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Foveal Differentiation and Inner Retinal Displacement Are Arrested in Extremely Premature Infants
Matthew L O'Sullivan1,2, Gui-Shuang Ying3, Shwetha Mangalesh1
1Department of Ophthalmology, Duke University, Durham, North Carolina, United States.
Insights
Foveal development is disrupted in preterm infants, with shallow pits and thick inner retinal layers evident from 30 weeks postmenstrual age. These differences persist, indicating arrested foveal maturation after preterm birth.
Area of Science:
- Ophthalmology
- Developmental Biology
- Neonatology
Background:
- Prematurity is associated with foveal hypoplasia in children.
- The precise timing and developmental course of foveal alterations following preterm birth are not well understood.
Purpose of the Study:
- To investigate the developmental trajectory of foveal pit morphology and retinal layer thickness in preterm infants.
- To determine if foveal development is altered from the time of preterm birth.
Main Methods:
- Serial optical coherence tomography (OCT) imaging of 102 preterm infants (30-42 weeks postmenstrual age).
- Measurement of foveal pit depth, inner retinal layer (IRL) thickness, and outer retinal layer (ORL) thickness.
- Comparison of foveal parameters based on gestational age using mixed-effects models.
Main Results:
- Foveal pit depth and IRL thickness were inversely related to gestational age.
- More premature infants exhibited thicker IRLs and shallower foveal pits.
- These differences were apparent by 30 weeks postmenstrual age and persisted through 42 weeks postmenstrual age, with no significant progression in pit deepening or IRL thinning.
Conclusions:
- Foveal development is arrested in extremely preterm infants from the earliest observed ages and does not progress normally.
- The normal developmental displacement of the inner retinal layer from the foveal center does not occur post-preterm birth.
- Foveal hypoplasia in premature children likely results from disturbances in foveal development manifesting within weeks of birth.
Purpose:
Children with a history of prematurity often have poorly developed foveae but when during development foveal differences arise. We hypothesize that the course of foveal development is altered from the time of preterm birth.
Methods:
Eyes of 102 preterm infants undergoing retinopathy of prematurity screening examinations in the STudy of Eye imaging in Premature infantS (BabySTEPS) (NCT02887157) were serially imaged between 30 and 42 weeks postmenstrual age (PMA) using handheld optical coherence tomography systems. Total retinal thickness, inner retinal layer (IRL) thickness, and outer retinal layer (ORL) thickness were measured at the foveal center and parafovea. Foveal put depth, IRL thickness, and ORL thickness were compared between infants born at different gestational ages using mixed effects models.
Results:
Foveal pit depth and IRL thickness were inversely related to gestational age; on average, the most premature infants had the thickest IRL and shallowest pits at all PMAs. Differences were evident by 30 weeks PMA and persisted through 42 weeks PMA. The foveal pits of the most premature infants did not progressively deepen, and the IRLs did not continue to thin with increasing chronological age.
Conclusions:
Foveation in extremely preterm infants is arrested from the earliest observed ages and fails to progress through term equivalent age. The developmental displacement of the IRL from the foveal center into the parafovea does not occur normally after preterm birth. These observations suggest that foveal hypoplasia seen in children with history of prematurity is due to disturbances in foveal development that manifest within weeks of birth.
