Relationship between foveal development and persistent avascular retina

Abstract

Purpose : Persistent avascular retina (PAR) is recognized as a long-term sequela of retinopathy of prematurity (ROP), and may predispose patients to late vitreoretinal complications, such as retinal detachment. It can be diagnosed in childhood with oral ultra-widefield fluorescein angiography (UWFFA) but this is not widely available or utilized. The purpose of this study was to evaluate the relationship between optical coherence tomography (OCT) macular parameters and the presence of PAR.

Methods : We recruited children aged 4–8 years from the i-ROP cohort study for long-term follow-up examination with both UWFFA and OCT angiography (OCTA). Exclusion criteria were UWFFA without clear visualization of zone 2 or low-quality OCTA. PAR was assessed by two masked graders. We compared birthweight (BW) and gestational age (GA) using a two-sample t-test and Mann-Whitney test, respectively, and OCT/A features between those with and without PAR using generalized estimating equations (GEE). Multiple comparisons were addressed using Benjamini & Hochberg p-value correction.

Results : 36 eyes of 21 patients met the study criteria. The Table summarizes the findings in both groups. We found higher central retina thickness (CRT), higher foveal vessel density (smaller FAZ), and lower quadrant vessel densities in eyes with PAR. The Figure shows the relationship between CRT and the probability of PAR.

Conclusions : It is well known that a history of premature birth is associated with less developed foveal architecture (thicker CRT). In this study, we found an association between CRT and the presence of PAR. In the future, OCT may help identify those patients who would most benefit from an UWFFA to identify clinically significant PAR.

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