THE DIAGNOSTIC SIGNIFICANCE OF FLUORESCENCE ANGIOGRAPHY FOR THE EARLY DETECTION AND PROGNOSTICATION OF THE DEVELOPMENT OF ACTIVE RETINOPATHY OF PREMATURITY IN THE INFANTS BORN ON THE DEADLINES OF GESTATION

Abstract

Aim. The objective of the present study was to elucidate the fluorescent angiographic characteristics, such as the features of retinal and choroidal microcirculation, depending on the duration of the active course of retinopathy of prematurity in the infants born on the deadlines of gestation (the gestational age of 21-26 weeks). Materials and methods. The study included 65 patients presenting with retinopathy of prematurity. A total of 102 sessions of fluorescence angiography (FA) of the retina were carried out, with 40% of the sessions being performed in duplicate. The gestational age of the infants ranged from 22 to 26 (mean 24.9+-1.0) weeks, their body weight at birth varied from 490 to 1,400 (mean BW 774.8+-152.6) g. All the patients were subdivided into 4 groups. Group 1 was comprised of 8 (12.3%) children at the initial stages of retinopathy of prematurity, group 2 consisted of 28 (43.1%) children presenting with threshold retinopathy of prematurity, group 3 was composed of 20 (30.8%) children with the recurring disorder, and group 4 involved 9 (13.8%) children experiencing induced regression of this pathology. The photographs of the fundus and digital video FA images were obtained with the use of the RetCam3 pediatric retinal camera (“Clarity”, USA). The 10% fluorescein solution was administered intravenously in the form of bolus injections at a dose of 7.5 mg/kg. Results. The present study has revealed some characteristic fluorescent and angiographic features of active retinopathy of prematurity in the extremely preterm born infants including instability of the retinal blood flow, variability in the filling of the choroid, various types of pathological branching of the blood vessels at the boundary between vascularized and avascular retina, etc. The comparative analysis of the angiograms and colour images of the fundus obtained with the use of the RetCam3 camera gave evidence of the high diagnostic value of the fluorescence angiography technique that provides the possibility for the early objective visualization and registration of the pathological changes in the retinal vasculature characteristic of the initial and threshold stages of the disease as well as for the reliable detection of the signs of its relapse (the local sites of re-proliferation) and regression of the pathology being considered. Conclusion. The application of the fluorescence angiography technique for the examination of the markedly prematurely born infants provides a safe and efficient tool allowing to greatly optimize both the early detection and prognostication of the development of active retinopathy of prematurity in the infants born on the deadlines of gestation.

Keywords

active retinopathy of prematurity / early gestational age / diagnostics / fluorescence angiography / laser-assisted treatment

References

[1] Федеральные клинические рекомендации. (Национальный протокол). Диагностика, мониторинг и лечение активной фазы ретинопатии недоношенных. Рос. педиатр. офтальмол. 2015; (1): 54-60.

[2] Катаргина Л.А. Ретинопатия недоношенных, современное состояние проблемы и задачи организации офтальмологической помощи недоношенным детям в РФ. Рос. педиатр. офтальмол. 2012; (1): 5-7.

[3] Сайдашева Э.И., Горелик Ю.В., Буяновская С.В., Ковшов Ф.В. Ретинопатия недоношенных: особенности течения и результаты лечения у детей со сроком гестации менее 27 недель. Рос. педиатр. офтальмол. 2015; (2): 28-32.

[4] Ng E., Lanigan B., OꞌKeefe M. Fundus fluorescein angiography in the screening for and management of retinopathy of prematurity. J. Pediatr. Ophthalmol. Strabismus. 2006; 43 (3): 85-90.

[5] Azad R.I., Chandra P., Khan M.A., Darswal A. Role of intravenous fluorescein angiography in early detection and regression of retinopathy of prematurity. J. Pediatr. Ophthalmol. Strabismus. 2008; 45 (10): 36-9.

[6] Lepore D. Fluorescein angiography in the management of retinopathy of prematurity. В кн.: Сборник научных трудов Научно-практической конференции с международным участием «Ретинопатия недоношенных». М.; 2016: 98.

[7] Сайдашева Э.И., Буяновская С.В., Ковшов Ф.В., Фомина Н.В. Информативность флюоресцентной ангиографии в диагностике ретинопатии недоношенных. В кн.: научных трудов Научно-практической конференции с международным участием «Ретинопатия недоношенных». М.; 2016: 118-21.

[8] Дитмар С., Хольц Ф.Г. Флюоресцентная ангиография в офтальмологии: Пер. с англ. под ред. М.М. Шишкина, А.А. Казарян. М.: ГЭОТАР-Медиа; 2011: 126-30.

[9] Хайман Х., Кельнер У., Ферстер М. Атлас по ангиографии глазного дна: Пер. с англ. под ред. Ю.С. Астахова, А.Б. Лисочкиной. М.: «МЕДпресс-информ»; 2008: 13-20.

[10] Lepore D., Molle F., Monica M. et al. Atlas of fluorescein angiographic findings in eyes undergoing laser for retinopathy of prematurity. Ophthalmology. 2011; 118 (1): 168-75.

[11] Shao Z., Dorfman А. et al. Choroidal Involution is a key component of oxygen-induced retinopathy. Retina. 2011; 52 (9): 238-48.

[12] Erol M., Coban D. et al. Choroidal thickness in infants with retinopathy of prematurity. Retina. 2016; 36 (6): 1191-8.

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