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D. E. Neely, A. Harris, L. McNulty, E. Hynes, L. McCranor, B. Siesky; Ocular Blood Flow Changes in Retinopathy of Prematurity. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4049.
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Retinal vascular changes, such as tortuosity and dilation of the posterior pole vessels (plus disease) along with variable development of neovascularization, are the hallmarks of retinopathy of prematurity (ROP). Recent studies such as the Early Treatment for Retinopathy of Prematurity Randomized Trial (ETROP) have led to revised indications for the treatment of ROP. This new treatment algorithm places particular emphasis upon the subjective clinical diagnosis of plus disease. The purpose of this study is to evaluate whether or not serial examination by color Doppler imaging may be used to predict those infants at risk for developing clinically significant ROP and to see if this technique may be used as an objective assessment of plus disease.
Prospective, clinical series of high risk preterm infants with birth weights less than 1251 grams. Seventy-four patients underwent serial ocular blood flow measurements every two weeks beginning at 31.9 + 4.0 weeks of age, just prior to indirect ophthalmoscopy for scheduled ROP examinations. Included patients had a mean baseline gestational age of 26.3 + 1.7 weeks. A repeated measures analysis of co-variance (ANCOVA) was used to model the ocular blood flow changes over time and to directly compare patients at the point in time that plus disease was first diagnosed. Clinically significant ROP was documented with RetCam photographs.
Of the 74 infants followed in this study, 16 (22%) developed significant type 1 ROP and required peripheral retinal ablation as recommended by the ETROP treatment criteria. The adjusted age of infants at the time of laser treatment was 36.7 + 2.2 weeks. While gestational age was found to have a significant effect upon ocular blood flow status, there did not appear to be any significant difference between the group of infants developing treatable ROP requiring laser ablation compared to the group of infants with more mild disease who did not require treatment.
While color Doppler imaging can provide reproducible, high-resolution measurements of the central retinal artery in extremely premature infants, it does not appear to be a clinically useful tool in the management of ROP nor does it appear to be useful as an objective assessment of plus disease.
Indiana University IRB #0208-28
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