The clinical use of ultra – Wide field imaging and intravenous fluorescein angiography in infants with retinopathy of prematurity

Purpose: To investigate the potential benefits and practicality of ultra – wide field (UWF) imaging and intravenous UWF fluorescein angiography (IV UWF – FA) in infants with retinopathy of prematurity (ROP) using an Optos® California device. Methods: This retrospective study involved 46 infants with a history of ROP who underwent UWF imaging with or without IV UWF – FA. ROP characteristics were identified using UWF color imaging. Retinal vascular findings following treatment were also assessed at IV UWF – FA analysis. All imaging sessions were performed under topical anesthesia without sedation. Main outcomes were the appearance of ROP at UWF color imaging and IV UWF–FA analysis, including status of ROP, neovascularizations, presence of plus disease, retinal vascular details, and resolution after treatment. Results: Seven (three girls) of the 46 infants (22 girls) underwent IV UWF–FA. Twelve IV UWF–FA sessions were performed in total. The oldest infant during IV UWF–FA analysis was at 55 postmenstrual weeks. Clinical characteristics of disease were easily identified at UWF color imaging. IV UWF–FA images also clearly revealed non-perfused retinal areas, fluorescein leakage, macular edema, retinal vascular abnormalities, and the status of the peripheral vascular termini. Complications of IV UWF–FA occurred in one infant in the form of patchy yellow skin discoloration around the injection site which completely disappeared on the first day following the procedure. Conclusions: Providing a high resolution panoramic view of the retina in a single image capture with no need for contact with the cornea appear to represent potential advantages of UWF imaging in infants with ROP. IV UWF–FA also seems to be a safe procedure which can be performed under topical anesthesia and that shows detailed retinal vascular alterations in patients with ROP. © 2021 Elsevier B.V.