Internet-based versus Conventional Referral System for Retinopathy of Prematurity Screening in Iran

Purpose: To compare the efficacy of an internet-based versus traditional referral system for retinopathy of prematurity (ROP) screening in Iran.

Methods: Two referral screening systems were compared in this prospective observational study. Group A (internet-based) comprised premature babies who were registered into an online system for screening. Their appointments were scheduled automatically based on standardized criteria. Group B (conventional) comprised premature babies whose referrals were based on oral or written recommendations. Babies were referred based on standard criteria (gestational age, GA, <37 weeks or birth weight < 3000 g).

Results: A total of 2115 neonates were screened between October 2011 and October 2012. From these 1896 met the inclusion criteria (group A n = 856, group B n = 1040). Time of first examination for neonates with GA≤27 weeks was 30.07± 2.72 weeks postmenstrual age in group A and 38.52± 7.03 weeks in group B (p = 0.049), and for neonates with GA>27 weeks was 4.86 ±1.77 and 8.16 ±4.93 weeks after birth in groups A and B, respectively (p < 0.001). All registered babies in group A attended their first screening exam. One case (0.1%) of advanced ROP developed in group A (in a patient with poor follow-up compliance), whereas advanced stages of ROP were seen in 26 cases (2.5%) in group B (p < 0.001).

Conclusion: An internet-based registration system for ROP screening resulted in fewer cases of delayed first examination and resulted in fewer babies with advanced ROP.     

Perinatal Risk Factors for the Retinopathy of Prematurity in Postnatal Growth and Rop Study

Objective: To evaluate perinatal risk factors for retinopathy of prematurity (ROP), in a large, broad-risk cohort of premature infants.

Study design: Secondary analysis of data from the Postnatal Growth and ROP (G-ROP) Study, a retrospective cohort study of infants undergoing ROP examinations at 29 North American hospitals in 2006–2012.

Results: Among 7483 infants, 3224 (43.1%) had any ROP and 931 (12.4%) had severe ROP (Type 1 or 2 ROP). In multivariable logistic regression analysis, significant risk factors for any ROP were lower birth weight (BW, odds ratio (OR) = 5.2, <501 g vs. >1250 g), younger gestational age (GA, OR = 32, <25 vs. >29 weeks), 1-min Apgar score <4 (OR = 1.2), race (OR = 1.6, White vs. Black), outborn (OR = 1.5), and delivery room intubation (OR = 1.3); and for severe ROP were lower BW (OR = 20, <501 g vs. >1250 g), younger GA (OR = 30, <25 vs. >29 weeks), male (OR = 1.5), Hispanic ethnicity (OR = 1.8), race (OR = 1.6, White vs. Black), outborn (OR = 1.6), and delivery room intubation (OR = 1.6). Together, these factors predicted well for any ROP (area under ROC curve (AUC) = 0.87) and severe ROP (AUC = 0.89), but BW and GA were the dominant factors for ROP (AUC = 0.86) and severe ROP (AUC = 0.88).

Conclusions: Based on the largest report to date with detailed ROP data from infants meeting current screening guidelines, ROP risk is predominantly determined by the degree of prematurity at birth, with other perinatal factors contributing minimally.     

Incidence and Risk Factors of Retinopathy of Prematurity in Babol,North of Iran

Purpose: To determine the incidence and risk factors for the development of retinopathy of prematurity (ROP) among premature infants.

Methods: New born infants with gestational age < 37 weeks were studied from October 2004 to April 2008. Potential risk factors, like gestational age (GA), birth weight (BW), supplemental oxygen therapy, acute respiratory distress syndrome (ARDS), sepsis, blood transfusion, and phototherapy were assessed.

Results: One hundred seventy-three newborn infants were evaluated. Mean BW ± standard deviation (SD) was 1680.64?±?462.5?g and Mean GA ± SD was 32.24?±?2.36 weeks. Incidence of ROP was 19% including 11.5% in prethreshold and 7.5% in threshold stages.

