Commentary - Journal of Clinical Ophthalmology (2021) New Insights in Ophthalmology

Commentary on long-term macular vascular density measured by OCT-A in children with retinopathy of prematurity

Ana Rita Carreira^*, João Cardoso, Diogo Lopes, Tomás Loureiro, Audrey Sampaio, Teresa Fonseca, Ana Vide-Escada, Nuno Campos

Ophthalmology Department of Hospital Garcia de Orta, E.P.E, Almada, Portugal

Corresponding Author:

Dr. Ana Rita Carreira
Ophthalmology Department of Hospital Garcia de Orta
E.P.E, Avenida Torrado da Silva
2805-267, Almada
Portugal
E-mail: arcarreira_28@hotmail.com

Accepted date: 08 February, 2021

Citation:Carreira AR, Cardoso J, Lopes D, et al. Commentary on long-term macular vascular density measured by OCT-A in children with retinopathy of prematurity. J Clin Ophthalmol 2020;5(S2):353-354.

About the Study

Laser photocoagulation is one of the therapeutical options for the treatment of Retinopathy of Prematurity (ROP) [1-3]. Although generally considered a safe procedure, it may be associated with an increased risk of cataract development and myopia [2,4,5]. Recent studies with optical coherence tomography angiography (OCT-A) in former preterm children with history of ROP have additionally demonstrated changes in macular morphologic and vascular parameters [6-11]. However, since there are few publications on this topic, we still do not know the long-term impact of laser treatment on macular parameters and vasculature in addition to the effects of the disease [6-11]. Our study aimed to assess long-term superficial vascular density measured by OCT-A in former preterm children with history of ROP with and without need of laser treatment.

Discussion

We enrolled a population of former premature children with a birth weight (BW) <1500 gr and/or gestational age (GA) <32 weeks that developed stage 2 or 3 ROP and kept follow-up at our department for more than 10 years. Children were divided in 2 groups according to laser requirement and underwent a complete ophthalmologic evaluation, including best corrected visual acuity (BCVA) assessment and OCT-A (Zeiss Cirrus HD-OCT 5000 with Angioplex 6 × 6 mm). Cases of high myopia (≥ -6.00 D) were excluded.

Fifteen eyes of children with history of stage 3 plus ROP, of whom 7 had involvement of zone 1, were included in Group 1 (Laser-requiring ROP) and 19 in Group 2 (Non-treated ROP), with a mean age of 14.80 ± 2.30 and 15.50 ± 1.50 years (p=0.57), respectively. Group 2 included 13 eyes of children with history of stage 2 ROP and 6 of stage 3 ROP, none of which with plus disease or involvement of zone 1. Group 1 had lower mean GA and BW than Group 2 (25.40 ± 0.80 vs 26.80 ± 1.40 weeks, p<0.001; 638.00 ± 112.00 vs 885.00 ± 99.00 gr, p<0.001, respectively). BCVA was lower in Group 1 (0.08 ± 0.04 logMAR vs 0.04 ± 0.07 logMAR, p=0.03). Group 1 had also lower vascular parameters, especially central and internal vascular density (9.15 ± 2.75 vs 10.52 ± 0.86 mm-1, p=0.05; 13.74 ± 1.00 vs 15.86 ± 0.64 mm-1, p=0.05; respectively). There were differences in morphological parameters between groups as well, particularly in mean macular thickness, which was higher in Group 1 (300.50 ± 10.50 vs 281.11 ± 2.50 μm, p=0.05), and in avascular zone circularity, lower in Group 1 (0.58 ± 0.06 vs 0.76 ± 0.02, p<0.001). BCVA was correlated with macular internal, external and total vascular density and flow (p<0.05). No correlation was found between BCVA and morphological parameters (p>0.05). GA and BW were both correlated with BCVA (p<0.001).

Our paper demonstrated that children with Laser-requiring ROP have a decrease of long-term BCVA, which was at least partially associated with a decrease in superficial macular vascular density and flow. Nevertheless, degree of prematurity was greater in children who underwent laser treatment, which might have influenced our results.

References

1. Akdogan M, Cevik S, Sahin O. The safety and effectiveness of 0.16 mg bevacizumab plus or minus additional laser photocoagulation in the treatment of retinopathy of prematurity. Indian J Ophthalmol. 2019;67:879-83.
2. Kieselbach G, Ramharter A, Baldissera I, et al. Laser photocoagulation for retinopathy of prematurity: Structural and functional outcome. Acta Ophthalmol Scand. 2006;84:21-6.
3. Mills MD. Evaluating the cryotherapy for retinopathy of prematurity study (CRYO-ROP). Archives of Ophthalmology. 2007;125:1276-81.
4. Lira R, Calheiros A, Barbosa M, et al. Efficacy and safety of green laser photocoagulation for threshold retinopathy of prematurity. Arq Bras Oftalmol. 2008;71:49-51.
5. Houston S, Wykoff C, Berrocal A, et al. Laser treatment for retinopathy of prematurity. Laser Med Sci. 2013;28:683-92
6. Chen Y, Chen S. Foveal microvasculature, refractive errors, optical biometry and their correlations in school-aged children with retinopathy of prematurity after intravitreal antivascular endothelial growth factors or laser photocoagulation. Br J Ophthalmol. 2019;104:691-6.
7. Bowl W, Bowl M, Schweinfurth S, et al. OCT Angiography in Young Children with a History of Retinopathy of Prematurity. Ophthalmol Retina. 2018;2:972-8.
8. Falavarjani K, Iafe N, Velez F, et al. Optical coherence tomography angiography of the fovea in children born preterm. Retina. 2017;37:2289-94.
9. Takagi M, Maruko I, Yamaguchi A, et al. Foveal abnormalities determined by optical coherence tomography angiography in children with history of retinopathy of prematurity. Eye. 2019;33:1890-6.
10. Chen Y, Chen Y, Chen S. 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;257:23-30.
11. 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;39:111-7.