Abstract
PurposeTo describe a wide array of peripheral vascular changes using fluorescein angiography in preterm neonates, without high risk characteristics for developing retinopathy of prematurity, that were exposed to high oxygen concentration.MethodsRetrospective, two center, case series. Newborns at two different hospitals with ≥1500 g or gestational age of ≥32 weeks, fluorescein angiography performed, and with high oxygen exposure without adequate control were included.Results294 infants diagnosed with ROP were analyzed. Only 28 eyes from 14 patients with peripheral vascular abnormalities in older and heavier babies were included. Two distinct type of peripheral vascular changes were observed: group 1 or non-proliferative: areas of capillary non-perfusion along with widespread arteriovenous shunting between adjacent primary vessels, tortuosity of primary vessels, abnormal budding of tertiary vessels and capillaries, abnormal capillary tufts and absence of foveal avascular zone; group 2 or proliferative: all of the characteristics of group 1 plus leakage of dye from the boundary between perfused and non-perfused retina and/or optic disc.ConclusionPeripheral vascular abnormalities different from retinopathy of prematurity are observed in older than 32 weeks of gestational age, and heavier than 1500 g babies. This makes the authors classify these patients as having a disease caused solely by oxygen dysregulation at the neonatal intensive care unit similarly to the oxygen induced retinopathy in experimental studies.
Highlights
Retinopathy of prematurity (ROP) is a well-known complication of preterm births, which currently represent about 10% of all births worldwide [1,2,3]
From a total of 294 infants diagnosed with ROP, we included 28 eyes from 14 patients with peripheral vascular abnormalities who met the inclusion criteria described in the “Methods” section
An important publication from our country stated that uncontrolled oxygen supplementation is the major risk for ROP requiring treatment for infants born >32 weeks of gestational age (GA), and that its regulation diminished the frequency of treatment for ROP [18]
Summary
Retinopathy of prematurity (ROP) is a well-known complication of preterm births, which currently represent about 10% of all births worldwide [1,2,3]. More mature babies may suffer from ROP stages, not typically found in these age groups, and must be examined despite being outside of the recommended guidelines for screening (birth weight ≤1500 g or gestational age of 30 weeks or less; newborns with a birth weight between 1500 and 2000 g or gestational age higher than 30 weeks, but under cardiorespiratory support or at risk for ROP; but still had record of have been exposed to high concentration of oxygen for long periods of time during neonatal care) [9, 10]. Previously vascularized retinas may suffer regression and later reactivation of the disease, which force the retina specialist to implement longer surveillance periods and properly discriminate between normal and abnormal peripheral vascular changes on allegedly low risk ROP neonates [4]
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