Differentiating Retinal Detachment and Retinoschisis Using Handheld Optical Coherence Tomography in Stage 4 Retinopathy of Prematurity

Abstract

Importance: Progression of retinopathy of prematurity (ROP) to stage 4 may require surgical intervention. The partial retinal detachment of stage 4 ROP may involve the fovea (stage 4B ROP) or may not (stage 4A ROP). This determination has heretofore been based on indirect ophthalmoscopy and documented with color fundus photography.

Objective: To investigate optical coherence tomography (OCT) features of eyes with stage 4 ROP and compare them with indirect ophthalmoscopy findings and grading of photographs.

Design, setting, and participants: In this study, research and clinical medical records of 15 infants with clinically diagnosed stage 4 ROP were retrospectively reviewed. Infants were treated at an academic center from May 2011 to January 2018.

Main outcomes and measures: Review of OCT images for the presence and foveal involvement of retinoschisis, retinal detachment, and/or vitreomacular traction masked to indirect ophthalmoscopy findings.

Results: Of the 15 included infants, 9 (60%) were male, the mean (SD) gestational age at birth was 23.9 (1.1) weeks, and the mean (SD) postmenstrual age at surgery was 42.4 (4.9) weeks. A total of 21 eyes were analyzed, of which 19 had adequate OCT imaging. Optical coherence tomography imaging extended to the retinal midperiphery but did not cover the entire region of possible detachment in each eye. Among these eyes, 7 eyes had peripheral retinoschisis without retinal detachment or foveal involvement, 5 eyes had peripheral retinoschisis and retinal detachment without foveal involvement, 7 eyes had either retinoschisis or retinal detachment involving the fovea, and 2 eyes had poor OCT signal owing to high retinal detachment.

Conclusions and relevance: Handheld OCT imaging is useful in clinical evaluation of stage 4 ROP to determine foveal involvement and differentiate retinal detachment and retinoschisis. Many infants diagnosed as having stage 4A ROP had retinoschisis without OCT evidence of retinal detachment. This group of infants may represent a substage of stage 4A ROP, ie, stage 4A-schisis by OCT. These findings suggest handheld OCT imaging may be useful in the clinical evaluation of stage 4 ROP. Further investigations are needed to determine if this subgroup portends a different prognosis and if this observation should alter future clinical practice.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Chen has received personal fees from Aerie Pharmaceuticals and Allergan. Dr Prakalapakorn has received grants from the National Eye Institute. Dr Vajzovic has received grants from Heidelberg Engineering. Dr Toth has received royalties through her university from Alcon and has unlicensed patents related to optical coherence tomography methods. No other disclosures were reported.

Figures

Figure 1.. Handheld Optical Coherence Tomography (OCT) Images and Fundus Photograph of a Right Eye With Stage 4A Retinopathy of Prematurity With Retinoschisis Without Retinal Detachment

A, An OCT B-scan through the fovea shows cystoid macular edema (white arrowheads). B and C, OCT B-scans through the retinal midperiphery in the area of the perceived retinal detachment on indirect ophthalmoscopy shows retinoschisis without retinal detachment (B) as well as preretinal neovascular elevations with retinoschisis (C) (blue arrowheads). The yellow lines mark the approximate location of the OCT B-scans on OCT retina view (insets) and fundus photograph (D).

Figure 2.. Handheld Optical Coherence Tomography (OCT) Images and Fundus Photograph of a Right Eye With Stage 4B Retinopathy of Prematurity With Both Retinoschisis and Retinal Detachment

A, An OCT B-scan through the fovea shows subretinal fluid and subretinal hyperreflective material (white arrowhead). B and C, OCT B-scans through the retinal midperiphery in the area of perceived retinal detachment on indirect ophthalmoscopy shows both retinoschisis (blue arrowheads) and retinal detachment (yellow arrowheads). The yellow lines mark the approximate location of the OCT B-scans on OCT retina view (insets) and fundus photograph (D).