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Shwetha Mangalesh, Xi Chen, Du Tran-viet, Neeru Sarin, Katrina Winter, S. Grace Prakalapakorn, Sharon Freedman, Cynthia A Toth; Short-term treatment effects on retinal microanatomy in preterm infants with severe retinopathy of prematurity. Invest. Ophthalmol. Vis. Sci. 2022;63(7):4192 – F0252.
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© ARVO (1962-2015); The Authors (2016-present)
We report optical coherence tomography (OCT)-based retinal microanatomical findings at the posterior pole pre- and post-treatment of retinopathy of prematurity (ROP).
As part of BabySTEPS (STudy of Eye imaging in Preterm infantS), research OCT volumes from pre-and post-treatment of Type 1 ROP were analyzed. We assessed: vascular dilation and tortuosity from en face retinal vessel maps centered on the optic nerve; presence of extraretinal neovascularization (eNV) from en face and B-scans; and presence of macular edema and retinal layer thicknesses at the foveal center from B-scans.
Of 42 eyes (21 infants) treated for ROP, 34 eyes received intravitreal bevacizumab at 33-37 weeks postmenstrual age (PMA) and 8 laser photocoagulation at 34-44 weeks PMA. OCT images were captured a mean±SD of 1±0.9 days pre- and 5±2 days post-treatment. Of 37 eyes with dilated vessels pre-treatment, 29 improved (narrowed) post-treatment and none worsened. Of 35 eyes with tortuous vessels pre-treatment, 22 improved (tortuosity decreased) and none worsened. eNV was visible in the posterior pole in 6 eyes; all improved post-treatment (Fig 1A,B). Macular edema was present in 12 eyes pre-treatment, persisted in 9 post-treatment, and 7 eyes developed macular edema post-treatment (Fig 1C,D). At the foveal center, the photoreceptor layer (mean difference(MD)= +12.08µm, p=.006) and choroid (MD =+34.12µm, p<.001) were thicker post-treatment (matched-pairs analysis).
This is the first comprehensive evaluation of the short-term effects of ROP treatment on retinal microanatomy. We found an increase in photoreceptor layer and choroidal thickness early post-treatment of Type 1 ROP with either bevacizumab or laser. eNV and vascular dilation and tortuosity predictably improved following treatment. In contrast, macular edema, an inner retinal phenomenon not associated with choroidal thickness [Mangalesh et al Ophth Ret 2020], had a variable response to ROP treatment with improvement, persistence or new-onset after treatment.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
OCT of an infant with Type 1 ROP treated with intravitreal bevacizumab. On the day of treatment, pre-treatment (A, C); one week post-treatment (B, D). En face showed dilated and tortuous vessels and eNV nasal to the optic disc (A), both of which improved post-treatment (B). Foveal B-scan showed absence of macular edema pre-treatment (C), and presence post-treatment (D).
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