Spectral-Domain Optical Coherence Tomographic Assessment of Severity of Cystoid Macular Edema in Retinopathy of Prematurity

Abstract

Objective To investigate whether the severity of cystoid macular edema (CME) in neonates who were 31 to 36 weeks’ postmenstrual age, as viewed by spectral-domain optical coherence tomography (SD-OCT) imaging, predicts the severity of retinopathy of prematurity (ROP) or is related to systemic health. Design Of 62 prematurely born neonates in a prospective institutional review board–approved study, 42 met the following inclusion criteria: at least 1 SD-OCT imaging session prior to 37 weeks’ postmenstrual age and prior to ROP laser treatment, if a laser treatment was performed, and an ophthalmic ROP examination at or after 41 weeks’ postmenstrual age, evidence of complete retinal vascularization in zone III, or documentation through telephone report of such information after transfer of care. Measures of CME severity, including central foveal thickness, retinal layer thicknesses, and foveal-to-parafoveal thickness ratio in 1 eye per subject, were compared with ROP outcomes: laser treatment, maximum plus disease, and maximum ROP stage. Systemic health factors were also correlated. Results Cystoid macular edema was present in 50% of neonates. Multiple elongated cystoid structures within the inner nuclear layer were most common. The presence of CME was not associated with ROP outcomes. The central foveal thickness, the thickness of the inner retinal layers, and the foveal-to-parafoveal thickness ratio were higher in eyes that required laser treatment or that developed plus disease or ROP stage 3. Cystoid macular edema was not clearly associated with systemic factors. Conclusions Cystoid macular edema is common in premature infants screened for ROP before 37 weeks’ postmenstrual age, with the most common SD-OCT phenotype of a bulging fovea from multiple elongated cystoid spaces. Detection of CME is not associated with ROP severity; however, tomographic thickness measurements could potentially predict a higher risk of requiring laser treatment or developing plus disease or ROP stage 3. Systemic health factors are probably not related to the development of CME.

Poorer Neurodevelopmental Outcomes Associated with Cystoid Macular Edema Identified in Preterm Infants in the Intensive Care Nursery

“…The highest quality foveal scan of 1 randomly chosen eye was selected from each available imaging session by criteria including good contrast, ability to see inner retinal layers, and lack of tilt. Only 1 eye per infant was considered for analysis because Maldonado et al 11 demonstrated bilaterally of CME in all infants with both eyes imaged as well as a correlation coefficient of 0.989 for central foveal thickness (CFT) between study and fellow eyes. Each foveal scan was graded by 1 of the 2 graders qualitatively for the presence of CME and quantitatively for CFT, parafoveal thickness at 1000 µm distance inferiorly and superiorly from the foveal center for vertical scans or nasally and temporally from the foveal center for horizontal scans, and INL thickness.…”

“…Resolution of CME is reported in some, but not all, cases, making it unclear whether this subclinical finding is a physiologic process during normal retinal development or a marker of underlying pathologic features. 11,12,14 …”

Lateral and axial measurement differences between spectral-domain optical coherence tomography systems

“…We decided to evaluate two commercial platforms that are commonly used in human adult imaging, clinical research, and randomized clinical trials. [2][3][4] We chose a commercial hand-held portable platform approved for retinal imaging in pediatric human subjects 5,14,[20][21][22] and in basic animal research. [23][24][25] Furthermore, the largest ongoing randomized trial for age-related macular degeneration (AMD), the NEI-sponsored Age-Related Eye Disease Study 2, exclusively allows the Bioptigen SDOIS platform for its longitudinal, observational ancillary SDOCT study (AREDS2 Ancillary SDOCT Study).…”

“…SDOCT provides estimates of retinal layer thicknesses across the macula to aid in clinical diagnosis and treatment decisions for a variety of ocular diseases. [2][3][4][5][6] Interpretation of data has been complicated by the variety of platforms designed by commercial SDOCT instrument manufacturers, each with different proprietary software technologies. Previous studies have identified OCT-derived retinal thickness measurement variability due to differences in their segmentation algorithms, their reported axial resolutions in tissue, their scan density options, and their ability to correct for subject fixation.…”

Características estruturais maculares de olhos de pré-escolares nascidos prematuros: análise por tomografia de coerência óptica e oftalmoscopia binocular indireta

“…Os autores se propuseram a observar se a severidade do edema cistoide de mácula, encontrado em 50% dos 42 prematuros estudados, tinha algum valor preditivo para a necessidade de tratamento. Eles concluíram que o edema cistoide de mácula não estava diretamente relacionado com a gravidade preditiva para tratamento da retinopatia da prematuridade, mas a espessura foveal e parafoveal aumentada sim (24) . A relação encontrada neste estudo pode oferecer uma explicação para o que foi encontrado no grupo G1 do presente estudo, pois a espessura foveal foi significativamente maior nos prematuros deste grupo G1 em relação ao grupo G2.…”