Screening and Follow-Up of Acute ROP: Reproducibility of Fluorescein Angiography

Donatella Barillà, Rosanna Guagliano, Chiara Bertone, Anna Maffia, Carlo Bruttini, Francesca Periti, Carmen Plaitano, Cristina Arpa, Silvia Montescani, Carmine Tinelli, Ivano Riva, Luciano Quaranta

Research output: Contribution to journalArticlepeer-review


INTRODUCTION: Binocular indirect ophthalmoscopy (BIO) is fundamental for screening of retinopathy of prematurity (ROP). Digital retinal imaging devices with fluorescein angiography (FA) proved to be useful in screening and management of ROP. FA provides valuable additional information that is not detectable through ophthalmoscopy. FA images are relatively easy to interpret even by personnel without specific experience in ROP. The aim of this study is to evaluate reproducibility of FA for the screening and follow-up of ROP.

METHODS: A total of 106 pairs of FA images of 30 eyes of 15 premature infants with stage II ROP were evaluated by 5 ophthalmologists: 2 experts, 2 non-experts, and 1 expert in reading FA in adult patients. Each operator gave a score to each of following parameters: leakage, ischemic areas, peripheral plus disease and vascular anomalies. The images were reviewed twice. Intra- and inter-concordance between the readers of the FA findings was evaluated by the means of Cohen's kappa coefficient (κ).

RESULTS: The intra-operator concordance was very good (κ > 0.81) for all FA findings. Inter-operator concordance was good (κ > 0.41) for all operators and all FA findings. Global concordance was: substantial (intra-inter readers: κ > 0.61) for leakage, ischemic areas, and plus disease; almost perfect (κ > 0.81) for vascular anomalies; and moderate (κ = 0.41-0.60) for continuity/discontinuity of the ischemic areas. Total FA score was directly correlated to the percentage of treatment: a score ≥ 7 was correlated with 100% treatment and a score ≤ 3 with no treatment. Treatment timing was inversely correlated to FA score: a score ≥ 8 was correlated with a timely treatment (≤ 6 days), and a score ≤ 7 was correlated with a delayed treatment (< 10 days).

CONCLUSION: This study showed that FA represents a reproducible imaging technique. It is useful for detecting ROP progression, and to define the treatment timing and type.

Original languageEnglish
Pages (from-to)860-868
Number of pages9
JournalAdvances in Therapy
Issue number2
Publication statusPublished - Feb 2020


  • Birth Weight
  • California/epidemiology
  • Female
  • Fluorescein Angiography/methods
  • Follow-Up Studies
  • Gestational Age
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Male
  • Mass Screening/methods
  • Ophthalmoscopy/methods
  • Reproducibility of Results
  • Retinopathy of Prematurity/diagnosis


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