Utility of handheld optical coherence tomography imaging in the surgical management of preterm infants with advanced retinopathy of prematurity.

PURPOSE: The advent of handheld optical coherence tomography (OCT) as a research instrument has significantly advanced our understanding of retinopathy of prematurity (ROP). We aim to determine if OCT imaging can aid in surgical decision-making for preterm infants with advanced ROP. METHODS: This case series included seven preterm infants with clinical stage 4 or 5 ROP who underwent bedside OCT imaging at a single academic center. Handheld OCT was performed before and/or after treatment (i.e. intravitreal bevacizumab, laser photocoagulation, and/or vitrectomy). OCT images were reviewed for presence of retinoschisis or retinal detachment, foveal involvement, and posterior extent of retinal elevation observed on indirect ophthalmoscopy. RESULTS: Among the seven preterm infants included, six infants (8 eyes) had clinical stage 4 ROP, and one infant (one eye) had stage 5 ROP. Preoperative OCT demonstrated foveal involvement and/or progressive traction in two eyes, which informed the decision to proceed with vitrectomy. In one eye with stage 5 ROP, postoperative OCT one month following vitrectomy revealed retinal reattachment not evident on clinical examination, supporting deferral of additional surgery. In six eyes treated with intravitreal bevacizumab and/or laser photocoagulation, OCT was helpful in monitoring posterior extension of retinal elevation. The absence of progression and/or improvement in retinoschisis in context with the clinical findings, supported the decision to avoid surgery in these cases. CONCLUSIONS: Handheld OCT provided valuable insights in evaluating foveal involvement, monitoring progression of retinal elevation, supporting informed clinical decision-making, and reducing the need for surgical intervention in select infants with advanced ROP.