Early retinopathy of prematurity findings identified with fluorescein angiography

Abstract

Fluorescein angiography has been fundamental for the understanding and description of vascular disorders affecting the retina and choroid. The aim of this report is to assess the early anatomic retinal changes visible with angiography, and their relation with the clinical findings of retinopathy of prematurity. Ten babies were included in the study, the initial examination being at 2 weeks after birth. Two cycles of tropicamide 0.8 % and phenylephrine 5 % eye drops were instilled into both eyes 30 min before examination. A RetCam II was used to obtain digital retinal images, after instilling topical anesthesia (tetracain 0.5 %) and using a contact gel. Fluorescein angiography was undertaken following administration of an intravenous bolus of 0.1 ml/kg saline fluorescein 10 % followed by a 3.0-ml isotonic saline flush, with the assistance of the neonatologist; the right and left eyes were imaged. We observed that some of the vascular abnormalities described for threshold disease by Lepore were already present at the second week of life, preceding the diagnosis of threshold disease by 3-4 weeks in two cases. The main findings in our cases were arterio-venous shunts, surrounded by areas of capillary non-perfusion, rosary-bead-like hyper-fluorescence, tortuosity and leakage from distal arterioles, none of which were detectable in the digital fundus pictures. Early ROP screening at the NICU that includes FA is a safe procedure, and gives the examiner details of vascular changes that are not detectable by indirect ophthalmoscopy, which could predict the progression to threshold disease, and provide an alert about the need of therapeutic interventions.