OCT findings as a biomarker of disease activity in retinopathy of prematurity.

PURPOSE: To determine the value of handheld spectral-domain OCT (SD-OCT) in detecting macular changes in retinopathy of prematurity (ROP) and their association with disease activity. METHODS: This cross-sectional study included 95 eyes of 59 infants diagnosed with treatment-requiring ROP. All eyes underwent indirect ophthalmoscopic examination and handheld SD-OCT imaging prior to treatment. Clinical staging, presence of plus disease, and prior therapies were recorded. OCT images were analyzed for cystoid macular edema (CME), retinoschisis, preretinal tissue, and subclinical retinal detachment. Associations between OCT findings and clinical parameters were evaluated. RESULTS: Based on indirect ophthalmoscopy, 34.7% of eyes were at stage 3, 34% stage 4 A, 12% stage 4B, 3% aggressive ROP, and 14% presented with persistent avascular retina. CME was detected in 6 eyes (6.3%), significantly associated with plus disease (67%, p = 0.04), but not with gestational age, birth weight, or ROP stage. Retinoschisis was identified in 7 eyes (7.3%), predominantly in stage 4 A cases (71.4%). Preretinal tissue (3.1%) was observed mainly in aggressive ROP eyes. OCT refined staging in one case, reclassifying stage 4 A as stage 4B due to macular involvement. CONCLUSION: Handheld SD-OCT uncovers macular abnormalities invisible to ophthalmoscopy and can alter disease staging. The significant association of CME with plus disease highlights its potential as biomarkers of disease activity. Routine OCT integration could transform ROP evaluation by refining staging and guiding timely intervention.