Refractive and visual outcomes of macular edema of prematurity as detected by handheld spectral-domain optical coherence tomography

Abstract

Purpose : Cystoid macular edema (CME) is a frequent finding in preterm infants at risk for retinopathy of prematurity (ROP). Although this edema resolves after 1-2 months, its longitudinal effects on the emmetropization process and visual acuity remain unclear.

Methods : This is a prospective, observational clinical cohort study. Newborn infants screened for ROP at two tertiary academic hospitals underwent awake handheld spectral domain (SD)- OCT between 2015 and 2018. Follow-up eye examinations were performed at 9 months, 2 years, and 5 years of age by a single ophthalmologist masked to the OCT findings. Cycloplegic refractions using streak retinoscopy and age-appropriate visual acuity measurements by Teller acuity or optotype testing were performed. A single, trained grader analyzed only right eye images. CME was categorized as Type A (marked distortion) and Type B (preserved foveal contour). CME was correlated to spherical equivalence and categories of low myopia, high myopia (<-5 diopters), low hyperopia, high hyperopia (>5 diopters), and high astigmatism (≥2 diopters cylinder), visual acuity, and strabismus using a generalized linear mixed model at each time point.

Results : 100 preterm infants were enrolled (52.1% male, mean birth weight 1018.09 ± 290.16 g, gestational age 28.38 ± 2.87 weeks). Of these, 16 were excluded due to inadequate image quality or missing data. Of the remaining 81 preterm infants (324 imaging sessions), 56 never developed CME, 14 had type A, and 11 type B. Mean central foveal thickness was 233 microns (±113) for all CME. Risk factors for later myopia at most time points included low gestational age (p≤0.003), low birth weight (p≤0.001), ROP stage (p≤0.006), prior laser treatment, and intraventricular hemorrhage (p≤0.002). At 9 months, 19% of right eyes with CME developed mild myopia compared to 10% without (p=0.25). At 2 years, 12% with CME developed mild myopia compared to 21% without (p=0.40). At 5 years, no infants with CME developed myopia but 8% without CME developed low myopia and another 8% developed high myopia (p=1.00). CME also did not correlate with high astigmatism, strabismus, or poor visual acuity outcomes.

Conclusions : CME is a frequent, transient finding visualized by handheld SD-OCT among premature infants and is not associated with long-term refractive and visual clinical significance within the 5-year follow-up period.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.