Purpose

Aggressive posterior retinopathy of prematurity (AP-ROP) is a vision-threatening disease with a significant rate of progression to retinal detachment. The purpose of this study was to characterize AP-ROP quantitatively by demographics, rate of disease progression, and a deep learning-based vascular severity score.

Design

Retrospective analysis.

Participants

The Imaging and Informatics in ROP cohort from 8 North American centers, consisting of 947 patients and 5945 clinical eye examinations with fundus images, was used. Pretreatment eyes were categorized by disease severity: none, mild, type 2 or pre-plus, treatment-requiring (TR) without AP-ROP, TR with AP-ROP. Analyses compared TR with AP-ROP and TR without AP-ROP to investigate differences between AP-ROP and other TR disease.

Methods

A reference standard diagnosis was generated for each eye examination using previously published methods combining 3 independent image-based gradings and 1 ophthalmoscopic grading. All fundus images were analyzed using a previously published deep learning system and were assigned a score from 1 through 9.

Main Outcome Measures

Birth weight, gestational age, postmenstrual age, and vascular severity score.

Results

Infants who demonstrated AP-ROP were more premature by birth weight (617 g vs. 679 g; P = 0.01) and gestational age (24.3 weeks vs. 25.0 weeks; P < 0.01) and reached peak severity at an earlier postmenstrual age (34.7 weeks vs. 36.9 weeks; P < 0.001) compared with infants with TR without AP-ROP. The mean vascular severity score was greatest in TR with AP-ROP infants compared with TR without AP-ROP infants (8.79 vs. 7.19; P < 0.001). Analyzing the severity score over time, the rate of progression was fastest in infants with AP-ROP (P < 0.002 at 30–32 weeks).

Conclusions

Premature infants in North America with AP-ROP are born younger and demonstrate disease earlier than infants with less severe ROP. Disease severity is quantifiable with a deep learning-based score, which correlates with clinically identified categories of disease, including AP-ROP. The rate of progression to peak disease is greatest in eyes that demonstrate AP-ROP compared with other treatment-requiring eyes. Analysis of quantitative characteristics of AP-ROP may help improve diagnosis and treatment of an aggressive, vision-threatening form of ROP.

中文翻译：

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早产儿侵袭性后部视网膜病变：北美大型队列的临床和定量成像特征。

目的

早产儿侵袭性后部视网膜病变 (AP-ROP) 是一种威胁视力的疾病，其进展为视网膜脱离的速度非常快。本研究的目的是通过人口统计学、疾病进展速度和基于深度学习的血管严重程度评分来定量表征 AP-ROP。

设计

回顾性分析。

参与者

使用来自 8 个北美中心的 ROP 成像和信息学队列，包括 947 名患者和 5945 次具有眼底图像的临床眼科检查。预处理眼睛按疾病严重程度分类：无、轻度、2 型或预加、需要治疗 (TR) 无 AP-ROP、TR 有 AP-ROP。分析比较了带 AP-ROP 的 TR 和不带 AP-ROP 的 TR，以研究 AP-ROP 与其他 TR 疾病之间的差异。

方法

使用先前公布的方法结合 3 个独立的基于图像的分级和 1 个检眼镜分级，为每次眼部检查生成参考标准诊断。所有眼底图像都使用先前发布的深度学习系统进行分析，并分配了 1 到 9 的分数。

主要观察指标

出生体重、胎龄、经后年龄和血管严重程度评分。

结果

表现出 AP-ROP 的婴儿在出生体重（617 g 对 679 g；P  = 0.01）和胎龄（24.3 周对 25.0 周；P < 0.01）方面更早产，并且在更早的经后年龄（34.7周与 36.9 周；P < 0.001）与没有 AP-ROP 的 TR 婴儿相比。与没有 AP-ROP 婴儿的 TR 相比，有 AP-ROP 婴儿的 TR 的平均血管严重程度评分最高（8.79 对 7.19；P  < 0.001）。随着时间的推移分析严重程度评分，AP-ROP 婴儿的进展速度最快（ 在 30-32 周时P < 0.002）。

结论

在北美，患有 AP-ROP 的早产儿比 ROP 不太严重的婴儿出生时更年轻，并且更早地表现出疾病。疾病严重程度可通过基于深度学习的评分进行量化，该评分与临床确定的疾病类别相关，包括 AP-ROP。与其他需要治疗的眼睛相比，表现出 AP-ROP 的眼睛进展到疾病高峰的速度最大。分析 AP-ROP 的定量特征可能有助于改进对侵袭性、威胁视力的 ROP 形式的诊断和治疗。