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Xi Chen, Du Tran-Viet, Alexandria Dandridge, Sharon Freedman, Lejla Vajzovic, Cynthia A Toth; Differentiating retinal detachment and retinoschisis using handheld optical coherence tomography in stage 4 retinopathy of prematurity. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3935.
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© ARVO (1962-2015); The Authors (2016-present)
Despite treatment with laser ablation of avascular retina and intravitreal injection with anti-VEGF agents, some preterm infants progress to stage 4 retinopathy of prematurity (ROP) requiring vitrectomy for repair of retinal detachment. Stage 4 ROP is defined as partial retinal detachment not involving (stage 4A) or involving (stage 4B) the fovea as determined by indirect ophthalmoscopy. We studied the optical coherence tomography (OCT) features of infants with stage 4 ROP and compared them to clinical examinations.
We performed a retrospective review of handheld OCT imaging (Bioptigen) and Retcam fundus photography obtained from infants who were identified as stage 4A or 4B ROP on pre-operative clinical examination by indirect ophthalmoscopy and brought to the operative room for examination under anesthesia and vitrectomy to repair the presumed retinal detachment. OCT imaging included multiple volumes of macula and retinal periphery.
Included for analysis were 14 eyes (11 preterm infants) with adequate OCT imaging quality. 5/8 eyes with clinical stage 4A ROP exhibited retinoschisis without OCT evidence of retinal detachment. In 3/14 eyes with diagnosis of stage 4 ROP and inability to determine foveal involvement, OCT showed subretinal fluid under the fovea and/or retinoschisis with foveal involvement. In 3/14 eyes, the diagnoses were changed from stage 4A to 4B (1/3) or stage 4B to 4A (2/3) following OCT imaging. Other features observed on OCT included cystoid macular edema, intraretinal cystic spaces, intraretinal hyperreflective dots, subretinal hyperreflective material, preretinal membranes, preretinal neovascular elevations and optic disc elevation.
Handheld OCT imaging is useful in clinical evaluation of stage 4 ROP to determine foveal involvement and differentiate retinal detachment and retinoschisis. Many infants with stage 4A ROP have retinoschisis without imaging evidence of retinal detachment. Further investigations are needed to determine if retinoschisis without retinal detachment in ROP portends a more favorable prognosis and if this observation should alter clinical management.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
OCT imaging of an eye with stage 4B ROP with retinal detachment (A) and an eye with stage 4A ROP with retinoschisis (B) without OCT evidence of retinal detachment. Other features observed on OCT in eyes with stage 4 ROP are shown in (C).
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