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

Abstract

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.

Choroidal Thickness by Handheld Swept-Source Optical Coherence Tomography in Term Newborns

“…All volumes were assessed for the presence of punctate hyperreflective vitreous opacities which, when present, were quantified using a semiautomated software developed at the University of Washington (https://github. com/uw-biomedical-ml/segmentations), as previously 14 Hyperreflective opacities, not attached to retina, visible above background and excluding above the optic nerve † Non-tractional vitreous bands 16 Hyperreflective linear opacities in the vitreous, parallel to the retina, seen in ≥3 consecutive B-scan frames Tractional vitreous bands 16 Vitreous bands that appear to meet the retina at a steeper angle Persistent inner retinal layers 11 , 12 , 34 Presence of foveal retinal layers from inner to outer nuclear layers Subretinal fluid 17 , 42 Hyporeflective space between the retina and the RPE at the fovea Foveal ellipsoid zone 10 Presence of an ellipsoid zone at the fovea Dome-shaped macula 27 Retinal, RPE, and choroid convexity on both sides of the fovea Epiretinal membrane 19 Thick linear hyperreflectivity at the inner retina with visible separation from the retina but not overlying vessels or optic nerve Cystoid macular edema 11 , 12 Hyporeflective spaces typically present in the inner nuclear layer in and around the fovea in multiple B-scans, distorting retinal layers Vessel elevation 13 A spiked vessel extending beyond the retinal surface (defined as mild or severe) located >1/2 disc diameter from the optic disc Scalloped retinal layers 13 Scalloped inner plexiform layer (mild) or inner and outer plexiform layers (severe) located >1/2 disc diameter from the optic disc Hyporeflective vessels 13 Hyporeflective vessel lumen with shadowing columns found >1/2 disc diameter from the optic disc Retinal spaces 13 Hyporeflective spaces next to vessels that do not create shadowing * All findings were evaluated by two trained graders with a third trained grader serving as the tiebreaker.…”

“…Punctate hyperreflective vitreous opacities 14 have also been associated with ROP in preterm infants and may relate to normal ocular development in full-term infants. 15 Structural abnormalities, including epiretinal membrane (ERM) 11 and cystoid macular edema (CME), 11 have been associated with both tractional and non-tractional vitreous bands in premature infants, 14,16 with unknown impact on choroidal thickness. Finally, subfoveal fluid 17 is a finding of unclear etiology found in roughly 15% of full-term newborns and may represent variation in normal early ocular development.…”

Letter to the Editor: Spontaneous Attachment of Rhegmatogenous Retinal Detachment Following Vitrectomy for Stage 4B Retinopathy of Prematurity and Atypical Retinal Changes Post-Resolution

“…A plausible hypothesis for late-onset subretinal fluid at the macula could be vitreous and epiretinal traction-induced intraretinal and subretinal fluid. 4 On release of the vitreous and epiretinal traction, the fluid also disappeared.…”

Quantitative Handheld Swept-Source Optical Coherence Tomography Angiography in Awake Preterm and Full-Term Infants

“…6,7 Subclinical morphologic findings in the retina and vitreous, such as punctate hyperreflective vitreous opacities, vitreous bands, preretinal tissue, epiretinal membrane, cystoid macular edema, retinoschisis, retinal detachment, and cross-sectional retinal vascular changes associated with plus disease, have been visualized using handheld OCT at the time of ROP screening. [8][9][10][11][12][13] To visualize the retinal vasculature, indirect ophthalmoscopy, retinal fundus photography, and fluorescein angiography are traditionally employed. However, these methods are variably limited by lack of microvascular detail, lack of objective measurements, and necessity for venous injection of fluorescein dye.…”

“… 6 , 7 Subclinical morphologic findings in the retina and vitreous, such as punctate hyperreflective vitreous opacities, vitreous bands, preretinal tissue, epiretinal membrane, cystoid macular edema, retinoschisis, retinal detachment, and cross-sectional retinal vascular changes associated with plus disease, have been visualized using handheld OCT at the time of ROP screening. 8 – 13 …”