The incidence of ROP was 47.3% for infants with gestational age ≤ 32 weeks. All 33 infants with ROP had a gestational age of ≤ 34 weeks. The incidence of ROP was 33.3% for infants with BW < 1500 gr. ROP developed in 2 (6%) infants with BW > 2000 gr. Blood transfusion (Odds Ratio [OR]?=?2.45, P?=?0.031), phototherapy (OR?=?2.405, P?=?0.038), gestational age (OR?=?14.2, P?=?0001) and ARDS (OR?=?2.1, P?=?0.047) were associated to ROP. With multivariate logistic regression analysis, low GA and blood transfusion were related to ROP.

Conclusions: The results show that the incidence of ROP is relatively high in our region. Low GA, low BW, phototherapy, ARDS, and blood transfusion were the main risk factors for development of ROP.     

Validation of the existing modified screening criteria for detection of all cases of Retinopathy of Prematurity in preterm babies – 11 year study from a governorate referral hospital in Oman

Purpose

To study appropriateness of our modified screening criteria for detection of all cases of Retinopathy of Prematurity (ROP) among preterm babies.

Method

Retrospective observational cohort study among preterm neonates who underwent ROP screening as per set protocol for 11 years at Nizwa Hospital, Al Dhakilya Governorate, Oman. We screened all babies with gestational age ⩽32 weeks or BW ⩽ 1500 g. Preterm babies >32 weeks of GA or BW > 1500 g with unstable clinical course believed to be at high risk by the attending neonatologist also were screened.

Results

During the study period 528 babies were screened for ROP of which 76 babies were excluded due to death, associated congenital ocular malformation and loss for follow-up either due to transfer to other institution or defaulting. Thus 452 babies were included in the final analysis. Incidence of ROP was 46.4% of which 27.9% had mild ROP, 11.3% had severe ROP which regressed and 7.3% had severe ROP who were treated. The incidence of ROP among infants with GA < 26 wks, 26–28 wks, 29–30 wks, 31–32 wks and above 32 weeks was 100.0%, 80.0%, 59.3%, 34.4% and 19.4% respectively.56 babies of this cohort belonged to Extended (modified) criteria group. Among these 12 babies had ROP out of which 9 had mild ROP and 3 had severe ROP. Among cases with severe ROP, two cases regressed spontaneously and one case needed treatment.Multivariate analysis using stepwise regression model showed statistically significant association of GA and BW to development of ROP.We would have missed few babies with ROP if we had followed other criteria.

Conclusion

Our modified screening criteria seem to be appropriate as no infant with severe ROP was missed during the study period. Incidence of severe ROP among babies in the extended criteria group (5.4%) is low but significant compared to lower gestational age. We plan to formulate a scoring system following all risk factor analysis to enable us to optimize the number of infants screened. Detection of all babies with ROP is important as they need long-term follow-up for the timely detection and management of associated ocular comorbidities.     

Weight gain measured at 6 weeks after birth as a predictor for severe retinopathy of prematurity: study with 317 very low birth weight preterm babies

Background  Recent studies suggest that postnatal weight gain can play an important role in the development of retinopathy of prematurity (ROP). Aim  To analyze the low weight gain (WG) from birth to 6 weeks of life to predict the development of severe retinopathy of prematurity (ROP) among very low birth weight preterm babies (VLBW). Methods  A prospective cohort study included 317 newborns with birth weight (BW) ≤1,500 g and gestational age (GA) ≤32 weeks. The main outcome was the development of severe ROP (defined as threshold ROP and higher stages of ROP). In all patients, the proportion of the WG was defined as the preterm weight measured at 6 weeks of life minus the BW divided by the BW. Seventeen risk factors for ROP were studied by univariate analysis. Chi-square test and Student’s t-test were used to compare no-ROP/mild ROP patients and severe ROP patients. Logistic regression and receiver operating characteristic (ROC) curve were used to determine if the WG proportion was independently related to severe ROP development and if it was capable of predicting severe ROP. Ophthalmological examinations started between the fourth and sixth week of life, and were repeated until the 45th week of postmenstrual age. Weight gain proportion was always calculated at completed 6 weeks of life. Results  Mean GA and mean BW of the whole cohort were 29.6 weeks (±1.9) and 1,124 grams (±239.5) respectively. After logistic regression, the low WG proportion under 51.2% from the BW, measured at 6 weeks of life, showed OR 3.007 (95%CI: 1.195-7.566; P = 0.019), for severe ROP, when adjusted for BW and for any stage intraventricular hemorrhage. Area under the ROC curve was 0.63 (95%CI: 0.495-0.761; P = 0.037). For the discriminative cutoff of 51.2% of the WG proportion, sensitivity and specificity values were 66.3% and 62.6% respectively. Positive and negative predictive values were 10.2% and 94.7% respectively. Conclusions  Low WG by six weeks of life is an important and independent risk factor for severe ROP and is capable to predict the development of severe ROP in most patients that needed treatment.     

