Handheld Spectral Domain Optical Coherence Tomography as a Tool to Assess Retinopathy of Prematurity Zone and Stage in Premature Infants

Abstract

 

Purpose

 

This study used the wide angle Envisu R2300-II (Bioptigen, Inc, Morrisville, NC) handheld spectral domain optical coherence tomography (SDOCT) to diagnose ROP zone and stage.

 

Methods

 

Nine premature infants receiving routine ROP screening in the North Carolina Children’s Hospital Neonatal Critical Care Center underwent imaging with the Envisu R2300-II. Attempts were made to image the ROP ridge and the border between zones 1 and 2. Images were analyzed using the InViviVue 2.0 (Bioptigen, Inc, Morrisville, NC) software, using calipers to identify the zone 1-2 border (twice the distance from the optic nerve to the foveal depression). SDOCT results were compared to the clinical ROP examination and RetCam (Clarity Medical Systems, Inc, Pleasanton, CA) images when available.

 

Results

 

Nine premature infants (median gestational age 27 weeks, range 23-30 weeks; median birth weight 760g, range 615-1196g; median postmenstrual age at imaging 37 weeks, range 32-52 weeks) were imaged with handheld SDOCT. Of the 13 imaging sessions, 4 sessions (3 infants, 3 eyes) captured the zone 1-2 border and 3 sessions (1 infant, 1 eye) captured the ROP ridge, confirmed with RetCam. The ROP ridge consisted of preretinal hyperreflective structures located in zone 1 and measured 0.19x0.30mm and 0.21x0.60mm at the time of the zone 2 stage 3 clinical diagnosis. The infant then received bilateral intravitreal bevacizumab injections. At 1 week post-treatment these structures measured 0.14x0.15mm and 0.16x0.33mm, respectively. At 2 weeks post-treatment, they measured 0.11x0.10mm and 0.11x0.25mm, respectively.

 

Conclusions

 

The Envisu R2300-II identified ROP zone and stage in some infants, in one case contradicting the clinical zone diagnosis. Images also demonstrated progressively decreasing size of the ridge’s neovascular structures following bevacizumab. The Envisu R2300-II could potentially enhance objectivity in assessing zone and stage of ROP, to help determine need for treatment as well as treatment response. Larger studies are necessary to fully evaluate the ability of handheld SDOCT to accurately diagnose zone and stage of ROP.

 

 

Handheld SDOCT B-scan revealing hyperreflective preretinal structures (asterisks) consistent with the neovascular ridge.

 

 

Volume intensity projection displaying the zone 1-2 border. Asterisks indicate the corresponding location of the preretinal structures.

 

Keywords: 706 retinopathy of prematurity • 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • 700 retinal neovascularization