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Clinton Warren, Jonathon Young, Mara R Goldberg, Vesper Williams, Thomas B Connor, Deborah Costakos; Fluorescein angiography in persistent retinopathy of prematurity. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):979.
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The current screening guidelines for retinopathy of prematurity (ROP) recommend screening cessation at a postmenstrual age (PMA) of 45 weeks in the absence of prior type 1 ROP. Some infants may demonstrate persistent avascular retina, peripheral neovascularization, and other vascular abnormalities beyond a PMA of 45 weeks. The natural history of retinal non-perfusion and neovascularization among this population is not well understood and may predispose to the development of late exudative retinopathy and tractional retinal detachment. We performed a retrospective study to analyze the angiographic findings among infants that demonstrated persistent ROP in Zone III and peripheral Zone II after a PMA of 45 weeks.
This is a retrospective, observational study of infants with persistent ROP in Zone III and peripheral Zone II after a PMA of 45 weeks. ROP screening was performed by a single examiner at the Children's Hospital of Wisconsin using indirect ophthalmoscopy and 360° scleral depression. Fundus photos and fluorescein angiograms obtained using a RetCam3 digital imaging system were reviewed. Patient records were also reviewed for gender, gestational age, birth weight, medical history, and oxygen status.
A total of 4 premature infants (8 eyes) were identified to have persistent ROP in Zone III and/or peripheral Zone II after a PMA of 45 weeks. Three of the subjects were male and one female. The mean birth weight was 674.5 grams. The mean gestational age was 24.6 weeks. The mean PMA at time of imaging was 51.25 weeks. Indirect ophthalmoscopy demonstrated Zone III Stage 3 ROP in 2 patients and peripheral Zone II Stage 3 ROP in 2 patients. Plus disease was absent in all four subjects. Peripheral avascular retina was demonstrated by fluorescein angiography in all four subjects. Fluorescein angiography also revealed areas of peripheral neovascularization with focal sites of active leakage.
Fluorescein angiography can reveal areas of peripheral neovascularization and active leakage among infants with persistent ROP, findings not easily appreciated by indirect ophthalmoscopy or color fundus photography. This may suggest that infants with persistent ROP may benefit from extended surveillance or laser ablation to reduce the risk of late complications.
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