Purpose: Bedside examination of premature infants at risk for retinopathy of prematurity (ROP) is performed predominantly with ophthalmoscopic en face viewing of the retina. Although postmortem retinal microstructures have been studied at the vascular–avascular junction, a critical location for pathogenesis of ROP, to date this has not been possible in vivo. Herein we present bedside, nonsedated in vivo cross-sectional imaging and analysis of retinal microstructures at the vascular–avascular junction in infants with ROP using handheld spectral-domain (SD) OCT. Design: Prospective observational study. Participants: Eleven preterm infants whose parents or guardians gave consent for research imaging during ROP screening examinations. Methods: We imaged the vascular–avascular junction in the temporal retina using an SD OCT system (Envisu; Bioptigen, Inc., Research Triangle Park, NC) in 18 eyes from 11 preterm infants with zone I or II and stage 0 through 4 ROP. B-scan and en face images were analyzed and compared with historical light micrographs. Main Outcome Measures: Spectral-domain OCT morphologic features at the vascular–avascular junction. Results: Multiple bedside SD OCT findings at the vascular–avascular junction were comparable with historic light micrographs. Thickened inner retinal ridge structure in stage 2 ROP was comparable with thickened vanguard and rear guard cells visible on micrographs; vascular tufts on the posterior retinal surface in stage 2 ROP, broad arcs of neovascularization above the retina in stage 3 ROP, and splitting of inner retinal layers into clefts on either side of neovascularization mimicked findings on historic light micrographs. A unique finding was thickening of the avascular inner retinal band adjacent to neovascularization. On SD OCT imaging over several weeks, neovascularization and retinal clefts diminished after intravitreal bevacizumab therapy. Conclusions: Retinal morphologic features at the vascular–avascular junction imaged with handheld SD OCT are consistent with known histopathologic features and provide the advantage of monitoring change in vivo over time. These unique findings provide new insights into preterm retinal neurovascular development in ROP.
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