Insights into Advanced Retinopathy of Prematurity Using Handheld Spectral Domain Optical Coherence Tomography Imaging
Insights into Advanced Retinopathy of Prematurity Using Handheld Spectral Domain Optical Coherence Tomography Imaging
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DOI：
10.1016/j.ophtha.2009.06.003
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发表时间：
2009-12-01
期刊：
影响因子：
13.7
通讯作者：
Toth, Cynthia A.
中科院分区：
文献类型：
--
作者：
Chavala, Sai H.;Farsiu, Sina;Toth, Cynthia A.
目的：探讨光谱域光学相干断层扫描(SD OCT)对早产儿视网膜病变(ROP)的亚临床解剖。设计：前瞻性观察病例系列。研究对象：3例低出生体重儿、重度早产儿。方法：使用便携式裂隙灯和间接检眼镜进行临床检查。使用手持SDOCT设备和Retcam(Clarity Medical Systems，Pleasanton，CA)或视频间接记录进行成像。在新生儿重症监护病房，1名患者在没有镇静的情况下进行了光谱域光学相干断层成像。主要观察指标：通过临床检查、影像检查和SD OCT检查，活体测定玻璃体视网膜的形态、解剖和病理。结果：手持系统在婴儿眼获得了线性和体积成像，尽管有血管晶状体和玻璃体条带。有明显玻璃体出血的眼睛不能进行成像。SDOCT图像分析显示晚期ROP患者视网膜前结构(宽度409~2700am，高度212~440am)、视网膜劈裂和视网膜脱离。儿科眼科专家在常规检查或影像检查中均未发现视网膜劈裂和视网膜前结构。视网膜前结构的位置和大小各不相同，可能代表视网膜前纤维血管的增殖。结论：手持式SD OCT成像可用于镇静剂或非镇静剂的新生儿，可提供有价值的亚临床解剖信息。这种新的成像方式可以显示标准检查不明显的ROP后部病变的位置和程度。如果研究基于这种成像技术的发现来验证管理策略，这可能会影响未来的临床决策。财务披露(S)：在参考文献之后，可能会发现专有或商业披露。眼科2009；美国眼科学会116：2448-2456(C)2009。
Purpose: To elucidate the subclinical anatomy of retinopathy of prematurity (ROP) using spectral domain optical coherence tomography (SD OCT).Design: Prospective, observational case series.Participants: Three low-birth-weight, severely premature infants.Methods: Clinical examination was performed using a portable slit lamp and indirect ophthalmoscope. Imaging was performed by using a handheld SD OCT device and Retcam (Clarity Medical Systems, Pleasanton, CA) or video-indirect recording. Spectral domain optical coherence tomography imaging was conducted without sedation at the bedside in the neonatal intensive care unit on 1 patient. The other 2 patients had an examination under anesthesia with SD OCT imaging in the operating room.Main Outcome Measures: In vivo determination of vitreoretinal morphology, anatomy, and pathology by clinical examination, imaging, and SD OCT.Results: Linear and volumetric imaging was achieved with the handheld system in infant eyes despite tunica vasculosa lentis and vitreous bands. Imaging was not possible in eyes with notable vitreous hemorrhage. Analysis of SD OCT images revealed preretinal structures (ranging from 409 to 2700 Am in width and 212 to 440 Am in height), retinoschisis, and retinal detachment in the posterior pole of patients with advanced ROP. Both the retinoschisis and the preretinal structures were not identified on conventional examination or imaging by expert pediatric ophthalmologists. The preretinal structures varied in location and size, and may represent preretinal fibrovascular proliferation. Some were found in close proximity to blood vessels, whereas others were near the optic nerve.Conclusions: Handheld SD OCT imaging can be performed on the sedated or nonsedated neonate and provides valuable subclinical anatomic information. This novel imaging modality can reveal the location and extent of posterior ROP pathology not evident on standard examination. This could affect future clinical decision-making if studies validate a management strategy based on findings from this imaging technique.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. Ophthalmology 2009; 116:2448-2456 (C) 2009 by the American Academy of Ophthalmology.