Choroidal measurements in decision making for retinopathy of prematurity: a decision tree analysis

Mohammadreza Mehrabi Bahar; Farhad Salari; Afsar Dastjanifarahani; Fariba Ghassemi; C Armitage Harper 3rd; Fatemeh Bazvand

doi:10.1186/s40942-023-00520-6

Choroidal measurements in decision making for retinopathy of prematurity: a decision tree analysis

Int J Retina Vitreous. 2024 Jan 11;10(1):4. doi: 10.1186/s40942-023-00520-6.

Authors

Mohammadreza Mehrabi Bahar¹, Farhad Salari¹, Afsar Dastjanifarahani¹, Fariba Ghassemi¹, C Armitage Harper 3rd², Fatemeh Bazvand³

Affiliations

¹ Retina Services, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran.
² Austin Retina Associates, University of Texas-San Antonio, Austin, USA.
³ Retina Services, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran. ft.bazvand@gmail.com.

Abstract

Background: To compare the choroidal thickness and vascular profile of premature infants with ROP (retinopathy of prematurity) using a handheld SD-OCT device.

Methods: We performed horizontal SD-OCT scans through the fovea in 115 eyes of 66 premature infants. Premature infants included 2 groups [infants with ROP requiring treatment (as treatment group) vs. infants without ROP or with ROP not- requiring treatment (as no-treatment group)] Choroidal thicknesses (CT) were measured at 5 points, including the fovea, 250 µm, and 500 µm mm nasal and temporal to the fovea. The choroidal vascularity index (CVI) and choroidal stromal index (CSI) were also calculated. The classification and regression tree (CRT) algorithm was used to predict the need for treatment based on all OCT characteristics.

Results: Mean CT was higher in 500 µm nasal to the fovea compared to temporal CT (275.8 ± 64.8 and 257.1 ± 57.07, P value < 0.03). No statistically significant difference was found regarding CVI, corrected CVI, and temporal and nasal CT in the treatment group versus the no-treatment group. The foveal CT was significantly lower in ROP patients with the plus disease compared to not-plus ROP (P value = 0.03. ANOVA, Bonferroni posthoc test). CT was not significantly different between plus and pre-plus patients (P-value = 0.9, ANOVA, Bonferroni posthoc test). No significant relationship was found between the stage of ROP and choroidal thickness (P value > 0.05, GEE). The decision tree analysis showed that in infants with ROP, the most important predictor for the need for treatment is CSI.

Conclusion: This study delineated the possible effectiveness of choroidal measurements as an additive to decision-making for ROP. We also demonstrated that choroidal involution is associated with the presence of plus disease, not with the stage of ROP. We demonstrated that choroidal measurements are very sensitive but not specific tools for assessing the need for treatment in ROP patients.

Keywords: Choroidal thicknesses; Choroidal vascular index; Intravitreal bevacizumab; Retinopathy of prematurity; Spectral domain optical coherence tomography.