Is there a role for high-frequency ultrasonography in clinical staging of retinopathy of prematurity?

Abstract

Purpose: To compare 20-MHz ultrasonography with ophthalmoscopy in the staging of retinopathy of prematurity (ROP).

Methods: We used a handheld 20-MHz ultrasound system to examine 38 eyes of 19 neonates who had an indirect ophthalmoscopic examination (diagnosis masked) within 48 hours prior to ultrasonography. Determination of ROP by indirect ophthalmoscopy was compared with independent identification of ultrasonic features indicative of ROP stages.

Results: In masked cases, ultrasonography correctly identified 13 of 18 (72.2% sensitivity) eyes with zone 2, stage 2 ROP or worse and 19 of 20 (95.0% specificity) normal eyes (zone 2, stage 1 ROP or better) (chi-square, 18.4; P < .001).

Conclusion: In the neonatal nursery, a 20-MHz handheld ultrasound system may be an effective screening tool to initially identify ROP for further ophthalmoscopic evaluation and management.

Figures

Figure 1

Crib-side examination for retinopathy of prematurity.

Figure 2

Appearance of the normal anterior segment. L = lens posterior; CB = ciliary body; and C = cornea.

Figure 3

Ridges (arrows) in zone 2, stage 2 retinopathy of prematurity typically appear as shallow elevations, often hyperreflective, seen in the region anterior to the equator. Examples in two eyes are shown above.

Figure 4

Progression of zone 1, stage 2 retinopathy of prematurity (ROP) during a 5-week period, and accompanying diagrammatic interpretations. (a) Zone 1 ROP with a posterior tangential membrane (long arrow). The posterior lens is indicated by a short arrow. (b) Additional anterior cyclitic membrane (arrow) 4 weeks later. Diffuse vitreous hemorrhage is present and retinal traction is suggested, as indicated in the diagram. (c) At 5 weeks, further hemorrhagic organization of membranes can be seen. A funnelshaped total retinal detachment created by centripetal traction by both the posterior zone 1 tangential membrane and the anterior cyclitic membrane (arrow) is evident. Vitreous hemorrhage is present on both membranes, as is subretinal hemorrhage, indicated by the gray area in the adjacent diagram. These findings were corroborated by subsequent vitrectomy.