Retinopathy of prematurity incidence and treatment modalities in moderate and late preterm infants: a study from two tertiary centers

ObjectiveThe aim of this study was to evaluate the incidence, severity, and treatment modalities of retinopathy of prematurity (ROP) in moderate and late preterm infants with a gestational age (GA) >31 + 6 weeks.MethodsROP screening results of preterm infants with GA >31 + 6 weeks to 36 + 6 weeks between March 2013 and January 2019 were evaluated retrospectively. Infants were divided into 2 groups according to GA as 32–33 + 6 weeks (moderate preterm) and 34–36 + 6 weeks (late preterm). In these groups, any ROP and severe ROP (requiring treatment) development rates and ROP types and treatment modalities were evaluated.ResultsA total of 4156 preterm infants, 1875 (45.1%) female and 2281 (54.9%) male, were included. Overall, 1466 (35.2%) of the infants were moderate preterm and 2690 (64.8%) were late preterm. The incidences of any ROP and severe ROP were 22% and 2.5%, respectively. The rate of severe ROP was 5.3% in moderate preterm infants and 0.9% in late preterm infants. Significant correlations were determined between duration of hospital stay, birth weight (BW), and GA with ROP development (r = +0.415, r = ?0.258, r = ?0.199, respectively; p < 0.001 for all). Of 102 patients (2.5%) requiring treatment, 64 (62.7%) had laser, 34 (33.3%) had intravitreal bevacizumab (IVB), 2 (1.9%) had sequential IVB and laser, and 2 (1.9%) had vitreoretinal surgery.ConclusionROP seems to still be an important health problem in moderate and late preterm infants in our country according to data from screening high-risk preterm infants with a GA >31 + 6 weeks. In this cohort, ROP development correlates with GA, BW, and duration of hospitalization significantly.     

Retinopathy of prematurity: are we screening too many babies?

PURPOSE: With advancement in neonatal care units, early detection of retinopathy of prematurity (ROP) in premature and very-low-birth-weight infants is important. Numerous studies have reported an increased risk of ROP in prematurely born infants, but only few have been long-term and strictly population-based. The aim of the present study was to find out whether birthweight <1251 grams and gestational age <30 weeks could provide a safe and efficient means of detecting treatable ROP. We have retrospectively tried to ascertain the incidence and associated risk factors that may contribute to the management of babies with ROP. METHODS: Infants either with a birth weight below 1500 g or a gestational age of less than 32 weeks were screened for ROP during an 8-year period by a single examiner.Results An incidence of 64/205 (31.2%) ROP was noted. The mean age at detection was 5.5 +/- 2 weeks of life. The maximum stage reached was stage 1 in 27 (13.2%), stage 2 in 24 (11.7%) and stage 3 in 10 (4.8%) babies. Threshold ROP was present in three (1.5%) babies. Significantly fewer (150/205 = 73%) babies would have been examined had a birth weight of <1251 grams and a gestational age <30 weeks been applied. there were five (8%) babies with birth weight >1250 grams and eight (12%) babies with gestational age >30 weeks amongst babies with ROP but all were stage 1 or stage 2. All the stage 3 ROP and the threshold ROP cases were babies with birth weight <1000 grams and gestational age below 28 weeks. CONCLUSION: Ophthalmic examination may be safely and efficiently concentrated in babies with birth weight <1251 grams and gestational age below 30 weeks. Birth weight (P < 0.005) and gestational age (P < 0.01) were the only significant risk factors. During this 8-year period there was no significant decrease in the number of babies screened for ROP and the overall incidence of all stages of the disease has remained constant. In the present series a lower incidence of severe ROP was noted compared to most previous studies. Our experience from this study suggests the need for further refinement of screening guidelines in order to focus screening on the vision-threatening stages of ROP.     

