title: Understanding clinically undetected macular changes in early retinopathy of prematurity on spectral domain optical coherence tomography.
abstract: OBJECTIVE
  To investigate macular changes in acute retinopathy of prematurity (ROP).
  
  
  METHODS
  Fifty-four premature infants with ROP and 20 controls underwent routine ROP screening with indirect ophthalmoscopy and imaging. A tabletop spectral domain optical coherence tomography (SD-OCT) scanner (Spectralis; Heidelberg Engineering, Heidelberg, Germany) was converted into a handheld device to image infants in the office sans sedation.
  
  
  RESULTS
  SD-OCT images were obtained in all infants in the office. On SD-OCT, 23 of 79 eyes (29.1%) with stage 2 ROP showed abnormal foveal changes despite clinically normal foveae. Of the 23 eyes, 2 distinct patterns of foveal involvement were observed: "pattern A," which was characterized by dome-shaped foveal elevation and cystoid spaces with highly reflective intervening vertical septae, and "pattern B," which was characterized by preservation of the foveal depression with fewer intraretinal cystoid spaces. These patterns were seen in 12 (52.2%) and 11 (47.8%) eyes, respectively. All eyes (100%) belonging to stage 1 ROP (27) and the normal group (40) had no abnormal SD-OCT changes. The mean central foveal thickness was 156.9 ± 28.3 μm, 206.5 ± 98.7 μm, and 135.9 ± 17.6 μm for stage 1, 2, and normal eyes, respectively (P < 0.001). Nineteen of the 23 eyes underwent serial imaging at 52 weeks' postmenstrual age (PMA), and all of them revealed normalization of foveal contours at this visit.
  
  
  CONCLUSIONS
  SD-OCT changes of the macula in mild ROP have not been previously described. Our method reveals that infants may be imaged supine and unanesthetized in the office. We hypothesize that these transient foveal changes at the critical time of fovealization in premature infants may influence their visual acuity in the adult life.
authors.affiliation: Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India. anandvinekar@yahoo.com
authors.forename: Anand
authors.initials: A
authors.lastname: Vinekar
authors.forename: Kavitha
authors.initials: K
authors.lastname: Avadhani
authors.forename: Munusamy
authors.initials: M
authors.lastname: Sivakumar
authors.forename: Padmamalini
authors.initials: P
authors.lastname: Mahendradas
authors.forename: Mathew
authors.initials: M
authors.lastname: Kurian
authors.forename: Sherine
authors.initials: S
authors.lastname: Braganza
authors.forename: Rohit
authors.initials: R
authors.lastname: Shetty
authors.forename: Bhujang K
authors.initials: BK
authors.lastname: Shetty
mesh_terms: D000208:Acute Disease; D005260:Female; D005584:Fovea Centralis / Q000473:pathology; D005654:Fundus Oculi; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008266:Macula Lutea / Q000473:pathology*; D008297:Male; D009887:Ophthalmoscopy / Q000379:methods; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence / Q000379:methods*