Abstract
Purpose: :
In patients with a history of retinopathy of prematurity (ROP), there is wide variability in visual acuity (VA) and little correlation with macular appearance. Optical coherence tomography (OCT) has suggested abnormalities of foveal contour and increased macular thickness in these patients, but their effect on VA remains unclear. This study was designed to answer the following questions: (1) Is there a difference in macular thickness or foveal contour between premature and full-term children?; (2) are OCT findings correlated to the presence of ROP?
Methods: :
Prospective, comparative cohort study. Children ≥8 yrs old were assigned to one of three groups: formerly premature (<32 weeks post-conceptional age) with ROP; formerly premature without ROP; fullterm (controls) matched to age and refractive error. All children underwent cycloplegic refraction, funduscopy, and spectral-domain OCT. Outcome measures were: central foveal thickness (CFT); inner and outer subfield thickness; macular volume; presence of foveal contour. Multivariable analysis was performed to identify any correlates with increased macular thickness.
Results: :
59 eyes of 32 patients were divided into three cohorts: (1) premature with ROP (24 eyes of 12 children); (2) premature with no ROP (16 eyes of 8 children); (3) fullterm (19 eyes of 12 children). CFT was significantly greater (p<0.001) among patients with ROP (302 µm) than in patients without ROP (279 µm) or controls (265 µm). An absent or blunted foveal depression was observed in 54% of formerly premature children, compared with 0% of controls. Multivariable regression analysis identified early gestational age, but not presence of ROP, as significantly correlated with increased macular thickness.
Conclusions: :
Increased foveal thickness and abnormalities of foveal contour appear to be vestiges of premature birth, are correlated with early gestational age, and appear to recapitulate fetal macular development. In the setting of clinical evaluation or clinical trials, it must be remembered that increased macular thickness may be a normal baseline for patients with a history of premature birth.
Keywords: macula/fovea • retinopathy of prematurity • imaging/image analysis: clinical