The Characteristics and Short-term Refractive Error Outcomes of Cystoid Macular Edema in Premature Neonates as Detected by Spectral-Domain Optical Coherence Tomography

Bondalapati, Sailaja; Milam, Ronald W.; Ulrich, J. Niklas; Cabrera, Michelle T.

doi:10.3928/23258160-20150909-04

Cited by 10 publications

(15 citation statements)

References 18 publications

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“…With the increasing use of handheld SD-OCT among the infant population, we are now able to appreciate subclinical findings that affect the retinal microarchitecture in premature infants. [4][5][6][7][8][9] To our knowledge, this is the first comprehensive report on vitreous findings documented by handheld SD-OCT among infants screened for ROP. Lee et al 4 described "vitreous material shadowing" that was seen in 7 of 207 handheld SD-OCT images from premature infants screened for ROP but did not describe the source of the shadowing nor correlate the shadows to ROP stage.…”

Section: Discussionmentioning

confidence: 85%

“…11,12 Occult CME and ERM may play a role in the decreased vision observed in this population. 9,12,13 Furthermore, longitudinal data on adults with a history of ROP show that these patients have a high risk for premature cataract formation, 14,15 glaucoma, [16][17][18][19] retinal tears, 20 and retinal detachments, [21][22][23] all of which may in part result from vitreous abnormalities. Some studies suggest that these complications occur with greater frequency with increasing severity of ROP, 15,19 yet severe complications can occur even in patients with regressed disease that never required treatment.…”

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confidence: 99%

“…Examination with SD-OCT can identify epiretinal membrane (ERM), cystoid macular edema (CME), retinoschisis, intraretinal deposits, and macular detachments that are not detected on clinical examination by experienced ROP screeners. [4][5][6][7][8][9] At present, there is a paucity of literature regarding vitreous SD-OCT findings in premature infants.…”

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Vitreous Bands Identified by Handheld Spectral-Domain Optical Coherence Tomography Among Premature Infants

et al. 2018

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IMPORTANCE Handheld spectral-domain optical coherence tomography (SD-OCT) can provide insights into the complex interactions occurring at the vitreoretinal interface in retinopathy of prematurity (ROP) to enhance our understanding of ROP pathology. OBJECTIVE To characterize vitreous bands in premature infants with use of handheld SD-OCT. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study conducted from July 7, 2015, to February 28, 2017, at 2 university-based neonatal intensive care units. Seventy-three premature infants who required routine ROP screening examination were recruited. Informed consent was obtained from all legal guardians. Trained graders who were masked to the clinical assessment analyzed each SD-OCT scan of the right eye for vitreoretinal findings. A third trained grader mediated disagreements. MAIN OUTCOMES AND MEASURES Associations between the presence of vitreous bands in premature infants with ROP diagnoses and the presence of other vitreoretinal SD-OCT findings were investigated. RESULTS Of the 73 infants recruited, 6 infants' parents withdrew their children from the study, and 2 infants were too hemodynamically unstable for imaging, leaving a total of 65 participants. Of these, 32 (49%) were female, 36 (55%) were white, 10 (15%) were Hispanic, 3 (5%) were Native American, 4 (6%) were African American, 4 (7%) were Asian/Pacific Islander, and 8 (12%) were other. The mean (SD) gestational age was 28 (2.7) weeks, the mean (SD) birth weight was 997 g (286 g), and the mean (SD) postmenstrual age at imaging was 34 (3) weeks (mean [SD] total of 3 [2] imaging sessions). Comparing the 24 infants (37%) who had a right eye vitreous band at any time with the 41 (63%) who did not, no difference in mean birth weight, gestational age, postmenstrual age at imaging, sex, or race/ethnicity was identified. No associations with ROP stage (eg, in 6 [25%] infants with vitreous bands vs 4 [9.8%] in those without; P = .23), presence of plus disease (2 [8%] vs 2 [5%]; P = .84), or type 1 ROP (3 [12%] vs 3 [7%]; P = .66) were identified. Vitreous bands were associated with epiretinal membrane detected on SD-OCT (P = .001) with an odds ratio of 9.4 (95% CI, 2.8-31.3) in 15 [62%] infants with vitreous bands vs 6 [15%] in those without. Vitreous bands were also associated with cystoid macular edema (in 15 [62%] infants with vitreous bands vs 1 [27%] in those without; P = .005) with an odds ratio of 4.5 (95% CI, 1.5-13.3). CONCLUSIONS AND RELEVANCE In this study, the development of vitreous bands was associated with both cystoid macular edema and epiretinal membrane. These findings suggest a tractional pathogenesis to these entities among premature infants. This study did not find a direct association between vitreous bands and severe ROP. Additional study is needed to determine whether vitreous bands represent subclinical hyaloidal organization leading to retinal detachment in advanced ROP.

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Vitreous Bands Identified by Handheld Spectral-Domain Optical Coherence Tomography Among Premature Infants

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“…Cystoid macular edema has been reported to be present in up to 46.3%, 57.1%, and 87.5% of eyes affected by stage 1, 2, and 3 ROP, respectively. 5,13,23,51,[67][68][69] The presence of CME is associated with higher hyperopia and poorer neurodevelopmental and visual acuity outcomes. [70][71][72] A vascularity abnormality (VASO) score has been described that appears to be significantly higher in eyes with plus disease (Fig.…”

Section: Retinopathy Of Prematuritymentioning

confidence: 99%

Pediatric Optical Coherence Tomography in Clinical Practice—Recent Progress

Lee

Proudlock

Gottlob

2016

Invest. Ophthalmol. Vis. Sci.

