Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon.
School of Computer Science, University of Lincoln, Lincoln, United Kingdom; Massachusetts General Hospital & Brigham and Women's Hospital Center for Clinical Data Science, Boston, Massachusetts.
Ophthalmology. 2020 Aug;127(8):1105-1112. doi: 10.1016/j.ophtha.2020.01.052. Epub 2020 Feb 7.
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.
Retrospective analysis.
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.
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.
Birth weight, gestational age, postmenstrual age, and vascular severity score.
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).
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.
严重型早产儿视网膜病变（AP-ROP）是一种威胁视力的疾病，其视网膜脱离的进展率很高。本研究旨在通过人口统计学、疾病进展率和基于深度学习的血管严重程度评分对 AP-ROP 进行定量分析。
回顾性分析。
本研究使用了来自 8 个北美中心的成像和 ROP 信息学队列，其中包括 947 名患者和 5945 次临床眼部检查的眼底图像。预处理眼根据疾病严重程度进行分类：无、轻度、2 型或前加、无 AP-ROP 的治疗需要（TR）、有 AP-ROP 的 TR。分析比较了有 AP-ROP 的 TR 和无 AP-ROP 的 TR，以研究 AP-ROP 与其他 TR 疾病之间的差异。
使用先前发表的方法，结合 3 种独立的基于图像的分级和 1 种眼底镜分级，为每只眼检查生成参考标准诊断。使用先前发表的深度学习系统对所有眼底图像进行分析，并分配 1 到 9 的分数。
出生体重、胎龄、矫正胎龄和血管严重程度评分。
与无 AP-ROP 的 TR 婴儿相比，出现 AP-ROP 的婴儿出生时体重更轻（617 g 比 679 g；P=0.01）和胎龄更小（24.3 周比 25.0 周；P<0.01），且达到最大严重程度的矫正胎龄更早（34.7 周比 36.9 周；P<0.001）。与无 AP-ROP 的 TR 婴儿相比，有 AP-ROP 的 TR 婴儿的平均血管严重程度评分最高（8.79 比 7.19；P<0.001）。分析随时间推移的严重程度评分，AP-ROP 婴儿的进展速度最快（30-32 周时差异有统计学意义，P<0.002）。
与不太严重的 ROP 婴儿相比，北美出现 AP-ROP 的早产儿出生时更不成熟，疾病发生更早。基于深度学习的评分可以定量评估疾病严重程度，与临床上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，出现 AP-ROP 的眼睛达到疾病高峰的进展速度最快。分析 AP-ROP 的定量特征可能有助于改善对这种侵袭性、威胁视力的 ROP 疾病的诊断和治疗。
