Importance: Macular edema during infancy, a subclinical feature identified in premature infants by handheld spectral-domain optical coherence tomography (SD-OCT), has been associated with poorer visual acuity and neurodevelopmental outcomes. Features of macular edema on fluorescein angiography (FA) are needed to understand its pathophysiology, but to date have not been reported previously. Objective: To investigate the FA features of macular edema during infancy. Design, Setting, and Participants: A retrospective review was conducted of 8 infants at Duke Eye Center who received simultaneous SD-OCT and FA imaging from July 1, 2011, to June 30, 2017. Research and clinical care images were obtained during examination of the infants under anesthesia or at the bedside in the neonatal intensive care unit. Main Outcomes and Measures: Side-to-side comparison of research handheld SD-OCT images and clinically indicated FA. Results: Imaging was conducted at a mean (SD) of 42.8 (4.2) weeks' postmenstruation age in the 8 infants (1 [13%] female; 2 [25%] African American; 6 [75%] white). Examination of the FA and SD-OCT images found (1) no macular fluorescein leakage in 3 eyes of 2 infants with retinopathy of prematurity without macular edema and 1 eye with a single cyst, (2) equivocal fluorescein leakage in 2 eyes of 1 infant with mild macular edema, (3) late macular fluorescein leakage in 4 eyes of 2 infants with moderate to severe macular edema, and (4) macular fluorescein leakage from posterior preretinal neovascularization in the macula in 4 eyes of 3 infants with retinopathy of prematurity without macular edema. Conclusions and Relevance: This observation of fluorescein leakage in 4 infant eyes with macular edema provides new insights into the possible mechanisms of this subclinical finding. Macular fluorescein leakage could indicate a breakdown or delayed maturation of the blood-retinal barrier or dysfunction of the retinal pigment epithelium. Furthermore, the cross-sectional OCT view aids in identifying preretinal neovascularization, which can also cause focal macular leakage in these infants. This new perspective may improve our understanding and potentially guide future treatments of premature infants with subnormal vision.
Importance: Macular edema during infancy, a subclinical feature identified in premature infants by handheld spectral-domain optical coherence tomography (SD-OCT), has been associated with poorer visual acuity and neurodevelopmental outcomes. Features of macular edema on fluorescein angiography (FA) are needed to understand its pathophysiology, but to date have not been reported previously. Objective: To investigate the FA features of macular edema during infancy. Design, Setting, and Participants: A retrospective review was conducted of 8 infants at Duke Eye Center who received simultaneous SD-OCT and FA imaging from July 1, 2011, to June 30, 2017. Research and clinical care images were obtained during examination of the infants under anesthesia or at the bedside in the neonatal intensive care unit. Main Outcomes and Measures: Side-to-side comparison of research handheld SD-OCT images and clinically indicated FA. Results: Imaging was conducted at a mean (SD) of 42.8 (4.2) weeks' postmenstruation age in the 8 infants (1 [13%] female; 2 [25%] African American; 6 [75%] white). Examination of the FA and SD-OCT images found (1) no macular fluorescein leakage in 3 eyes of 2 infants with retinopathy of prematurity without macular edema and 1 eye with a single cyst, (2) equivocal fluorescein leakage in 2 eyes of 1 infant with mild macular edema, (3) late macular fluorescein leakage in 4 eyes of 2 infants with moderate to severe macular edema, and (4) macular fluorescein leakage from posterior preretinal neovascularization in the macula in 4 eyes of 3 infants with retinopathy of prematurity without macular edema. Conclusions and Relevance: This observation of fluorescein leakage in 4 infant eyes with macular edema provides new insights into the possible mechanisms of this subclinical finding. Macular fluorescein leakage could indicate a breakdown or delayed maturation of the blood-retinal barrier or dysfunction of the retinal pigment epithelium. Furthermore, the cross-sectional OCT view aids in identifying preretinal neovascularization, which can also cause focal macular leakage in these infants. This new perspective may improve our understanding and potentially guide future treatments of premature infants with subnormal vision.
Authors: Ramiro S Maldonado; Rachelle V O'Connell; Neeru Sarin; Sharon F Freedman; David K Wallace; C Michael Cotten; Katrina P Winter; Sandra Stinnett; Stephanie J Chiu; Joseph A Izatt; Sina Farsiu; Cynthia A Toth Journal: Ophthalmology Date: 2011-09-21 Impact factor: 12.079
Authors: Michelle T Cabrera; Ramiro S Maldonado; Cynthia A Toth; Rachelle V O'Connell; Bei Bei Chen; Stephanie J Chiu; Sina Farsiu; David K Wallace; Sandra S Stinnett; Gabriela M Maradiaga Panayotti; Geeta K Swamy; Sharon F Freedman Journal: Am J Ophthalmol Date: 2011-09-16 Impact factor: 5.258
Authors: Domenico Lepore; Fernando Molle; Monica M Pagliara; Antonio Baldascino; Carmine Angora; Maria Sammartino; Graham E Quinn Journal: Ophthalmology Date: 2010-08-14 Impact factor: 12.079
Authors: Ramiro S Maldonado; Rachelle O'Connell; Simon B Ascher; Neeru Sarin; Sharon F Freedman; David K Wallace; Stephanie J Chiu; Sina Farsiu; Michael Cotten; Cynthia A Toth Journal: Arch Ophthalmol Date: 2012-05
Authors: Ramiro S Maldonado; Sharon F Freedman; C Michael Cotten; Jeffrey M Ferranti; Cynthia A Toth Journal: J AAPOS Date: 2011-02 Impact factor: 1.220
Authors: Adam M Dubis; C Devika Subramaniam; Pooja Godara; Joseph Carroll; Deborah M Costakos Journal: Ophthalmology Date: 2013-05-11 Impact factor: 12.079
Authors: Martin Hložánek; Zbyněk Straňák; Zuzana Terešková; Jan Mareš; Inka Krejčířová; Marie Česká Burdová Journal: Diagnostics (Basel) Date: 2022-05-18