Accepted Manuscript Choroidal Imaging with Use of Hand-held Spectral Domain Optical Coherence Tomography in Preterm and Term Infants Susan M. Carden, MBBS, FRANZCO, FRACS, PhD PII:
To appear in:
Survey of Ophthalmology
Received Date: 23 January 2014 Accepted Date: 23 January 2014
Please cite this article as: Carden SM, Choroidal Imaging with Use of Hand-held Spectral Domain Optical Coherence Tomography in Preterm and Term Infants, Survey of Ophthalmology (2014), doi: 10.1016/j.survophthal.2014.01.007. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Choroidal Imaging with Use of Hand-held Spectral Domain Optical Coherence Tomography in Preterm and Term Infants Tomas A. Moreno, Rachelle V. O'Connell, Stephanie J. Chiu, Sina Farsiu, Michelle T. Cabrera, Ramiro S. Maldonado, Du Tran-Viet, Sharon F. Freedman, David K. Wallace, and Cynthia A. Toth Invest Ophthalmol Vis Sci. 2013 June; 54(6): 4140–4147. Published online 2013 June 14. doi: 10.1167/iovs.12-11471
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Abstract Purpose.To determine whether choroidal imaging is feasible in preterm and term infants using an 840nm portable spectral domain optical coherence tomography (SD-OCT) system without the use of enhanced-depth imaging techniques and to assess choroidal development by comparing choroidal thickness of preterm infants, term infants, and adults. Methods. SD-OCT images were obtained from 86 preterm infants, 59 term infants, and nine adults using a portable SD-OCT system plus nine adults using a tabletop system. An unprocessed image across the macula from one randomly selected eye of each participant was selected for determination of whether the choroidal-scleral junction (CSJ) could be visualized and for measurement of choroidal thickness. Results. Subfoveal CSJ was visualized in 96% of young-preterm infants (imaged from 30–36 weeks postmenstrual age [PMA]); 78% of term-aged preterm infants (imaged from 37–42 weeks PMA); 49% of term infants; and 39% of adult subjects. Racial pigmentation did not affect CSJ visibility in young-preterm infants (P = 0.57). Subfoveal choroidal thickness (SFCT) in young-preterm infants, term-aged preterm infants, term infants, and adults was 176 ± 53 µm, 289 ± 92 µm, 329 ± 66 µm, and 258 ± 66 µm, respectively, and these were all statistically significantly different from one another except term-aged preterms to adults. Conclusions. Infant choroid can be imaged with a portable SD-OCT system without enhanced depth imaging. Melanin in the RPE and choroid does not hinder outer choroidal imaging in young-preterm infants without advanced retinopathy of prematurity (ROP). In preterm infants, choroidal thickness increased with age but was thinner when compared to term infants suggesting delayed development due to ROP.
Moreno et al describe their studies in choroidal imaging using the hand-held, non-contact, spectral domain optical coherence tomography (SD-OCT) in the neonatal intensive care unit. They compare images from preterm infants, term infants and adults. The authors aimed to visualize the choroidal-scleral junction with the SD-OCT.
In term-aged infants, there was some difficulty with this because the pigment in the choroid had increased making the junction indistinct. In contrast, the choroidal-scleral junction in the pre-term infants was easier to visualize because the choroidal pigment had not developed sufficiently. As Moreno et al comment, the choroidal pigment tends to develop at around 34 weeks postmenstrual age. On the other hand, the pigment in the RPE layer develops much earlier on in gestation, at about 2 months. The choroid in the preterm infants was thinner than in the term infants, and while it did continue to develop and thicken, it stayed thinner than in the term infants. Questions arise as to why this might be important. The blood supply of photoreceptors is from the choriocapillaris; could a thinner choroid lead to less nutrient supply and a build-up of metabolites? In other words, could the growth of the photoreceptors be ‘stunted’ due to having an inadequate blood supply? In the examination and treatment of retinopathy of prematurity, our attention has been focused on the retinal blood vessels. But the choroid must play a significant part too.
SD-OCT has revolutionized our management of adults with retinal disease. That technology has only recently become available for infants. While it is in its early days, the potential is great. It may be that information such as choroidal thickness estimates helps us to decide which infants are more atrisk of developing severe retinopathy of prematurity. As more information comes to light and as the technique improves in terms of ease and manageability in the nursery, our understanding of the developing preterm retina and choroid should expand.
Susan M. Carden MBBS, FRANZCO, FRACS, PhD
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