EXUDATIVE RETINAL DETACHMENT DOCUMENTED BY HANDHELD SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY AFTER RETINAL LASER PHOTOCOAGULATION FOR RETINOPATHY OF PREMATURITY

INCIDENCE AND RISK FACTORS FOR EXUDATIVE RETINAL DETACHMENT FOLLOWING LASER PHOTOCOAGULATION FOR RETINOPATHY OF PREMATURITY

PURPOSE

Exudative retinal detachment (ERD) may result from laser photocoagulation for retinopathy of prematurity. Although risk factors have been hypothesized from case reports, comparative studies have not been reported. We sought to evaluate risk factors for ERD following laser, comparing affected and unaffected infants.

METHODS

Retrospective cohort study of infants undergoing retinopathy of prematurity laser at the Children's Hospital of Philadelphia over 6 years. All received near-confluent laser of avascular retina. Demographic, medical, and procedural risk factors for ERD were evaluated in univariate analysis because of the rarity of ERD.

RESULTS

Among 149 lasered infants, 6 infants (4%, 95% confidence interval [CI] 1.5%-8.6%) developed ERD. Race was a significant risk factor ( P = 0.01). Among 71 African American or Hispanic infants, 6 (8.5%, 95% CI 3.2%-17.5%) developed ERD. Among 78 non-African American or Hispanic infants, 0 (0%, 95% CI 0%-4.6%) developed ERD. There were no significant differences in the other studied factors.

CONCLUSION

Exudative retinal detachment was uncommon (4%) following retinopathy of prematurity laser. Despite so few cases, darker pigmented race with likely increased pigmented fundi was significantly associated with an increased ERD risk. Further study may reveal whether increased choroidal pigment causes greater laser tissue damage or makes it difficult to discern the ora, resulting in inadvertent lasering of the ciliary body, leading to ERD.

Exudative retinal detachment after laser in retinopathy of prematurity

Treatment of retinopathy of prematurity with laser photocoagulation can be very effective in preventing future blindness, but its complications should be well understood by the ophthalmologists performing the treatment. We present the case of a 4-month-old girl in whom laser photocoagulation led to an exudative retinal detachment in both eyes. The fluid eventually resolved after treatment with topical and systemic steroids, but the effects of persistent fluid led to permanent photoreceptor loss. Optical coherence tomography can be useful in diagnosing the complication of exudative retinal detachment after laser photocoagulation and monitoring treatment response.

Exudative Retinal Detachment After ROP Laser Photocoagulation

Exudative retinal detachment (ERD) can be a rare postoperative complication of laser photocoagulation surgery when used to treat type I retinopathy of prematurity (ROP). We present a case of bilateral ERD following ROP laser photocoagulation. A preterm male infant born at 24 weeks gestation and weighing 600 grams was diagnosed with stage 3/zone II/pre-plus ROP in both eyes. He was on oxygen therapy for 92 days due to chronic lung disease and was treated with laser photocoagulation at 40 weeks postmenstrual age. Initial laser settings (in use for over 15 years) were 300 mW power, 300 ms duration, and 300 ms intervals. Due to strong laser absorption, power was decreased to 250 mW for most of the procedure. He was prescribed prednisolone acetate drops four times per day for postoperative care. One week later, he developed complete ERD in both eyes. The patient was monitored in the neonatal intensive care unit (NICU) for three weeks and prednisolone acetate drops were increased to every two hours and tapered over one month. Complete resolution of ERD with residual peripheral exudate bilaterally was observed eight weeks after surgery.

This case suggests that even after the settings of an ROP laser have been used safely for 15 years, it is important to tailor settings for each individual patient utilizing the least power and duration for laser application as possible. Furthermore, this case highlights the importance of titrating laser power in response to spot blanching throughout the procedure. However, near-complete resolution of post-ROP laser ERD is possible with minimal changes to standard postoperative management.