Do current retinopathy of prematurity screening guidelines miss the early development of pre-threshold type 1 ROP in small for gestational age neonates?

PURPOSE: To investigate whether current UK retinopathy of prematurity (ROP) screening guidelines miss the early development of pre-threshold type 1 ROP in some neonates born small for gestational age (SGA) and consider if the guidelines should be changed. Methods: Data were collected on neonates of < or =31 completed weeks gestation and/or birth weight (BW) < or =1500 g born over a 37-month period. Babies who did not complete the screening programme in Cambridge and those with other ocular abnormalities were excluded. We compared the time course of ROP progression and the development of the early treatment for ROP pre-threshold ROP in relation to the gestational age and the BW of the babies. RESULTS: A total of 105 neonates were included, 11 (10.5%) were born SGA (less than 9th centile of predicted BW). Of these 11, 2 (18.2%) had pre-threshold ROP at their first screen (median post-natal age (PNA) 6.5 weeks, median postmenstrual age (PMA) 33.5 weeks). No other neonate in this group developed pre-threshold ROP.Of the 94 other neonates, none had pre-threshold ROP at first screen (median PNA 7.1 weeks). Pre-threshold ROP developed in 12 (12.8%) of these babies between 8 and 12 (median 11.5) post-natal weeks, at a PMA of 33-38 (median 35.5) weeks. CONCLUSION: Current UK ROP screening guidelines recommend first screening at 6-7 post-natal weeks. Our study suggests that pre-threshold type 1 ROP can develop before this especially in SGA babies. We suggest that screening should either start at 4 post-natal weeks in such babies, or be based on PMA rather than PNA, to allow timely laser therapy.     

Characteristics of severe retinopathy of prematurity patients in China: a repeat of the first epidemic?

AIM: To describe the characteristics of babies treated for severe retinopathy of prematurity (ROP) in a tertiary referral unit in China, to provide information to assist in determining screening criteria. METHODS: Information on consecutive babies referred to one eye department for treatment of stage 3 (prethreshold and threshold disease), and stages 4 and 5 ROP between January 2001 and May 2005 were retrieved from medical records. RESULTS: Data from 114 babies were analysed. The number of babies treated increased from nine in 2001 to 52 in 2004. The numbers of infants in each stage of ROP were as follows: stage 3, 40 babies; stage 4, 19 babies, and stage 5, 55 cases. The mean gestational age (GA) was 29.8 (SD 1.9) weeks (range 26-34 weeks) and the mean birth weight (BW) was 1432 (319) g (range 760-2500 g). 31 babies had BWs more than 1500 g (27.2%). 10 cases (8.8%) had GAs more than 32 weeks, and 82 (71.9%) had GAs more than 28 weeks. Overall, 18 (16.2%) infants exceeded UK screening criteria, and 34 (30.4%) exceeded the criteria used in the United States. The median age at presentation was 5.5 months (range 1-72 months). CONCLUSION: Comprehensive screening programmes for ROP are urgently needed in China. Screening criteria recommended by the American Academy of Pediatric Ophthalmology and Strabismus and the Royal College of Ophthalmologists, United Kingdom, may not be suitable for China where bigger, more mature babies are developing severe disease.     

