The analysis of foveal microvascular anomalies in retinopathy of prematurity after anti-vascular endothelial growth factor therapy on optical coherence tomography angiography

Abstract Purpose To investigate the quantitative vascular or structural differences in the foveal section of the eyes in ROP children and healthy children using optical coherence tomography angiography (OCTA).Methods This cross-sectional observational comparative study consisted of 75 eyes (44 subjects). Subjects were divided into 4 groups based on the diagnosis or treatment: diagnosed with ROP and treated by intravitreal injection of Conbercept, or Ranibizumab, lesions spontaneously regressed, and healthy age-matched term-born children. Central foveal thickness (CFT), foveal avascular zone (FAZ), superficial/deep capillary plexus (SCP/DCP), and choroidal vessel density (VD) at the foveal section were collected by spectral-domain OCT and OCTA. Correlations between foveal microvasculature, preterm status and visual acuity were also evaluated.Results There were significant differences between the four groups in the FAZ area, CFT, VD-SCP (whole-image), and VD-SCP (parafoveal). The FAZ area of ROP children was significantly smaller than that in age-matched term-born healthy children (p=0.009). The CFT of group Conbercept was considerably lower than that of the group Ranibizumab (p=0.044). The FAZ area showed a positive correlation with choroid VD (p=0.012) and a negative correlation with CFT, VD-SCP (foveal), and VD-DCP (foveal)(p<0.001, p<0.001, p=0.001), whilst the CFT was positively correlated with VD-SCP (foveal) and VD-DCP (foveal)(p=0.003, p=0.001).Conclusion ROP children possess a smaller FAZ area, of which no significant difference is noted when comparing different anti-VEGF agents employed. Anti-VEGF treatment could reduce the CFT, and Conbercept had a better performance than Ranibizumab. Correlation between the microvascular anomalies and central foveal thickness also exists.