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A methodological approach for evaluation of foveal immaturity after extremely preterm birth

Journal article
Authors R. Rosen
Johan Sjöstrand
M. Nilsson
K. Hellgren
Published in Ophthalmic and Physiological Optics
Volume 35
Issue 4
Pages 433-441
ISSN 0275-5408
Publication year 2015
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
Pages 433-441
Language en
Keywords foveal development, foveal microanatomy, gestational age, optical coherence tomography, OPTICAL COHERENCE TOMOGRAPHY, AVASCULAR ZONE, VISUAL-ACUITY, CHILDREN, PREMATURITY, RETINOPATHY, HYPOPLASIA, THICKNESS, INFANTS, RETINA, Ophthalmology
Subject categories Clinical Medicine


PurposeTo characterize typical microanatomical alterations of immaturity in the fovea, that remain into childhood, after extremely preterm birth before 27weeks gestational age (GA) and to suggest a clinical methodological evaluation tool. MethodsSubjects were consecutively recruited at age 6.5years and organized infour groups (10 subjects in each): Group A (full-term), Group B (GA 25-27weeks) without retinopathy of prematurity (ROP), Group B* (GA 25-27weeks) and Group C (GA 23-24weeks) both with ROP stage 3. Foveal microanatomy was studied using a grading system of OCT-scans. ResultsPrematurely born children (including Group B, B* and C) had significantly reduced foveal depth (mean difference -53m, p<0.001), thicker inner retinal layer (mean difference 21.6, p=0.005) and thicker outer nuclear layer (mean difference 23.5, p<0.001) than controls. Foveal depth and inner retinal layer thickness were significantly correlated to GA (p=0.003 and p=0.017 respectively) within the preterm group. Foveal depth increased with 14.1m per week between GA 23 and 27. The three hyper reflective bands of the outer segments as well as a central protuberance of inner and outer segment layers were present in all children. ConclusionPrevious studies have revealed signs of immaturity affecting most retinal layers at time of birth in prematurely born children. The present study adds information to which extent these signs of underdevelopment remains to later in life. The applied method showed that premature birth before GA 27weeks commonly leads to characteristic anatomical alterations of the foveal anatomy expressed as reduced foveal depth and incomplete extrusion of the inner retinal layers. Although deviations of the outer nuclear layers can be seen in the most extremely preterm born children, the outer part of the fovea generally develops well, independent of prematurity. The single most important determinant for the degree of foveal maturation seems to be GA.

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