Department of Ophthalmology, University of California - Los Angeles, Los Angeles, CA, USA; Doheny Eye Institute, Pasadena, CA, USA; Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, China.
Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA.
Prog Retin Eye Res. 2022 Sep;90:101067. doi: 10.1016/j.preteyeres.2022.101067. Epub 2022 May 17.
Early development of the fovea has been documented by histological studies over the past few decades. However, structural distortion due to sample processing and the paucity of high-quality post-mortem tissue has limited the effectiveness of this approach. With the continuous progress in high-resolution non-invasive imaging technology, most notably optical coherence tomography (OCT) and OCT angiography (OCT-A), in vivo visualization of the developing retina has become possible. Combining the information from histologic studies with this novel imaging information has provided a more complete and accurate picture of retinal development, and in particular the developing fovea. Advances in neonatal care have increased the survival rate of extremely premature infants. However, with enhanced survival there has been an attendant increase in retinal developmental complications. Several key abnormalities, including a thickening of the inner retina at the foveal center, a shallower foveal pit, a smaller foveal avascular zone, and delayed development of the photoreceptors have been described in preterm infants when compared to full-term infants. Notably these abnormalities, which are consistent with a partial arrest of foveal development, appear to persist into later childhood and adulthood in these eyes of individuals born prematurely. Understanding normal foveal development is vital to interpreting these pathologic findings associated with prematurity. In this review, we first discuss the various advanced imaging technologies that have been adapted for imaging the infant eye. We then review the key events and steps in the development of the normal structure of the fovea and contrast structural features in normal and preterm retina from infancy to childhood. Finally, we discuss the development of the perifoveal retinal microvasculature and highlight future opportunities to expand our understanding of the developing fovea.
过去几十年来,组织学研究已经记录了黄斑的早期发育。然而,由于样本处理和高质量死后组织的缺乏,导致这种方法的效果有限。随着高分辨率非侵入性成像技术的不断进步,尤其是光学相干断层扫描(OCT)和 OCT 血管造影(OCT-A),活体观察发育中的视网膜已经成为可能。将组织学研究的信息与这种新型成像信息相结合,为视网膜发育,特别是黄斑的发育提供了更完整、更准确的图像。新生儿护理的进步提高了极早产儿的存活率。然而,随着存活率的提高,视网膜发育并发症也随之增加。与足月婴儿相比,早产儿存在几个关键的异常,包括黄斑中心内层的增厚、更浅的黄斑凹、更小的黄斑无血管区以及光感受器发育延迟。值得注意的是,这些异常与黄斑发育部分停滞一致,似乎在这些早产儿的眼睛中一直持续到后期儿童期和成年期。了解正常的黄斑发育对于解释与早产相关的这些病理发现至关重要。在这篇综述中,我们首先讨论了各种适用于婴儿眼部成像的先进成像技术。然后,我们回顾了正常黄斑结构发育的关键事件和步骤,并对比了从婴儿期到儿童期正常和早产儿视网膜的结构特征。最后,我们讨论了周边视网膜微血管的发育,并强调了未来扩展对发育中黄斑认识的机会。