• Foveal Development in Preterm Infants Treated for ROP

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD

    Journal Highlights

    Ophthalmology, March 2018

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    Vogel et al. studied foveal development and cystoid macular changes (CMCs) in preterm infants, including the potential effects of treatment with in­travitreal bevacizumab or laser photocoagulation. They found that outer retinal thickening at the foveal center occurs faster with bevacizumab—and that laser treatment produces earlier extrusion of inner retinal layers and delayed development of the ellipsoid zone at the foveal center.

    This observational case series includ­ed 131 preterm infants who underwent screening for retinopathy of prematurity (ROP). Of these, 108 did not receive treatment, 9 had intravitreal bevaci­zumab only, 10 had laser only, and 4 received both treatments.

    Handheld optical coherence tomog­raphy was performed longitudinally for all participants. Thickness of the inner and outer retinal layers was measured at the foveal center and the nasal and temporal foveal rims. Treated and untreated eyes were compared, with adjustments made for confounding variables. Correction for distortions and measurement errors caused by off-axis scans was accomplished by resca­ling images to their native anatomic aspect ratio (this is important because off-axis scans are more common when nonsedated infants are imaged). The main outcome measures were 1) weekly changes in thickness of the inner and outer retinal layers and 2) the presence of inner retinal lay­ers, the ellipsoid zone, and CMCs.

    Results showed that foveal center thickness increased 3.1 μm per week in untreated eyes and 7.2 μm per week in bevacizumab-treated eyes (p = .038). Laser-treated eyes were less likely than untreated eyes to have all inner retinal layers present at the foveal center (odds ratio, 0.04; p = .001) and to have an ellipsoid zone at the foveal center (odds ratio, 0.07; p = .024). CMCs were ob­served in 53% of patients and 22% of imaging sessions.

    A strength of this study is the large sample size, resulting in data for 744 imaging sessions. Long-term follow-up and additional studies are needed to determine the anatomic and function­al significance of the findings. Such knowledge may help guide treatment decisions for infants with ROP.

    The original article can be found here.