Association between retinal vascular fractal dimensions and retinopathy of prematurity: an AI-assisted retrospective case-control study.

PURPOSE: The main objective of this study was to analyze the fractal dimensions (D(f)) of retinal vasculature in premature infants with retinopathy of prematurity (ROP) and determine their correlation with ROP severity.

METHODS

We conducted a single-center retrospective case-control study involving 641 premature patients with ROP (641 eyes) and 684 normal preterm infants (684 eyes) matched for corrected gestational age (CGA). Computer-assisted techniques were used to quantify peripapillary retinal vascular D(f), vessel tortuosity (VT), and vessel width (VW).

RESULTS

Compared to the normal preterm groups, patients with ROP exhibited a significant increase in retinal vascular D(f) by 0.0061 (P = 0.0002). Subgroup analyses revealed a significant association between increasing ROP severity and increased retinal vascular D(f) (P < 0.05). Multivariable-adjusted ordered logistic regression models demonstrated that retinal vascular D(f) (aOR: 3.307, P < 0.0001) was significantly independent and associated with ROP severity. For every 0.1 increase in D(f), the probability of ROP requiring intervention increased by 33.07%. Multiple linear regression models indicated a significant positive correlation between D(f) and VT, as well as VW around the optic disc (P < 0.0001). For every 1 (104 cm-3) increase in VT, D(f) increased by 0.0010. Similarly, for every 1 (μm) increase in VW, D(f) increased by 0.0025.

CONCLUSIONS

Our findings suggest that increased D(f) in retinal vessels is a pathological characteristic of ROP. This increase may be attributed to the curvature and width of the retinal vasculature in infants with ROP. Quantitative measurement of retinal vascular D(f) could serve as a valuable vascular indicator for assessing the severity of ROP.