Use of an online screening algorithm - Weight,Insulin-derived growth factor 1, Neonatal Retinopathy of Prematurity (WINROP) for predicting retinopathy of prematurity in Indian preterm babies

Purpose:Inopathy of prematurity (WINROP) Weight, insulin-derived growth factor 1, neonatal ROP algorithm is an online tool that has been validated as a predictor of retinopathy of prematurity (ROP) in various countries. The current study was designed to evaluate the predictive ability of WINROP algorithm (http://winrop.com) using postnatal weight gain in detecting Type 1 ROP in Indian babies.Methods:Prospective single centre observational study of 153 consecutive preterm babies who were eligible for screening for ROP as per the standard guidelines. Sixteen babies were excluded from the study because of various reasons. Thirty-five babies had gestational age ≥32 weeks and were ineligible for WINROP algorithm. Online WINROP algorithm was used for 102 babies with gestation at birth less than 32 weeks. The alarms triggered by WINROP were documented.Results:Laser treatment was done in 30 babies who developed Type 1 ROP. Of these, WINROP alarm was signaled in 24 babies and 6 babies developed ROP without any WINROP alarm. These babies had associated comorbidities like respiratory distress syndrome, patent ductus arteriosus, bacterial sepsis, and ventilatory support. WINROP alarm was significantly associated with Type 1 ROP (P < 0.001). The sensitivity of WINROP was 80% and specificity was 80.6% with a positive predictive value of 63.2% and negative predictive value of 90.6% in detecting Type 1 ROP. In the present study, no baby who was ineligible for WINROP developed Type 1 ROP.Conclusion:WINROP provides a novel online monitoring screening tool for identifying babies at risk of developing Type 1 ROP. In our cohort, none of the babies whose period of gestation was more than or equal to 32 weeks developed sight threatening Type 1 ROP. WINROP algorithm may also be useful in Indian population.     

Analysis of prenatal and postnatal risk factors of retinopathy of prematurity in a tertiary care hospital in South India

Context:

Recent advances in neonatology have influenced the incidence and severity of ROP in a dichotomous fashion.

Aims:

To determine the incidence of ROP and to analyse its risk factors.

Settings and Design:

Prospective clinical case series.

Materials and Methods:

282 preterm infants with birthweight < 1500g and/or gestational age ≤ 32 weeks and also those with gestational age > 32 weeks, with birthweight between 1500-2000 g, who were at risk for ROP were selected. Weight gain proportion was measured as weight at 6 weeks minus birthweight divided by birthweight.

Statistical Analysis:

Univariate and multivariate logistic regression.

Results:

Incidence of any ROP was 21.6% while severe ROP was 6.7%. Prenatal factors like multiple gestation (P = 0.510) and antenatal steroids (P = 0.104) were not significantly associated with ROP. On multivariate analysis, postnatal factors like weight at birth < 1250 g (P = 0.01) and gestational age between 31-32 weeks (P = 0.02) were independent risk factors for any ROP, while intraventricular hemorrhage (P = 0.03) was the only independent risk factor for severe ROP. Mean birthweight of infants with severe ROP was 1056 ± 207 g (P = 0.004), which was significantly low. After logistic regression, the mean weight gain proportion at 6 weeks, of those neonates with severe ROP was 30%.

Conclusions:

Low birthweight and prematurity were the most important risk factors for developing any ROP, while intraventricular hemorrhage was the independent risk factor for developing severe ROP. The mean postnatal weight gain at 6 weeks was not statistically significant in neonates with severe ROP.     

早产儿视网膜病变激光光凝治疗效果及预后影响因素分析

目的:观察激光光凝术治疗阈值前Ⅰ型和阈值期早产儿视网膜病变(ROP)的临床效果,分析光凝术后病变进展的影响因素。方法:回顾分析激光光凝治疗ROP患者46例89眼,其中阈值前Ⅰ型57眼,阈值期32眼。采用810nm激光对周边视网膜无血管区进行光凝治疗。根据光凝术后结果分为病变消退组和进展组。随访视网膜解剖结构和ROP病变的变化,分析ROP病变部位、病变程度、光凝点数量、机械辅助呼吸、败血症、新生儿肺炎等因素与光凝术后病变进展的相关性。结果:ROP89眼经激光光凝治疗后病变完全消退79眼(89%),病变进展10眼(11%)。光凝治疗ROP病变消退组与进展组比较,出生胎龄、出生体重、首次光凝校正胎龄差异无统计学意义(P=0.668,0.495,0.143)。病变进展组的Ⅰ区病变、阈值病变、急性进展性后极部早产儿视网膜病变(AP-ROP)、光凝点数量均较病变消退组明显增加,差异有统计学意义(P=0.035,0.017,0.000,0.031)。Logistic回归分析结果显示,AP-ROP与光凝术后病变进展有关(P=0.001)。AP-ROP患眼光凝术后病变进展的可能性是非AP-ROP患眼的12.167倍(95%CI:2.733～54.154)。结论:激光光凝术能有效控制早期ROP的病变进展,使大部分阈值前Ⅰ型和阈值期ROP病变完全消退。急性进展性后极部早产儿视网膜病变光凝术后容易发生视网膜脱离,是影响光凝术后疗效的最主要因素。     

