Pediatric Retinal Imaging with SD-OCT

摘要

Objective: Optical coherence tomography (OCT) allows routine examination of the human retina. While conventional OCT devices are limited mainly to adults, the availability of a handheld system enables expansion of the technique to pediatric populations, with the primary clinical applications being shaken baby syndrome and retinopathy of prematurity. It is thought that some aspects of foveal development continue after birth; thus we sought to apply this technique to examine the postnatal aspects of foveal development in a series of pediatric patients. Methods: Twenty-seven subjects ranging in age from 30 weeks gestation to 4 years of age were imaged using Bioptigen Hand Held Probe SD-OCT (HHP-SDOCT) (Bioptigen, Research Triangle Park, NC, USA). Sixty-three total imaging sessions were performed, with some subjects being followed for several weeks during their stay in the NICU or undergoing several exams under anesthesia (EUA). We evaluated the success rate of obtaining useable images, instrument usability, occurrence of sub-clinical pathology, and the appearance of the fovea compared to adults. Results: We obtained usable images in 71% of awake infants in the NICU (39/55) and 100% (8 of 8) of subjects imaged as part of an EUA. These numbers are comparable to other reports. The size and weight of the handheld probe was generally well tolerated by six users, though smaller hands had some difficulty manipulating the probe. Qualitatively, foveal pit morphology in the younger infants was clearly distinguishable from the adult retina a?? specifically, the excavation of the inner retina was incomplete in the young infants. Retinal lamination also differed from adults a?? the outer photoreceptor layers (ELM and IS/OS junction) were absent in the earliest retinas and emerged around postnatal week 10, starting in the periphery and moving towards the fovea. These features were consistent with that previously documented using histological techniques. Conclusions: Hand-held OCT imaging is a viable technique for assessing normal and diseased neonate retinas. Longitudinal imaging should offer the opportunity to characterize the postnatal aspects of foveal development.