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Graefes Arch Clin Exp Ophthalmol. 2019 Apr;257(4):677-688. doi: 10.1007/s00417-019-04274-6. Epub 2019 Feb 21.

Three-dimensional pattern of extraretinal neovascular development in retinopathy of prematurity.

Author information

1
Department of Ophthalmology, Duke University School of Medicine, 2351 Erwin Road-Suite 1002 AERI, Durham, NC, 27710, USA.
2
Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA.
3
Department of Pediatrics, Duke University School of Medicine, Erwin Rd, Durham, NC, 27710, USA.
4
Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, UT, USA.
5
Department of Ophthalmology, Duke University School of Medicine, 2351 Erwin Road-Suite 1002 AERI, Durham, NC, 27710, USA. cynthia.toth@dm.duke.edu.
6
Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA. cynthia.toth@dm.duke.edu.

Abstract

BACKGROUND:

The application of three-dimensional (3D) visualization techniques to evaluate the earliest visible onset of abnormal retinal vascular development in preterm infants with retinopathy of prematurity (ROP), using bedside non-contact optical coherence tomography (OCT) imaging to characterize morphology and sequential structural changes of abnormal extraretinal neovascularization.

METHODS:

Thirty-one preterm infants undergoing routine ROP screening with written informed consent for research imaging were enrolled in this prospective observational study. We imaged the macula and temporal periphery of preterm infants using a handheld OCT system (Envisu 2300 or handheld swept-source research system). The scans obtained were segmented and, using enhanced ray casting, were converted to 3D volumes to which color filter was applied.

RESULTS:

Using colorized 3D visualization, we defined extraretinal neovascular structures as buds, bridging networks, and placoid lesions. We could longitudinally follow progression and regression of extraretinal neovascularization in stage 3 ROP after treatment in one infant over 12 weeks and document the appearance of early buds, and formation of florid neovascularization. From stages 2 to 3 ROP, we observed progression from sessile buds to a complex plaque that corresponded to stage 3 ROP on clinical examination. We demonstrated regression of neovascular complexes to small pre-retinal tufts after treatment with anti-VEGF.

CONCLUSIONS:

The extension of OCT processing to include surface flattening and colorization that further improved structural analysis rendered better understanding of extraretinal tissue. Our ability to image similar areas in the same infant over multiple visits enabled us to study the evolution of these structural components and follow pathological vascular events longitudinally in development and regression after treatment. These methods can be applied to further study which are likely contribute to our understanding of the pathophysiology of neovascularization in ROP.

KEYWORDS:

3D; OCT; Optical coherence tomography; ROP; Retinopathy of prematurity; Visualization

PMID:
30790072
PMCID:
PMC6698900
[Available on 2020-04-01]
DOI:
10.1007/s00417-019-04274-6
[Indexed for MEDLINE]

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