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Wadim Bowl, Monika Andrassi-Darida, Christoph Friedburg, Magdalena Bokun, Knut Stieger, Birgit Lorenz; Functional and morphological long-term changes of the inner retina in primary school aged children with a history of ROP. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4496.
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To investigate long-term functional and morphological alterations of the peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell layer (GCL) in a cohort of former preterm infants screened systematically for retinopathy of prematurity (ROP) with serial wide-field digital imaging (RetCam I, US).
One hundred and forty children (age 6-12y, mean 9.3y) took part in the long-term study: former premature infants without ROP (A: n=60); with spontaneously resolved ROP (B: n=40); treated ROP (C: n=10); an age-matched control group of children born at term (N: n=30). Examinations included visual acuity (VA), orthoptic status, light increment sensitivity (LIS: Goldmann I, 200ms) with fundus-controlled perimetry (FCP) (MP1, IT), SD-OCT-imaging (Spectralis, DE), Ganzfeld ERG (Espion, US) and mfERG (Veris, US), retinal imaging (FF450plus, DE) and ultra-widefield-imaging (Optos, UK). OCT-scans were segmented and analyzed with custom made software (DiOCTA). Retinal morphology was compared with RetCam images at the time of ROP screening. FCP was superimposed with analyzed OCT-images of individual retinal layers in order to receive a detailed structure-function correlation.
Mean VA, central and pericentral LIS in FCP decreased with increasing severity of ROP (from 14 to 12dB at 2.8°; from 11 to 8dB at 8° for N and C respectively). The pRNFL-thickness was thinner in children with ROP (C: 53µm) compared to control subjects (N: 86µm). The nasal segments of the pRNFL-thickness scan (C: minor 36µm) were more affected than temporal (C: minor 7µm). The GCL was significantly thinner in C (37µm) than N (72µm), depending on the state of the pRNFL. The thinning of the GCL correlated with the reduction of LIS in FCP. The morphology of the optic nerve head could be identified in early screening images matched to current images and reflected the configuration of the optic nerve head in current fundus images.
The pRNFL-, the GCL-thickness and the LIS in children with a medical history of mild or severe ROP are significantly reduced in comparison to control subjects. Precise diagnostic methods, like FCP, allow discovering the subtle distinctions in retinal sensitivity between affected children and the control group. A careful analysis of early screening images permits a prediction of the following development of the optic nerve head in preterm born children.
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