Ejercicios De Dibujo

Dynamic documentation of the evolution of retinopathy of prematurity in video format
Leslie MacKeen, BSc,a and Anna Ells, MD, FRCS(C)b
INTRODUCTION Serial digital photographic examinations have been combined into a video format, which shows development and evolution of the disease over time. This dynamic format has changed the teaching of retinopathy of prematurity (ROP) by illustrating thesubtle changes in the temporal arcade angle and choroidal vascular pattern, which can be observed over time in these videos. Consecutive weekly or biweekly images were obtained on the same infant and were captured using digital retinal photography (RetCam 120) and then archived on compact discs. Those infants that were most photographic and demonstrative of the evolution of ROP were selected foranimation. The optic nerve vessels were aligned and image border blended into the previous image using a layer mask, thus creating an animation of consecutive images. The videos highlight the evolving features of ROP, such as development of arborized vessels posterior to the ridge, development of Stage 3 lesions, progression of plus disease, choroidal vascular changes accompanying the progression ofROP, dynamic changes in the temporal arcade angle, and regression of disease following last photocoagulation. The documentation of this disease as it evolves and its presentation in video format, using digital retinal photographic technology, has allowed subtle anatomical changes to be visualized and potentially studied. This process highlights a new dimension of the dynamic nature of the diseasefor those involved in the care of an infant with ROP. ( J AAPOS 2008;12:349-351)

METHODS

DISCUSSION

CONCLUSIONS

edside digital imaging technology captures longitudinal images of retinopathy of prematurity (ROP) in a given patient. Serial digital imaging examinations were combined into a video format to show development and evolution of the disease over time. Subtle dynamic changes inthe retinal vascular architecture can be identified and studied in a unique manner to contribute to our current understanding of retinopathy in the very low birth weight infant.

B

Methods
Premature infants underwent weekly or biweekly ROP retinal examinations in three neonatal intensive care units. Screening criteria and examination schedules were performed according to recommended ROPscreening guidelines.1 Local ethics review board approval was obtained for photographic documentation and the project was performed in compliance with Health Insurance Portability and Accountability Act.
Author affiliations: aClarity Medical Systems, Pleasanton, California; and b Alberta Children’s Hospital, Calgary, Alberta, Canada Submitted April 18, 2007. Revision accepted February 18, 2008. Publishedonline May 6, 2008. Reprint requests: Anna Ells, MD, FRCS(C), Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta, Canada (email: anna.ells@calgaryhealthregion.ca). Copyright © 2008 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/2008/$35.00 0 doi:10.1016/j.jaapos.2008.02.006

Longitudinal patient-imaging studies were reviewed and image setsthat demonstrated evolution of ROP were selected for animation. Each “video” frame represents a weekly examination of the same patient. These frames were combined into a video format to demonstrate the evolution of ROP pathology over time. Videos were created in the following manner: images were exported from the RetCam (Clarity Medical Systems Inc., Pleasanton, CA) as bitmap (.bmp) files andopened in Adobe® Photoshop 7 (Adobe Systems, San Jose, CA). Some images were enhanced in a standardized way with a Photoshop action. This action consisted of pasting a copy of the image over itself as a layer and selecting “multiply” from the layer menu. This made the layer transparent over the first layer and increased the saturation of the image. The “Auto Level” command was then applied to process...