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Andrea Portilla Demichelis, Fernando Schoonewolff, Michael F. Chiang, Rachel Bollens, Hayley Winninghoff, Jose A Hernandez-Vargas, Virgilio Morales-Canton, Maria A Martinez Castellanos, Ana I. Ortiz; Fluorescein angiographic findings in spontaneously-regressing stage 1 or 2 retinopathy of prematurity. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5861.
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To correlate the clinical and fluorescein angiography (FA) findings in infants with mild retinopathy of prematurity (ROP) that underwent spontaneous regression.
Retrospective case series of infants who underwent FA for clinical evaluation of stage 1 or 2 ROP which regressed spontaneously. Retinal images and FAs were captured using a wide-angle device (RetCam-II; Clarity Medical Systems, Pleasanton, CA) under topical anesthesia. Intravenous injection of 10% fluorescein, dosage 0.1 ml/kg was used. Infants noted to have macular abnormalities underwent additional imaging with optical coherence tomography (OCT).
We included 20 eyes of 10 infants that were diagnosed as follows: ROP stage 1 in zone II (4 eyes of 2 patients) ROP stage 2 in zone II without plus disease (6 eyes of 3 patients), ROP stage 1 in zone III (8 eyes of 4 infants) and ROP stage 2 zone III (2 eyes of 1 patient). In patients diagnosed with stage 2 we found in the junction between vascular and avascular retina over the elevated ridge diffuse leakage similar to the leakage pattern of pathological neovascularization, capillary free areas in the newly developing area, some dilatation of the vessels and irregular branching in the vessels near the ridge. As the eyes of the patients with stage 2 aforementioned regressed to stage 1, we found some areas of hypoperfusion of capillaries with peri-vascular hyperfluorescence in distal developing vessels that regressed completely. FA showed some variability in both retinal circulation and choroidal filling patterns in stage 2 and persisted after the regression to stage 1. Regarding the macular area in both stage 1 and 2, we found some areas of hyperfluorescence of peri-macular vessels in a pattern that suggested an exudative macular pathology. No abnormalities in macular architecture were noted on OCT imaging. Once the retinal vasculature reached the ora serrata, vascular abnormalities regressed.
Using FA, we were able to distinguish the developing pattern of retinal vessels and assessed vascular leakage. We identified changes in capillary beds and other hypoperfused areas of the retina and choroid and recognized angiographic features of the junction zone between the vascularized and non vascularized retina. Our findings help understand patterns of retinal vascular development in premature infants.
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