Abstract
Introduction
Binocular indirect ophthalmoscopy (BIO) is fundamental for screening of retinopathy of prematurity (ROP). Digital retinal imaging devices with fluorescein angiography (FA) proved to be useful in screening and management of ROP. FA provides valuable additional information that is not detectable through ophthalmoscopy. FA images are relatively easy to interpret even by personnel without specific experience in ROP. The aim of this study is to evaluate reproducibility of FA for the screening and follow-up of ROP.
Methods
A total of 106 pairs of FA images of 30 eyes of 15 premature infants with stage II ROP were evaluated by 5 ophthalmologists: 2 experts, 2 non-experts, and 1 expert in reading FA in adult patients. Each operator gave a score to each of following parameters: leakage, ischemic areas, peripheral plus disease and vascular anomalies. The images were reviewed twice. Intra- and inter-concordance between the readers of the FA findings was evaluated by the means of Cohen's kappa coefficient (κ).
Results
The intra-operator concordance was very good (κ > 0.81) for all FA findings. Inter-operator concordance was good (κ > 0.41) for all operators and all FA findings. Global concordance was: substantial (intra–inter readers: κ > 0.61) for leakage, ischemic areas, and plus disease; almost perfect (κ > 0.81) for vascular anomalies; and moderate (κ = 0.41–0.60) for continuity/discontinuity of the ischemic areas. Total FA score was directly correlated to the percentage of treatment: a score ≥ 7 was correlated with 100% treatment and a score ≤ 3 with no treatment. Treatment timing was inversely correlated to FA score: a score ≥ 8 was correlated with a timely treatment (≤ 6 days), and a score ≤ 7 was correlated with a delayed treatment (< 10 days).
Conclusion
This study showed that FA represents a reproducible imaging technique. It is useful for detecting ROP progression, and to define the treatment timing and type.
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Acknowledgements
We thank the participants of the study.
Funding
No funding or sponsorship was received for this study or publication of this article.
Editorial Assistance
The authors are grateful to Dr. Sheila McVeigh for translation.
Authorship
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Prior Presentation
The abstract has been presented at The EVER 2018 congress, Nice, France (Oct. 4–6, 2018).
Disclosures
Donatella Barillà, Rosanna Guagliano, Chiara Bertone, Anna Maffia, Carlo Bruttini, Francesca Periti, Carmen Plaitano, Cristina Arpa, Silvia Montescani, Carmine Tinelli, Ivano Riva and Luciano Quaranta declare that they have no conflict of interest with this submission.
Compliance with Ethics Guidelines
This study received ethical approval from the ethics committee of the IRCCS Policlinico San Matteo on 26 July 2010, the approval number is E_201000003802. All subject signed an informed consent prior to initiation of this study, which adhered to the tenets of Helsinki and was approved by the Institutional Review Board committee.
Data Availability
The datasets during and/or analysed during the current study are available from the corresponding author on reasonable request.
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Barillà, D., Guagliano, R., Bertone, C. et al. Screening and Follow-Up of Acute ROP: Reproducibility of Fluorescein Angiography. Adv Ther 37, 860–868 (2020). https://doi.org/10.1007/s12325-019-01209-9
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DOI: https://doi.org/10.1007/s12325-019-01209-9