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Prevalence of Retinopathy of Prematurity
1. The Prevalence Of Retinopathy Of
Prematurity And Relationship With Various
Factors Among Infants Admitted In SNCU
,RIMS RANCHI Contributing To Screening
Programmes
By - Dr. Abhishek Kumar
Sinha
Junior Resident,R.I.M.S
Ranchi
2. Introduction
❖ Retinopathy of prematurity (ROP) is a proliferative retinopathy which is the preventable
common cause of the blindness in preterm infants. Detection and treatment of the ROP have
become more important because the progression of the disease is very quick. It has several
risk factors but the most important risk factors are low gestational age (GA) and low birth
weight (BW) [1]. A lot of screening guidelines have been based on these factors to identify
infants needing examination.
❖ The incidence of the ROP is different in countries. In developed countries, ROP-associated
blindness incidence has been reported to be lower than 10% of extremely preterm born
children but in middle-income countries, the incidence is greater than 40% .
❖ In this retrospective study, we analyzed the incidence of ROP. We aimed to contribute to
screening programmes.
3. Subjects and Methods
❖ Approval was obtained from the local ethics committee for the study. The
study conformed to the tenets of the Declaration of Helsinki.
❖ In this retrospective study,182 premature infants who were born with GA ≤ 37
weeks at our hospital were examined.
❖ Exclusion criteria were lethal congenital anomalies, death before examination,
death or loss to follow up before complete retinal vascularisation has
developed and incomplete screening procedure.
4. ❖ ROP was classified according to the international classification of ROP
and screening procedure was designed in accordance with suggestions of
the American Academy of Pediatrics, American Academy of
Ophthalmology and American Association for Pediatric Ophthalmology
and Strabismus.
❖ The diagnosis of severe ROP is defined as threshold and type 1 pre-
threshold ROP. The Early Treatment for Retinopathy of Prematurity
(ETROP) study results recommended treating ROP with laser
photocoagulation. In zone II or III cases, we preferred laser treatment. In
zone I or posterior zone II cases, we prefer anti-VEGF.
5. ❖ Infants were classified into 4 groups according to GA; < 28 week, 28 - 31
weeks, 32 - 34 weeks, 35 - 37 weeks. Infants also classified into 8 groups
according to the BW; ≤ 750g, 751 - 999g, 1000 - 1249g, 1250 - 1499g, 1500 -
1749g, 1750 - 1999g, 2000 - 2499g, ≥ 2500g.
❖ Data analysis was conducted using SPSS V.20.0 (SPSS Inc., Chicago, IL).
Chi-square test was used to analyze qualitative variables. A difference with p
< 0.05 was considered significant.
6. Results
❖ During the study period, a total number of 182 preterm infants [105 female
(58%) & 77 male (42%)] with ≤ 37 week of GA were assessed. Mean GA was
31.9 ± 2.1 weeks (range: 25 - 37 weeks) and mean BW was 1575.4 ± 495.2g
(range: 690 - 4050g).
❖ The overall incidence of ROP was 35% (63/182). 36 infants (58%) had stage 1,
7 infants (10%) had stage 2, 14 infants (22%) had stage 3, 2 infants (0.03%) had
stage 4 and 5 of the disease and 4 infants (0.07%) had aggressive posterior
retinopathy of prematurity (APROP). Mean GA who had any stage of the
disease was 30.1 ± 2.1 weeks (range: 24 - 35.9 weeks) and mean BW was
1263.6 ± 390.2g (range: 690 - 3190g).
7. ❖ The incidence of ROP in female and male infants were 39% (40/105), 29%
(22/77), respectively. There was no significant difference between genders
(p = 0.065).
❖ The incidence of ROP in GA with < 28 week was 100%, 28 - 31 weeks was
63%, 32 - 34 weeks was 15%, 35 - 37 weeks was 13%. The incidence rate of
the disease was increased with the decrease in the GA (p < 0.001)
10. Discussion
❖ ROP is a preventable blinding disease of the retina. Although diagnosing and
treatment methods have been developed, ROP still threat premature infants
all over the world especially in middle-income countries such as India,
China,other parts of Asia, Eastern Europa, Latin America. Detection and
treatment with the screening programs are very important to prevent poor
vision. For screening programmes, detection of the risk factors and incidence
of ROP are essential. There are several risk factors in the development of
ROP but the BW and GA are considered the most important risk factors of
the disease
11. The Prevalence of Retinopathy of Prematurity and Relationship with Gestational
Age and Birth-Weight; Contributing to Screening Programmes
❖ In our study, the overall incidence of ROP was 35% and incidence of any stage of
ROP was 100% of infants with GA less than or equal to 28 weeks and 63% with GA
less than or equal to 32 weeks. We also found that the incidence of ROP BW with <
750g was 100%, 750 - 999g was 91%, 1000 - 1249g was 71% and 1250 - 1499g was
44%.
❖ In our country, our city &. nearby areas are less developed-region and socioeconomic
status of the population is low and these situations can explain the reason for high
incidence. The other reasons may be low prenatal care, delivery care, and postnatal
care standards.
❖ Screening criteria usually base on gestational age and birth weight. Several studies
have been done to create criteria for ROP screening programmes. These programmes
differ from one country to another country and change from time to time.
12. Limitation
❖ This study has some limitations. First of all, the study population is small &
the study was conducted in Ranchi only, so the results may not reflect the
true incidence of ROP in India.
13. Conclusions
❖ ROP is still a serious disease and its incidence is different between countries
and change from time to time according to the neonatal healthcare units
conditions and their developments.
❖ Screening criteria for ROP in our country must be wider than high-income
countries. In India, neonatal healthcare unit conditions should be improved
and national guidelines for ROP should be established.
![Introduction
❖ Retinopathy of prematurity (ROP) is a proliferative retinopathy which is the preventable
common cause of the blindness in preterm infants. Detection and treatment of the ROP have
become more important because the progression of the disease is very quick. It has several
risk factors but the most important risk factors are low gestational age (GA) and low birth
weight (BW) [1]. A lot of screening guidelines have been based on these factors to identify
infants needing examination.
❖ The incidence of the ROP is different in countries. In developed countries, ROP-associated
blindness incidence has been reported to be lower than 10% of extremely preterm born
children but in middle-income countries, the incidence is greater than 40% .
❖ In this retrospective study, we analyzed the incidence of ROP. We aimed to contribute to
screening programmes.](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)