Isolated retinal neovascularization in retinopathy of prematurity: clinical associations and prognostic implications.

OBJECTIVE: Isolated retinal neovascularization (IRNV) is a common finding in patients with stage 2 and 3 retinopathy of prematurity (ROP). This study aims to further classify the clinical course and significance of these lesions (previously described as "popcorn" based on clinical appearance) in patients with ROP as visualized with ultra-widefield optical coherence tomography (UWF-OCT). DESIGN: Single center, retrospective case series. PARTICIPANTS: Images were collected from 136 babies in the Oregon Health and Science University neonatal intensive care unit. METHODS: A prototype UWF-OCT device captured en face scans (>140°), which were reviewed for the presence of IRNV along with standard zone, stage, and plus classification. In a cross-sectional analysis we compared demographics and the clinical course of eyes with and without IRNV. Longitudinally, we compared ROP severity using a clinician-assigned vascular severity score (VSS) and compared the risk of progression among eyes with and without IRNV using multivariable logistic regression (MLR). MAIN OUTCOME MEASURES: Differences in clinical demographics and disease progression between patients with and without IRNV. RESULTS: Of the 136 patients, 60 developed stage 2 or worse ROP during their disease course, 22 of whom had IRNV visualized on UWF-OCT (37%). On average, patients with IRNV had lower birth weights (BW) (660.1g vs 916.8g, p = 0.001), gestational age (GA) (24.9 vs 26.1 weeks, p = 0.01), and were more likely to present with ROP in zone I (63.4% vs 15.8%, p < 0.001). They were also more likely to progress to stage 3 (68.2% vs 13.2%, p < 0.001) and receive treatment (54.5% vs 15.8%, p = 0.002). Eyes with IRNV had a higher peak VSS (5.61 vs 3.73, p < 0.001) and averaged a higher VSS throughout their disease course. On MLR, IRNV was independently associated with progression to stage 3 (p = 0.02) and requiring treatment (p = 0.03), controlling for GA, BW, and initial zone 1 disease. CONCLUSION: In this single center study, we found that IRNV occurs in higher risk babies and was an independent risk factor for ROP progression and treatment. These findings may have implications for OCT-based ROP classifications in the future.

Panretinal Optical Coherence Tomography.

We introduce a new concept of panoramic retinal (panretinal) optical coherence tomography (OCT) imaging system with a 140° field of view (FOV). To achieve this unprecedented FOV, a contact imaging approach was used which enabled faster, more efficient, and quantitative retinal imaging with measurement of axial eye length. The utilization of the handheld panretinal OCT imaging system could allow earlier recognition of peripheral retinal disease and prevent permanent vision loss. In addition, adequate visualization of the peripheral retina has a great potential for better understanding disease mechanisms regarding the periphery. To the best of our knowledge, the panretinal OCT imaging system presented in this manuscript has the widest FOV among all the retina OCT imaging systems and offers significant values in both clinical ophthalmology and basic vision science.

Association of Optical Coherence Tomography-Measured Fibrovascular Ridge Thickness and Clinical Disease Stage in Retinopathy of Prematurity.

Importance: Accurate diagnosis of retinopathy of prematurity (ROP) is essential to provide timely treatment and reduce the risk of blindness. However, the components of an ROP examination are subjective and qualitative. Objective: To evaluate whether optical coherence tomography (OCT)-derived retinal thickness measurements at the vascular-avascular junction are associated with clinical diagnosis of ROP stage. Design, Setting, and Participants: This cross-sectional longitudinal study compared OCT-based ridge thickness calculated from OCT B-scans by a masked examiner to the clinical diagnosis of 2 masked examiners using both traditional stage classifications and a more granular continuous scale at the neonatal intensive care unit (NICU) of Oregon Health & Science University (OHSU) Hospital. Infants who met ROP screening criteria in the OHSU NICU between June 2021 and April 2022 and had guardian consent were included. One OCT volume and en face image per patient per eye showing at least 1 to 2 clock hours of ridge were included in the final analysis. Main Outcomes and Measures: Comparison of OCT-derived ridge thickness to the clinical diagnosis of ROP stage using an ordinal and continuous scale. Repeatability was assessed using 20 repeated examinations from the same visit and compared using intraclass correlation coefficient (ICC) and coefficient of variation (CV). Comparison of ridge thickness with ordinal categories was performed using generalized estimating equations and with continuous stage using Spearman correlation. Results: A total of 128 separate OCT eye examinations from 50 eyes of 25 patients were analyzed. The ICC was 0.87 with a CV of 7.0%. Higher ordinal disease classification was associated with higher axial ridge thickness on OCT, with mean (SD) thickness measurements of 264.2 (11.2) µm (P < .001), 334.2 (11.4) µm (P < .001), and 495.0 (32.2) µm (P < .001) for stages 1, 2, and 3, respectively and with continuous stage labels (ρ = 0.739, P < .001). Conclusions and Relevance: These results suggest that OCT-based quantification of peripheral stage in ROP may be an objective and quantitative biomarker that may be useful for clinical diagnosis and longitudinal monitoring and may have implications for disease classification in the future.