Aggressive Posterior Retinopathy of Prematurity Clinical and Quantitative Imaging Features in a Large North American Cohort
Aggressive Posterior Retinopathy of Prematurity Clinical and Quantitative Imaging Features in a Large North American Cohort
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DOI：
10.1016/j.ophtha.2020.01.052
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发表时间：
2020-08-01
期刊：
影响因子：
13.7
通讯作者：
Campbell, J. Peter
中科院分区：
文献类型：
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作者：
Bellsmith, Kellyn N.;Brown, James;Campbell, J. Peter
目的：早产儿侵袭性后部视网膜病变 (AP-ROP) 是一种威胁视力的疾病，进展为视网膜脱离的几率很高。本研究的目的是通过人口统计学、疾病进展率和基于深度学习的血管严重程度评分来定量表征 AP-ROP。设计：回顾性分析。参与者：使用来自 8 个北美中心的 ROP 队列中的影像和信息学，包括 947 名患者和 5945 例眼底图像临床眼科检查。治疗前眼睛根据疾病严重程度进行分类：无、轻度、2 型或预加、需要治疗 (TR) 无 AP-ROP、TR 有 AP-ROP。分析比较了带有 AP-ROP 的 TR 和不带 AP-ROP 的 TR，以研究 AP-ROP 与其他 TR 疾病之间的差异。 方法：使用先前发布的方法，结合 3 个独立的基于图像的分级和 1 个检眼镜分级，为每次眼睛检查生成参考标准诊断。所有眼底图像均使用之前发布的深度学习系统进行分析，并从 1 到 9 进行评分。主要结果指标：出生体重、胎龄、月经后年龄和血管严重程度评分。结果：根据出生体重（617 克 vs. 679 克；P = 0.01）和胎龄（24.3 周 vs. 25.0 周；24.3 周 vs. 25.0 周）计算，表现出 AP-ROP 的婴儿早产率更高。与没有 AP-ROP 的 TR 婴儿相比，这种情况在更早的经后年龄（34.7 周与 36.9 周；P < 0.001）达到峰值严重程度。与没有 AP-ROP 的 TR 婴儿相比，有 AP-ROP 的 TR 婴儿的平均血管严重程度评分最高（8.79 vs. 7.19；P < 0.001）。随着时间的推移分析严重程度评分，AP-ROP 婴儿的进展速度最快（30-32 周时 P < 0.002）。 结论：北美患有 AP-ROP 的早产儿比 ROP 严重程度较低的婴儿出生更年轻，发病也更早。疾病严重程度可以通过基于深度学习的评分进行量化，该评分与临床确定的疾病类别（包括 AP-ROP）相关。与其他需要治疗的眼睛相比，表现出 AP-ROP 的眼睛进展到疾病高峰的速度最高。对 AP-ROP 定量特征的分析可能有助于改善侵袭性、威胁视力的 ROP 的诊断和治疗。 (C) 2020 年美国眼科学会
Purpose: Aggressive posterior retinopathy of prematurity (AP-ROP) is a vision-threatening disease with a significant rate of progression to retinal detachment. The purpose of this study was to characterize AP-ROP quantitatively by demographics, rate of disease progression, and a deep learning-based vascular severity score.Design: Retrospective analysis.Participants: The Imaging and Informatics in ROP cohort from 8 North American centers, consisting of 947 patients and 5945 clinical eye examinations with fundus images, was used. Pretreatment eyes were categorized by disease severity: none, mild, type 2 or pre-plus, treatment-requiring (TR) without AP-ROP, TR with AP-ROP. Analyses compared TR with AP-ROP and TR without AP-ROP to investigate differences between AP-ROP and other TR disease.Methods: A reference standard diagnosis was generated for each eye examination using previously published methods combining 3 independent image-based gradings and 1 ophthalmoscopic grading. All fundus images were analyzed using a previously published deep learning system and were assigned a score from 1 through 9.Main Outcome Measures: Birth weight, gestational age, postmenstrual age, and vascular severity score.Results: Infants who demonstrated AP-ROP were more premature by birth weight (617 g vs. 679 g; P = 0.01) and gestational age (24.3 weeks vs. 25.0 weeks; P < 0.01) and reached peak severity at an earlier postmenstrual age (34.7 weeks vs. 36.9 weeks; P < 0.001) compared with infants with TR without AP-ROP. The mean vascular severity score was greatest in TR with AP-ROP infants compared with TR without AP-ROP infants (8.79 vs. 7.19; P < 0.001). Analyzing the severity score over time, the rate of progression was fastest in infants with AP-ROP (P < 0.002 at 30-32 weeks).Conclusions: Premature infants in North America with AP-ROP are born younger and demonstrate disease earlier than infants with less severe ROP. Disease severity is quantifiable with a deep learning-based score, which correlates with clinically identified categories of disease, including AP-ROP. The rate of progression to peak disease is greatest in eyes that demonstrate AP-ROP compared with other treatment-requiring eyes. Analysis of quantitative characteristics of AP-ROP may help improve diagnosis and treatment of an aggressive, visionthreatening form of ROP. (C) 2020 by the American Academy of Ophthalmology