Changes in the microvasculature with active retinopathy of prematurity as evidenced by OCT angiography

   Purpose: to evaluate the degree of structural lesions of the microvasculature, depending on the stage and type of active ROP with optical coherence tomography (OCT) in angio-mode (OCTA).

   Material and methods. 63 premature infants (63 eyes) with active ROP were tested by OCT of the retina, of which 30 were tested by OCTA. Additionally, 10 premature infants (10 eyes) without signs of ROP were tested by OCTA. We assessed the area and perimeter of the foveal avascular zone (FAZ), the thickness of the retina in the fovea, the density of the superficial
and deep plexuses in the fovea and parafovea, the presence or absence of intraretinal, epiretinal and retinovitreal neovascular complexes.
   Results. We revealed gross structural and microvascular retinal pathology in children with ROP, which was more pronounced in children with an unfavorable course of the disease. Of these, the most affected were children with a shorter gestational period, i. e , more immature. In children with a favorable type of ROP course, a severe general condition has a serious impact on the child’s microvasculature state. The analysis of the correlation dependences of OCTA on the gestational age, stage and type of active ROP, showed a strong direct correlation between the retinal thickness in the fovea, the density of superficial plexus vessels in the fovea, the area and perimeter of the FAZ, on the one hand, and the course of the disease, which is crucial for the correct choice of management and treatment tactics.

   Conclusion. The OCTA data allow an objective assessment of the severity of the changes in the retinal vasculature, including its microcirculatory component. The data effectively supplement the clinical picture and help identifying the progressive course o f active ROP at the earliest stages of the pathological process, thereby contributing to timely treatment and good clinical and functional results.

1. Campbell J. P., Nudleman E., Yang J., et al. Handheld Optical Coherence Tomography Angiography and Ultra-Wide-Field Optical Coherence Tomography in retinopathy of prematurity. JAMA Ophthalmol. 2017; 135 (9): 977–81. doi: 10.1001/jamaophthalmol.2017.2481

2. Chen Y. C., Chen Y. T., Chen S. N. Foveal microvascular anomalies on optical coherence tomography angiography and the correlation with foveal thickness and visual acuity in retinopathy of prematurity. Graefes Arch. Clin. Exp. Ophthalmol. 2019; 257 (1): 23–30. doi: 10.1007/s00417-018-4162-y

3. Nonobe N., Kaneko H., Ito Y., et al. Optical coherence tomography angiography of the foveal avascular zone in children with a history of treatment-requiring retinopathy of prematurity. Retina. 2019; 39 (1): 111–7. doi:10.1097/IAE.0000000000001937

4. Терещенко А. В. Морфометрическое исследование состояния ретинальных сосудов на ранних стадиях ретинопатии недоношенных / А. В. Терещенко [и др.] // Офтальмология. – 2013. – 10 (3): 33–8. [Tereshhenko А. V., Belyj Yu. А., Isaev S. V., Trifanenkova I. G., Yudina Yu. А. Morphometric study of the state of the retinal vessels in the early stages of retinopathy of prematurity. Oftal'mologiya. 2013; 10 (3): 33–8 (in Russian)]. URL: https://www.ophthalmojournal.com/opht/article/view/105?locale=ru_RU

5. Терещенко А. В. Рабочая классификация ранних стадий ретинопатии недоношенных / А. В. Терещенко [и др.] // Офтальмохирургия. – 2008. – 1: 32–4. [Tereshhenko А. V., Belyj Y. U., Trifanenkova I. G., Tereshhenkova M. S. Working classification of early stages of retinopathy of prematurity. Oftal'mokhirurgiya. 2008; 1: 32–4 (in Russian)].

6. Аникина М. А. Оптическая когерентная томография — ангиография: перспективный метод в офтальмологической диагностике / М. А. Аникина, Т. Ю. Матненко, О. И. Лебедев // Практическая медицина. – 2018. – 114 (3): 7–10. [Anikina M. A., Matnenko T. Yu., Lebedev O. I. Optical coherence tomography-angiography: a promising method in ophthalmic diagnostics. Practical medicine. 2018; 114 (3): 7–10 (in Russian)].

7. Vinekar A., Chidambara L., Jayadev C., et al. Monitoring neovascularization in aggressive posterior retinopathy of prematurity using optical coherence tomography angiography. JAAPOS. 2016; 20 (3): 271–4. doi: 10.1016/j.jaapos.2016.01.013

8. Bowl W., Bowl M., Schweinfurth S., et al. OCT Angiography in young children with a history of retinopathy of prematurity. Ophthalmol Retina. 2018; 2 (9): 972–8. doi: 10.1016/j.oret.2018.02.004

9. Чернух А. М. Микроциркуляция / А. М. Чернух, П. Н. Александров, О. В. Алексеев. – Москва: Медицина, 1975. [Chernukh A. M., Aleksandrov P. N., Alekseev O. V. Microcirculation. Moscow: Medicine; 1975 (in Russian)].