Association Between Optic Nerve Morphology by Handheld Spectral Domain Optical Coherence Tomography and Intracranial Pathology in Preterm Infants.

This study investigates optic disc and macular morphology using handheld spectral domain-optical coherence tomography (SD-OCT) in preterm infants with and without brain pathology. In this prospective observational study, premature newborns underwent handheld SD-OCT at 36 weeks postmenstrual age. Semiautomated quantitative OCT analysis was performed including the optic disc and macula. Routine head ultrasound radiology reports were obtained from the medical record. A total of 69 patients (35 male and 34 female) were included. The average birth weight was 982.7 ± 277.4 g and gestational age was 27.99 ± 2.57 weeks. Extremely preterm infants born at <28 weeks' gestation had a larger cup diameter (P = 0.006), thinner nasal neural rim thickness (P = 0.010), and deeper maximal cup depth (P = 0.010) compared with preterm infants (≥28 weeks' gestation). Brain lesions on ultrasound examination were detected in 15 patients (21.7%), with all having intraventricular hemorrhage (IVH) and 2 patients also presenting with periventricular leukomalacia. Patients with IVH had a thicker central macular retinal nerve fiber layer, ganglion cell layer, and inner plexiform layer than those without IVH (P = 0.029, P = 0.022, and P = 0.002). These differences persisted after adjusting for retinopathy of prematurity stage (P = 0.042, P = 0.034, and P = 0.007, respectively). When controlling for gestational age, the ganglion cell layer and inner plexiform layer differences remained (P = 0.011 and P = 0.032, respectively). Optic nerve parameters did not differ between infants with and without IVH. IVH was associated independently with arrested foveal maturation with no discernible effect on optic disc morphology in the preterm newborn period. The macular structural changes detected by SD-OCT in preterm newborns with brain pathology may suggest the need for closer monitoring of visual development in these infants.