evaluation introduced by Agrawal et al in 2016(12).…”

Longitudinal Changes in Choroidal Thickness in Children with a History of Prematurity: An 18-month Prospective Cohort Study

“…By using OCT and fluorescein angiography, respectively, previous studies have also described altered choroidal filling patterns and decreased choriocapillaris vessel density in preterm children with and without ROP. 27,28 Children with ROP may exhibit visual acuity impairment after ROP regression despite normal macular appearance. In a study using electrophysiology, RPE degeneration and photoreceptor dysfunction were considered possible disease pathomechanisms.…”

Choroidal measurements in decision making for retinopathy of prematurity: a decision tree analysis

“…This choroidal vascular loss has been proven angiographically. In a study by Islam et al, the presence of choroidal hypo fluorescence in the central and or peripheral retina of ROP patients was demonstrated [ 26 ].…”