Evaluation of Macular Changes in Neonatal Retinal Pathology Using Spectral Domain Optical Coherence Tomography

Abstract

Purpose: : To report macular changes in retinal neonatal pathology assessed by spectral domain optical coherence tomography (OCT).

Methods: : Newborn infants with systemic pathology and suspected retinal disease underwent full eye exam using indirect ophthalmoscopy. Retinal images were acquired using Retcam II (Clarity Medical Systems, Pleasanton, CA). OCT images were taken using iVue spectral domain technology (Optovue, Inc., Fremont, CA) under topical anesthesia.

Results: : Eight infants (10 eyes) were screened, 4 eyes showed abnormal foveal changes. In a patient diagnosed with shaken baby syndrome and a macular hemorrhage, OCT demonstrated a dome shape elevation in the foveal area due to a sub-internal limiting membrane hemorrhage. A second case had intraretinal hemorrhages due to aggressive reanimation maneuvers; OCT revealed a macular hemorrhagic retinoschisis. A patient with neonatal candida endophthalmitis developed white "cotton ball" lesions in the retina in close proximity to the macular area. Retinal angiography showed late staining of these lesions and peripheral vascular leakage. Interestingly, OCT exposed involvement of the inner retinal layers as well as the contiguous vitreous forming a firework pattern, not seen in the clinical examination.

Conclusions: : Some of the changes in the macula of newborn patients caused by retinal pathology evaluated by OCT imaging have not been previously described. This imaging technology reveals clinical and sub-clinical macular changes that aid in the understanding of neonatal retina pathology.

Keywords: infant vision • macula/fovea • detection