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Maria Guadalupe Martinez, Luvia Rodriguez Quiñones, Virgilio Morales-Canton, Maria Ana Martinez-Castellanos; Retinal Fluorescein Angiographic Features In The Different Stages Of Retinopathy Of Prematurity. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5919.
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To describe the retinal vascular features in eyes of premature infants with different stages of retinopathy of prematurity (ROP).
Observational prospective, case series. We included 104 eyes of 54 patients, diagnosed with stage 1,2,3 or 4 with or without plus disease. Fundus photographs and fluorescein angiography (FA) were obtained using wide-field digital pediatric imaging system.
We included 104 eyes, 48 eyes (46.15%) were stage 1, 42 eyes (40.3%) stage 2, 12 eyes (11.5%) stage 3; both 4a and 4b 1 eye, 10.57% patients had plus disease. The mean gestational age was 28.15 weeks (25-32). Mean birth weight was 1266.59 grams (780-2500 grams). The most important angiographic findings in stage 1 are the loss of a normal dichotomic pattern, the vessels follow a “chandelier pattern” that will be changing until the normal dichotomic pattern is reached after the week 52, choroidal lobular pattern with a bulleye-like choroidal pattern in the macular area is seen in 79.1% of the screened eyes, capillary leak in the distal vessels is seen in 72.9%, and sacculations of vascular sprouts in the flat demarcation line is seen in 45.5%. In stage 2 the chandelier shape of the vessels is present in 80.9%, we were able to asses capillary free areas of developing retina in 72.3%, choroidal filling is patchy with non perfusion areas in 71.4%, capillary leak is seen all patients and we found an hyperfluorescent linear pattern in the demarcation line with no leakage in late phases. In stage 3 vascular tortuosity was observed in 91.6 % as well as absence of the foveal avascular zone, capillary non-perfusion throughout the vascularized retina and hyperfluorescence at zones of the neovascularization. In stage 4b we observed more extensive areas of no perfusion and increased vascular tortuosity than in 4a. Perifoveal leakage was present in all stages and plus disease. The presence of double line suggests continued formation of vessels in spontaneous regression of ROP. In the treated eyes there was a marked decrease of vascular tortuosity in 95.74%. Angiographic evidence of a foveal avascular zone was observed as followed by flattening of the demarcation line and subsequent growth of vessels to the capillary-free zones.
Fundus FA allows more objective assessment of disease stage and zone than the indirect ophthalmoscopy. Every ROP stage has a distinct angiographic pattern.
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