Abstract
Purpose :
The knowledge on the retinopathy of prematurity (ROP) has been based on examining the eyes of babies at risk of ROP at a certain point of time. In a prospective study we wanted to know the story on how and when an eye with no disease at birth develops retinopathy by serial fundus imaging.
Methods :
The fundi of babies at risk of ROP as per Indian standards [gestational age (GA) of 34 weeks or earlier and or birth weight (BW) less than 2 kg] were serially evaluated with a widefield paediatric retinal imaging device from within 2 weeks of birth and weekly thereafter till the development of ROP and few weeks thereafter. Those babies with media too hazy for fundus imaging,inadequate follow up or lack of parental consent were excluded. The study was conducted at a tertiary eye care center linked to a civil newborn care unit and was approved by the institute ethics committee. The images so captured for every eye were serially analysed to get an insight on how, when and what vascular changes precede the development of ROP.
Results :
A total of 234 babies were studied over 1 year out of which 42 babies developed ROP and 28 of them (55 eyes) could complete follow up till the study endpoint.The GA and BW of babies who developed ROP ranged from 25.1 to 40.2 (median 32) weeks and 680 to 1840 (median 1400) grams respectively. The full blown picture of ROP was observed to start from 15 to 39 (median 26) days while many subtle vascular changes appearaed as early as 9 to 26 (median:12) days of life. These included tortuosity of peripheral retinal vessels (50 eyes),short arteriovenous (A-V) shunts(40 eyes),pairing of vessels from adjacent quadrants/crowding/hyperacute branching (30 eyes), abrupt ending of the retinal blood vessels with a demarcation zone (11 eyes) and large vascular loops bridging the ends of multiple arterial and venous trunks (10 eyes).We observed the vascular-avascular junction to retract posteriorly as soon as there is a transition from early to full blown ROP. While majority of short A-V shunts in peripheral zones preceeded a ridge, large posterior A-V shunts were followed by aggressive ROP.
Conclusions :
Many vascular changes appear earlier than our current guideline for the 1st evaluation for ROP. These changes can be evaluated for their possible role as fundus biomarkers in the development of ROP.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.