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Published on: May 15, 2019
Evaluation of Hyaloid Artery Persistence as a Biomarker in Retinopathy of Prematurity Using OCT
Hanna N Luong1, Aaron S Coyner1, Elizabeth V Roti1
1Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon.
Insights
Hyaloid artery persistence, detected by handheld OCT, is linked to retinopathy of prematurity (ROP) severity. This finding suggests the hyaloid artery may be a new biomarker for ROP severity and retinal maturation in preterm infants.
Area of Science:
- Ophthalmology
- Neonatology
- Medical Imaging
Background:
- Retinopathy of prematurity (ROP) is a leading cause of visual impairment in preterm infants.
- Early detection and severity assessment of ROP are crucial for timely intervention.
- The hyaloid artery's regression pattern is a potential indicator of ocular development.
Purpose of the Study:
- To investigate the association between hyaloid artery persistence, visualized via handheld OCT, and the severity of ROP.
- To determine if hyaloid artery regression timing can serve as a biomarker for ROP severity.
Main Methods:
- Retrospective cohort study of 162 preterm infants' eyes undergoing ROP screening.
- Handheld ultra-widefield OCT used to detect hyaloid artery presence and model time to disappearance.
- Weibull survival analysis and cross-validated AUROCs used to assess ROP severity discrimination.
Main Results:
- Hyaloid artery was detected in 94% of eyes.
- Persistence was significantly prolonged in eyes with Mild and Severe ROP compared to No ROP.
- Median postnatal age of disappearance varied by ROP severity (9.1 weeks for No ROP, 11.7 for Mild, 12 for Severe).
- AUROCs showed moderate to strong discrimination between ROP severity groups.
Conclusions:
- Hyaloid artery persistence, detectable by OCT, is significantly associated with increased ROP severity.
- Hyaloid artery regression timing may function as a novel, quantifiable biomarker for ROP severity and retinal maturation in preterm infants.
Objective:
To evaluate whether hyaloid artery persistence, detected by handheld OCT, is associated with retinopathy of prematurity (ROP) severity.
Design:
A retrospective cohort study.
Subjects:
A total of 162 eyes of preterm infants undergoing ROP screening at a tertiary care neonatal intensive care unit were included.
Methods:
Handheld ultra-widefield OCT images were reviewed at each clinical encounter for the presence or absence of the hyaloid artery. Time to hyaloid artery disappearance was modeled using a Weibull accelerated failure time survival analysis incorporating interval censoring and clustering within subjects. Covariates included ROP severity (mild, moderate, or severe) and gestational age (GA). Leave-one-eye-out cross-validated area under the receiver operating characteristic curves (AUROCs) were calculated to evaluate the discriminative ability of hyaloid regression timing for ROP severity.
Main Outcome Measures:
The primary outcomes were postnatal age (PNA) at hyaloid artery disappearance and AUROC values for No vs. Mild, No vs. Severe, and Mild vs. Severe ROP.
Results:
The hyaloid artery was detectable by OCT in 152 of 162 (94%) eyes. Compared with eyes with No ROP, hyaloid artery persistence was significantly prolonged in Mild ROP (acceleration factor [AF], 1.354; P = 0.002) and Severe ROP (AF, 1.414; P = 0.006). Median PNA of hyaloid artery disappearance, adjusted for mean GA, was 9.1 weeks for No ROP, 11.7 weeks for Mild ROP, and 12 weeks for Severe ROP. Leave-one-eye-out cross-validated AUROCs demonstrated moderate discrimination between No versus Mild ROP (AUROC = 0.71) and Mild versus Severe ROP (AUROC = 0.76), and strong discrimination between No vs. Severe ROP (AUROC = 0.96).
Conclusions:
The hyaloid artery is commonly detectable in preterm infants using OCT. Persistence of the hyaloid artery is significantly associated with increasing ROP severity and may serve as a novel, quantifiable biomarker of disease severity and retinal maturation.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