Atypical Late-Onset Exudative Retinal Detachment in a Treatment-Naïve Infant With Retinopathy of Prematurity

A male infant born at 23 weeks gestation with a birthweight of 660 grams presented with retinopathy of prematurity (ROP) that began progressing at 44 weeks. He subsequently developed Zone III, Stage 3, pre-plus disease in both eyes (OU), as well as scattered exudates in the macula, dragged vessels temporally, and an exudative retinal detachment temporally in the left eye after a period of regressing and stable ROP. After bilateral laser photocoagulation, there was regression of the neovascularization, resolution of the exudative detachment, and eventual stabilization of disease OU by 12 months postmenstrual age. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:403-406.].

Macular Sequelae Following Exudative Retinal Detachment After Laser Photocoagulation for Retinopathy of Prematurity

BACKGROUND AND OBJECTIVE

To report a series of exudative retinal detachments (ERDs) following laser photocoagulation for retinopathy of prematurity (ROP).

PATIENTS AND METHODS

Retrospective case series.

RESULTS

Eleven eyes of seven infants were identified who developed ERD following laser. Median gestation age was 25 weeks (interquartile range [IQR]: 24-27 weeks), and median birth weight was 662 grams (IQR: 538-850 grams). Median postmenstrual age at time of laser was 35 weeks (IQR: 33-39 weeks). ERD was diagnosed at a median of 7 days (IQR: 5-7 days) after laser and was managed with steroids. Bevacizumab was also used for certain cases. Time to resolution ranged from 1 to 5 weeks. Macular pigment changes, atrophy, window defect on fluorescein angiography, and photoreceptor loss on optical coherence tomography were noted in some cases following ERD resolution. Excluding one patient who expired at 3 months, median length of follow-up was 10 years (IQR: 9-13.5 years). Overall, only one patient, who presented with less severe ERD, had normal vision.

CONCLUSIONS

ERD is an uncommonly reported complication following laser for ROP. Macular changes following ERD resolution may have negative visual consequences. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:698-705.].

Handheld spectrally encoded coherence tomography and reflectometry for motion-corrected ophthalmic optical coherence tomography and optical coherence tomography angiography

Optical coherence tomography (OCT) is the gold standard for quantitative ophthalmic imaging. The majority of commercial and research systems require patients to fixate and be imaged in a seated upright position, which limits the ability to perform ophthalmic imaging in bedridden or pediatric patients. Handheld OCT devices overcome this limitation, but image quality often suffers due to a lack of real-time aiming and patient eye and photographer motion. We describe a handheld spectrally encoded coherence tomography and reflectometry (SECTR) system that enables simultaneous en face reflectance and cross-sectional OCT imaging. The handheld probe utilizes a custom double-pass scan lens for fully telecentric OCT scanning with a compact optomechanical design and a rapid-prototyped enclosure to reduce the overall system size and weight. We also introduce a variable velocity scan waveform that allows for simultaneous acquisition of densely sampled OCT angiography (OCTA) volumes and widefield reflectance images, which enables high-resolution vascular imaging with precision motion-tracking for volumetric motion correction and multivolumetric mosaicking. Finally, we demonstrate in vivo human retinal OCT and OCT angiography (OCTA) imaging using handheld SECTR on a healthy volunteer. Clinical translation of handheld SECTR will allow for high-speed, motion-corrected widefield OCT and OCTA imaging in bedridden and pediatric patients who may benefit ophthalmic disease diagnosis and monitoring.

A Structure-Based Drug Discovery Paradigm

Structure-based drug design is becoming an essential tool for faster and more cost-efficient lead discovery relative to the traditional method. Genomic, proteomic, and structural studies have provided hundreds of new targets and opportunities for future drug discovery. This situation poses a major problem: the necessity to handle the “big data” generated by combinatorial chemistry. Artificial intelligence (AI) and deep learning play a pivotal role in the analysis and systemization of larger data sets by statistical machine learning methods. Advanced AI-based sophisticated machine learning tools have a significant impact on the drug discovery process including medicinal chemistry. In this review, we focus on the currently available methods and algorithms for structure-based drug design including virtual screening and de novo drug design, with a special emphasis on AI- and deep-learning-based methods used for drug discovery.