Abstract
Background: Retinal morphology changes may be associated with prematurity and can lead to visual impairment. Optical coherence tomography angiography may contribute to understanding the pathomechanism of structural and vascular retinal impairment in premature children. The aim of this study was to assess an influence of prematurity, neonatal clinical characteristics, and a history of retinopathy of prematurity (ROP) on the morphology and retinal vascularity of macula in children. Methods: A case–control study of 123 preterm children and 86 full-term children was performed. The age of the subjects was 10.45 years (IQR: 8.12–12.77), while the age of the control group was 11.78 years (IQR: 8.81–13.79). Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA, angio-OCT) were performed using RTVueXR Avanti (Optovue, Fremont, CA, USA). Ganglion cell complex (GCC), foveal thickness (FT), parafoveal thickness (PFT), size of foveal avascular zone (FAZ) in superficial plexus, superficial capillary vessel density (sVD), deep capillary vessel density (dVD), central choroidal thickness (CCT), and presence of macular hypoplasia were analyzed. The association between OCT/angio-OCT results and clinical characteristics including the degree of ROP and therapy requirements was assessed in preterm infants. Results: Foveal morphology was affected in preterm children with high incidence of foveal hypoplasia (24.77%). GCC was thinner in preterm children compared to controls: avgGG 93 μm vs. 100 μm, p < 0.001. No associations between GCC and gestational age (R = −0.085; p = 0.228) and birth weight (R = −0.054; p = 0.446) were found. FAZ in preterm group was smaller than in controls (0.13 ± 0.09 vs. 0.22 ± 0.09; p < 0.001). FAZ area correlated with gestational age (R = 0.456; p < 0.001) and birth weight (R = 0.472; p < 0.001). Deep vessel density in the fovea was higher in preterm children than in control group (p < 0.001). PFT was significantly lower in preterm children compared to control group. However, increased thickness in the fovea was noted in preterm children (p < 0.001). FT was inversely correlated with gestational age (R = −0.562; p < 0.001) and birth weight (R = −0.508, p < 0.001). CCT was lower in preterm children (312 μm vs. 337.5 μm, p < 0.001) Parameters of GCC and FT were higher in patients with ROP required treatment compared to patients without ROP and spontaneously regressed retinopathy. FAZ was smaller in patients with retinopathy than in preterm children without ROP. Conclusion: Prematurity has a significant negative impact on GCC, macular morphology, and vascularization. In premature children, decreased FAZ, increased FT, and vessel density were strongly associated with gestational age, birth weight, Apgar score, ROP stage, and treatment requirement. Optical coherence tomography angiography is a useful tool for detecting retinal changes in premature children.
Highlights
Retinopathy of prematurity (ROP) is vasoproliferative disorder that commonly occurs in preterm children and still remains an important cause of blindness in childhood worldwide
A comparison of clinical and ophthalmic characteristics between analyzed eyes and eyes excluded from the analysis in the study population of preterm children is presented in the Supplementary Materials (Table S1)
The limitation of the optical coherence tomography angiography (OCTA) technique is the difficulty in obtaining good-quality images for analysis caused by fixation problems more often present in this specific population
Summary
Retinopathy of prematurity (ROP) is vasoproliferative disorder that commonly occurs in preterm children and still remains an important cause of blindness in childhood worldwide. Retinal neovascularization develops due to production of vascular endothelial growth factor (VEGF) in response to the primary avascular retinal area [1–4]. Children with a history of prematurity are reported to have higher risk of ocular disorders including reduced vision acuity, high refractive error, anisometropia, amblyopia, strabismus, glaucoma, cataract, and retinal detachment [1–3,6,7]. Children born preterm can have lower visual acuity despite normal-appearing fundus [8,9]. Preterm birth can lead to the disruption of normal retinal development. Foveal hypoplasia with absence of foveal depression, retention of inner retinal layers at foveal center, macula edema, retinoschisis, preretinal neovascularization, and retinal detachment have been reported in preterm children [2,3,13]
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