Abstract
Purpose :
Retinal and brain development occurring in the third trimester of pregnancy are dynamic processes of pathway formation and maturation of anatomy, and injury may result in tissue destruction, or delayed or abnormal formation. We assess whether retinal microanatomy as visualized with optical coherence tomography (OCT) at the bedside is associated with brain development in the preterm infant.
Methods :
Infants enrolled in a prospective study (NCT02887157) had bedside non-contact retinal imaging with an investigational swept-source OCT at the times of ROP clinical examinations. At near term equivalent age (TEA), infants had non-sedated (with ear coverings, monitoring, and swaddling) research brain MRI on a 3-Tesla scanner. High-resolution T1- and T2-weighted images were captured and scored by a neuroradiologist (JSS, masked to all but post-menstrual age [PMA]) for white and gray matter injury (Kidokoro et al, AJNR 2013). Retinal, optic nerve and choroidal OCT features and thicknesses at 35-37 weeks PMA (prior to ROP treatment) and also retinal nerve fiber layer (RNFL) at TEA were compared to MRI findings.
Results :
Global brain injury score was mean (SD) 4.8(4.5) in 55 infants who completed MRI. Several OCT measures at 35-37 weeks PMA were related to brain abnormalities. Center foveal thickness (CFT) of the inner nuclear layer (INL, a measure of macular edema) correlated with total white matter injury score (Spearman correlation coefficient, ρ=0.31, p=0.02). Other macular OCT measures correlated with abnormal enlargement of ventricles: negative correlation with choroidal thickness (ρ= -0.51, p<0.001) and with retinal nerve fiber layer (RNFL) thickness in the papillomacular bundle (ρ= -0.41, p= 0.002), and positive correlation with CFT of total retina (ρ=0.29, p=0.03) and of sub-layers except INL (ρ=0.28 to 0.29, p<0.04). Choroidal thinning also correlated with cerebellar abnormalities (ρ=-0.38, p<0.005). RNFL thinning at TEA also trended with dilated ventricle score (ρ= -0.26, p=0.06) but did not vary with global brain injury score.
Conclusions :
Retinal microanatomy findings are associated with white matter and cerebellar injury and with ventricle enlargement on MRI. Further longitudinal analyses are underway to examine the use of these OCT-based bedside markers as early indicators of preterm infant brain injury.
This is a 2020 ARVO Annual Meeting abstract.