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Brief Report
May 2018

Fluorescein Angiographic Characteristics of Macular Edema During Infancy

Author Affiliations
  • 1Department of Ophthalmology, Duke University, Durham, North Carolina
JAMA Ophthalmol. 2018;136(5):538-542. doi:10.1001/jamaophthalmol.2018.0467
Key Points

Question  What are the fluorescein angiographic features of macular edema during infancy?

Findings  In this study of 8 infants with pediatric retinal vascular diseases, macular edema during infancy was associated with late fluorescein leakage in the central macula in 4 eyes of 2 infants. Fluorescein leakage was also found in preterm infants with advanced retinopathy of prematurity and posterior preretinal neovascularization in the absence of macular edema.

Meaning  Late leakage on fluorescein angiography likely indicates breakdown or delayed maturation of the blood-retinal barrier in the retina and may provide insights into future treatments.

Abstract

Importance  Macular edema during infancy, a subclinical feature identified in premature infants by handheld spectral-domain optical coherence tomography (SD-OCT), has been associated with poorer visual acuity and neurodevelopmental outcomes. Features of macular edema on fluorescein angiography (FA) are needed to understand its pathophysiology, but to date have not been reported previously.

Objective  To investigate the FA features of macular edema during infancy.

Design, Setting, and Participants  A retrospective review was conducted of 8 infants at Duke Eye Center who received simultaneous SD-OCT and FA imaging from July 1, 2011, to June 30, 2017. Research and clinical care images were obtained during examination of the infants under anesthesia or at the bedside in the neonatal intensive care unit.

Main Outcomes and Measures  Side-to-side comparison of research handheld SD-OCT images and clinically indicated FA.

Results  Imaging was conducted at a mean (SD) of 42.8 (4.2) weeks’ postmenstruation age in the 8 infants (1 [13%] female; 2 [25%] African American; 6 [75%] white). Examination of the FA and SD-OCT images found (1) no macular fluorescein leakage in 3 eyes of 2 infants with retinopathy of prematurity without macular edema and 1 eye with a single cyst, (2) equivocal fluorescein leakage in 2 eyes of 1 infant with mild macular edema, (3) late macular fluorescein leakage in 4 eyes of 2 infants with moderate to severe macular edema, and (4) macular fluorescein leakage from posterior preretinal neovascularization in the macula in 4 eyes of 3 infants with retinopathy of prematurity without macular edema.

Conclusions and Relevance  This observation of fluorescein leakage in 4 infant eyes with macular edema provides new insights into the possible mechanisms of this subclinical finding. Macular fluorescein leakage could indicate a breakdown or delayed maturation of the blood-retinal barrier or dysfunction of the retinal pigment epithelium. Furthermore, the cross-sectional OCT view aids in identifying preretinal neovascularization, which can also cause focal macular leakage in these infants. This new perspective may improve our understanding and potentially guide future treatments of premature infants with subnormal vision.

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