Early retinopathy of prematurity findings identified with fluorescein angiography

Zepeda-Romero, Luz Consuelo; Oregon-Miranda, Aldo; Lizarraga-Barron, D. S.; Gutierrez-Camarena, O.; Meza-Anguiano, Alonso; Gutiérrez-Padilla, José Alfonso

doi:10.1007/s00417-013-2321-8

Cited by 29 publications

(23 citation statements)

References 6 publications

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“…However, FA does appear to be safe in children, including neonates with ROP, as no adverse effects have been reported in several series. 5–8 In addition, all experts in this current study agreed that FA is safe in neonates and infants. Given our findings, elucidating the risk-benefit ratio of FA imaging may warrant additional study.…”

Section: Discussionmentioning

confidence: 66%

Color Fundus Photography Versus Fluorescein Angiography in Identification of the Macular Center and Zone in Retinopathy of Prematurity

Patel

Klufas

Ryan

et al. 2015

American Journal of Ophthalmology

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Purpose To examine the utility of fluorescein angiography (FA) in identification of the macular center and the diagnosis of zone in patients with retinopathy of prematurity (ROP). Design Validity and reliability analysis of diagnostic tools Methods 32 sets (16 color fundus photographs; 16 color fundus photographs paired with the corresponding FA) of wide-angle retinal images obtained from 16 eyes of eight infants with ROP were compiled on a secure web site. 9 ROP experts (3 pediatric ophthalmologists; 6 vitreoretinal surgeons) participated in the study. For each image set, experts identified the macular center and provided a diagnosis of zone. Main Outcome Measures (1) Sensitivity and specificity of zone diagnosis (2) “Computer facilitated diagnosis of zone,” based on precise measurement of the macular center, optic disc center, and peripheral ROP. Results Computer facilitated diagnosis of zone agreed with the expert’s diagnosis of zone in 28/45 (62%) cases using color fundus photographs and in 31/45 (69%) cases using FA. Mean (95% CI) sensitivity for detection of zone I by experts as compared to a consensus reference standard diagnosis when interpreting the color fundus images alone versus interpreting the color fundus photographs and FA was 47% (35.3% – 59.3%) and 61.1% (48.9% – 72.4%), respectively, (t(9) ≥ (2.063), p = 0.073). Conclusions There is a marginally significant difference in zone diagnosis when using color fundus photographs compared to using color fundus photographs and the corresponding fluorescein angiograms. There is inconsistency between traditional zone diagnosis (based on ophthalmoscopic exam and image review) compared to a computer-facilitated diagnosis of zone.

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Section: Discussionmentioning

confidence: 66%

Color Fundus Photography Versus Fluorescein Angiography in Identification of the Macular Center and Zone in Retinopathy of Prematurity

Patel

Klufas

Ryan

et al. 2015

American Journal of Ophthalmology

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“…FA has recently been implemented to evaluate retinal vascular morphology in eyes injected with intravitreal anti-vascular endothelial growth factor (VEGF) therapy 26–28 ; however, current studies on FA in ROP have been predominately descriptive, limiting their clinical impact and conclusions. 12, 14, 15, 26, 27, 29 As such, a gap exists in understanding the utility of FA on the accuracy of diagnosis and management of ROP by pediatric ophthalmologists and retina specialists. The purpose of this study was to evaluate the influence of FA on the diagnosis and management of ROP by ROP experts using wide-angle fundus images.…”

mentioning

confidence: 99%

Influence of Fluorescein Angiography on the Diagnosis and Management of Retinopathy of Prematurity

et al. 2015

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Purpose To examine the influence of fluorescein angiography (FA) on the diagnosis and management of retinopathy of prematurity (ROP). Design Prospective cohort study. Participants Nine recognized ROP experts (3 pediatric ophthalmologists; 6 retina specialists) interpreted 32 sets (16 color fundus photographs; 16 color fundus photographs paired with the corresponding FAs) of wide-angle retinal images from infants with ROP. Methods All experts independently reviewed the 32 image sets on a secure web site and provided a diagnosis and management plan for the case presented, first based on color fundus photographs alone, and then by color fundus photographs and corresponding FA. Main Outcome Measures Sensitivity and specificity of the ROP diagnosis (zone, stage, plus disease, and category – i.e. no ROP, mild ROP, type-2 ROP, and treatment-requiring ROP) was calculated using a consensus reference standard diagnosis, determined from the diagnosis of the color fundus photographs by three experienced readers in combination with the clinical diagnosis based on ophthalmoscopic examination. The kappa statistic was used to analyze the average intergrader agreement among experts for the diagnosis of zone, stage, plus disease, and category. Results Addition of FA to color fundus photographs resulted in a significant improvement in sensitivity for diagnosis of stage 3 or worse disease (39.8% vs. 74.1%, P = 0.008), type-2 or worse ROP (69.4% vs. 86.8%, P = 0.013), and pre-plus or worse disease (50.5 vs. 62.6%, P = 0.031). There was a nonsignificant trend towards improved sensitivity for diagnosis of treatment-requiring ROP (22.2% vs. 40.3%, P = 0.063). Using the kappa statistic, addition of FA to color fundus photographs significantly improved intergrader agreement for diagnosis of treatment-requiring ROP. Addition of FA to color fundus photographs did not significantly affect intergrader agreement for the diagnosis of stage, zone, or plus disease. Conclusions Compared to color fundus photographs alone, fluorescein angiography may improve the sensitivity of diagnosis of ROP by experts, particularly for stage 3 disease. In addition, intergrader agreement for diagnosis of treatment-requiring ROP may improve with FA interpretation.

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“…Fluorescein angiography possibly offers additional information on vascular retinal changes. [22][23][24] Computer-based image analysis systems enable quantitative measurement of vessel width and tortuosity and potentially could make the diagnosis of plus disease more objective. 25 We found intra-expert agreement in ROP diagnosis and treatment to be considerably higher than inter-expert agreement, which was to be expected and supports the validity of the study results.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Inter-expert and Intra-expert Agreement on the Diagnosis and Treatment of Retinopathy of Prematurity

Gschließer

Stifter

Neumayer

et al. 2015

American Journal of Ophthalmology

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Early retinopathy of prematurity findings identified with fluorescein angiography

Cited by 29 publications

References 6 publications

Color Fundus Photography Versus Fluorescein Angiography in Identification of the Macular Center and Zone in Retinopathy of Prematurity

Color Fundus Photography Versus Fluorescein Angiography in Identification of the Macular Center and Zone in Retinopathy of Prematurity

Influence of Fluorescein Angiography on the Diagnosis and Management of Retinopathy of Prematurity

Inter-expert and Intra-expert Agreement on the Diagnosis and Treatment of Retinopathy of Prematurity

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