Imaging retinal neovascularization with handheld optical coherence tomography angiography in preterm infants with retinopathy of prematurity

Abstract

Purpose : Imaging techniques such as fluorescein angiography and handheld optical coherence tomography (OCT) have been helpful in characterizing retinal neovascularization in advanced retinopathy of prematurity (ROP). The advent of OCT angiography (OCT-A) offers an additional aspect of flow information. Our goal is to use handheld OCT-A to study the vascular flow prior to, during, and following regression of retinal neovascularization in infants with ROP.

Methods : Under an IRB-approved protocol, at the bedside, we used an investigational handheld noncontact swept source OCT-A system (UC3) to capture the structure and capillary flow of retinal neovascular tissue. We used customized MATLAB scripts to generate en face OCT-A images and cross-sectional OCT B-scans with flow overlay.

Results : At the bedside, we imaged various stages of retinal neovascularization, including early neovascular bud, established neovascular plaque, flat neovascularization, and regressed preretinal tissue in the eyes of 4 preterm infants at 36 to 52 weeks postmenstrual age. The subclinical neovascular bud arose from retinal vasculature with active vascular flow on OCT-A. Established neovascular plaque at the vascular-avascular junction appeared to be comprised of thinner superficial capillaries and more dilated deeper capillaries. Flat neovascularization in aggressive posterior ROP assumed a flatter configuration compared to the neovascular plaques. Regressed neovascularization following ROP treatment exhibited decreased vascular flow within the preretinal tissue, yet we observed flow in segments of larger retinal vessels that were elevated from its original intraretinal position. Of note, we did not observe obvious capillary loss leading to neovascular tissue.

Conclusions : OCT-A images from eyes of preterm infants document various changes in vascular flow within retinal neovascular tissue. Imaging advances such as this will further our understanding of the development, progression and regression of retinal neovascularization in ROP.

This is a 2020 ARVO Annual Meeting abstract.

 

OCT retina view (A), OCT-A image (B) and B-scan with flow overlay (C, D) of a neovascular plaque in the right eye of a preterm infant born at 24 weeks gestation age and imaged at 36 weeks postmenstrual age with clinically determined zone 1 stage 2 ROP with plus disease.