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Citation: Lee H, Proudlock FA, Gottlob I. Pediatric optical coherence tomography in clinical practice-recent progress. Invest Ophthalmol Vis Sci. 2016;57:OCT69-OCT79. DOI:10.1167/iovs.15-18825 PURPOSE. Optical coherence tomography (OCT) has revolutionized the diagnosis and management of adult retinal and optic nerve disease. Children were deprived of this technology until the recent development of handheld spectral-domain OCT (HH-SDOCT). In this article, we review the applications of OCT imaging in pediatric ophthalmology.METHODS. This study was a review of the literature.RESULTS. The acquisition and interpretation of pediatric tomograms differ significantly from those for adults, with adjustments needed to account for the shorter axial lengths, higher refractive errors, and ongoing retinal and optic nerve development in the pediatric eye. Handheld SDOCT is increasingly being used as an adjunctive diagnostic tool in retinopathy of prematurity (ROP) and nonaccidental injury (NAI) by providing additional morphologic information that is not normally clinically discernible. The role of HH-SDOCT in streamlining diagnosis in infantile nystagmus syndrome, retinal dystrophies, and degenerations has been established. Optical coherence tomography can also help differentiate between pediatric intraocular tumors, for example, hamartomas and retinoblastoma; monitor tumor progression; and monitor treatment response. In addition, HH-SDOCT is establishing its role as a noninvasive monitoring tool in children affected by optic nerve pathology such as glaucoma, optic nerve atrophy and hypoplasia, optic pathway glioma, and pseudotumor cerebri. CONCLUSIONS.Handheld SDOCT can provide novel insights into the natural history of retinal and optic nerve diseases in young children. For example, in achromatopsia and albinism, in vivo OCT studies have provided evidence of altered but ongoing retinal development in early childhood, which suggests that potentially targeting treatment at an earlier age may optimize visual function by normalizing retinal development.

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“…OCT in these infants has identified numerous retinal pathologies including epiretinal membrane (ERM), cystoid macular edema (CME), retinoschisis, and the ROP ridge. [3][4][5][6][7][8] Maldonado et al identified four additional plus disease-associated handheld SD-OCT findings in infants with severe ROP (elevated retinal vessels, scalloped retina, hyporeflective vessel lumen, and retinal spaces). 9 We previously described both punctate hyperreflective vitreous opacities and vitreous bands identified by handheld SD-OCT in premature infants screened for ROP.…”

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Vitreous Findings by Handheld Spectral-Domain OCT Correlate with Retinopathy of Prematurity Severity

Legocki

Gillette

Grant

et al. 2020

Ophthalmology Retina

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Objective: To evaluate the association between retinopathy of prematurity and vitreous findings in premature infants detected by handheld spectral-domain optical coherence tomography.Design: Prospective, observational cohort study.Participants: Consecutive sample of 92 premature infants requiring retinopathy of prematurity screening at two academic neonatal intensive care units, between July 2015 and March 2018. Methods:Infants underwent handheld spectral domain optical coherence tomography at the time of routine retinopathy of prematurity examinations. Two masked, trained graders analyzed right eye vitreoretinal findings including semi-automated quantification of punctate hyperreflective vitreous opacities within 5 foveal/parafoveal B-scans (Vitreous Opacity Ratio). Main Outcome Measures:Excluding post-treatment data, vitreous findings were compared to clinical retinopathy of prematurity diagnoses.Results: Agreement between image graders for all vitreoretinal findings was 91% (kappa=0.86 [95% confidence interval, 0.82-0.90], P<0.001). Among 92 infants undergoing 280 imaging sessions (52% male, mean gestational age 28.3±2.8 weeks, mean birthweight 1014.5±285.0 grams), 36/92 (39%) developed retinopathy of prematurity. Punctate hyperreflective vitreous opacities were identified in 61/92 (66%) infants. The presence of punctate hyperreflective vitreous opacities at least once was associated with a diagnosis of retinopathy of prematurity (62% vs. 29% without opacities, P=0.003), maximum retinopathy of prematurity stage (P=0.001), pre-plus or plus disease (24% vs. 5%, P=0.005), and type 1 disease (14% vs. 2%, P=0.03).

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The Characteristics and Short-term Refractive Error Outcomes of Cystoid Macular Edema in Premature Neonates as Detected by Spectral-Domain Optical Coherence Tomography

Abstract: CME was associated with ROP and younger GA, but not with myopia. Intravitreal bevacizumab for type 1 ROP has inconclusive effects on CME.

Cited by 10 publications

References 18 publications

Vitreous Bands Identified by Handheld Spectral-Domain Optical Coherence Tomography Among Premature Infants

Vitreous Bands Identified by Handheld Spectral-Domain Optical Coherence Tomography Among Premature Infants

Pediatric Optical Coherence Tomography in Clinical Practice—Recent Progress

Vitreous Findings by Handheld Spectral-Domain OCT Correlate with Retinopathy of Prematurity Severity

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