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Felix Victor Chen, Linda Alejandra Cernichiaro-Espinosa, Kimberly D Tran, Catherin Isabel Negron, Audina M. Berrocal; Ultra-widefield fluorescein angiography in adults with spontaneously regressed versus treated retinopathy of prematurity. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2771.
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Controversy exists regarding vascular arrest as a sequela of vascular endothelial growth factor (VEGF) inhibitor use in patients with retinopathy of prematurity (ROP). To date, an association between anti-VEGF use and avascularity cannot be made due to limited literature on the natural history of retinal vascularity in both treated and untreated ROP. Here, we perform a retrospective study assessing the peripheral vascular appearance by ultra-widefield fluorescein angiography (UWFA) in adults with a known history of ROP.
We recruited patients with a diagnosis of ROP from the retina clinic at Bascom Palmer Eye Institute from March 2017 to November 2017. Only charts of patients 18 years or older with a UWFA were reviewed. Images were captured using UWFA, optical coherence tomography (OCT), and color fundus photography. Incidences of retinal vascular appearances were compared using Fisher exact test.
A total of 17 eyes from 9 patients were analyzed. Patient ages range from 18 to 64 years with a mean of 35.3 years. 11 eyes were treatment-naïve, while 6 eyes received laser or cryotherapy. Color pictures showed similar rates of peripheral avascular retina in untreated and treated ROP (73% vs. 67%, p=1.0).UWFA of untreated and treated ROP demonstrated no significant differences in rates of surveyed abnormalities in retinal vasculature, including peripheral avascular retina (Table 1). In untreated eyes, vascularity was present in zone 1 in 9%, zone 2 in 9%, and zone 3 in 82% of eyes. Of note, all avascular retinas in treated eyes appear posterior to laser scars but anterior to the leaking hyperfluorescent FAZ.OCT of eyes with and without hyperfluorescent FAZ showed no difference in rates of flat (83% vs. 25%, p=0.2), staphylomatous (17% vs. 50%, p=0.5), and normal foveae (0% vs. 25%, p=0.4). In both groups, all eyes had persistent inner retina while showing no difference in rates of interdigitation zones (67% vs 100%, p=0.5) or atrophic inner segment/outer segment junctions (33% vs 0%, p=0.5). No eyes in either group demonstrated cystic spaces on macular OCT.
Avascular retina appears in both treated and untreated patients. Prospective data on the natural history of spontaneously regressed and treated ROP need to be evaluated in the era of intravitreal injections for ROP to help determine ramifications of leaving the remaining retina untreated.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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