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.