深圳地区早产儿视网膜病变10年发病情况分析

目的 观察深圳地区近10年早产儿视网膜病变（ROP）发病状况和变化趋势。方法 2004年1月至2013年6月对在深圳市人民医院、深圳市妇幼保健院等新生儿重症监护病房住院或早产儿出院后至深圳市眼科医院ROP专科门诊检查且符合筛查标准的9100名早产儿进行了ROP筛查。首次检查在出生后4～6周开始。接受筛查的早产儿中,男性5401名,女性3699名;出生体重520～2990 g,平均出生体重（1710±410） g。其中,＜1000 g者206名;1000～1499 g者2473名;1500～1999 g者4038名;≥2000 g者2383名。出生胎龄24～36周,平均出生胎龄（31.57±1.99）周。其中,＜28周者208名;28～32周者3608名;33～34周者3553名;＞34周者1731名。采用双目间接检眼镜配合巩膜压迫器和（或）广角数码视网膜成像系统进行眼底检查。按照国际ROP分类法的规定和ROP早期治疗研究标准记录检查结果。双眼病变不对称时,记录病变严重眼;所有接受治疗的病例统一定义为重症ROP。回顾分析近10年ROP总体发病率、重症率,以及第一、二阶段即2004年至2008年和2009年至2013年6月ROP发病率、重症率的变化情况。结果 9100名早产儿中,发生不同程度ROP 1137例,发病率12.49%;重症ROP 454例,占筛查人数的4.99%。出生体重＜1000、1000～1499、1500～1999、≥2000 g者,ROP发病率分别为62.62%、28.40%、11.34%、3.63%;重症率分别占筛查人数的34.95%、12.21%、3.73%、0.49%。出生胎龄＜28、28～32、33～34、＞34周者,ROP发病率分别为67.31%、25.27%、7.22%、3.87%;重症率分别占筛查人数的37.02%、10.71%、1.79%、0.68%。第二阶段ROP发病率、重症率与第一阶段比较,ROP发病率、重症率分别从14.64%、6.52%降至11.47%、4.26%,差异有统计学意义（χ²=26.96、26.61,P＜0.05）。出生体重＜1000 g的患儿,第二阶段ROP发病率、重症率明显低于第一阶段,差异有统计学意义（χ²=13.676、5.271,P＜0.05）。出生胎龄＜28周的患儿,第一阶段ROP发病率与第二阶段ROP发病率比较,差异无统计学意义（χ²=0.843,P＞0.05）;第二阶段重症率较第一阶段明显下降,差异有统计学意义（χ²=4.757,P＜0.05）。结论 2004年至2013年深圳地区ROP发病率和重症率逐年下降。     

A predictive score for retinopathy of prematurity in very low birth weight preterm infants

Aims

This study describes the development of a score based on cumulative risk factors for the prediction of severe retinopathy of prematurity (ROP) comparing the performance of the score against the birth weight (BW) and gestational age (GA) in order to predict the onset of ROP.

Methods

A prospective cohort of preterm infants with BW⩽1500 g and/or GA⩽32 weeks was studied. The score was developed based on BW, GA, proportional weight gain from birth to the 6th week of life, use of oxygen in mechanical ventilation, and need for blood transfusions from birth to the 6th week of life. The score was established after linear regression, considering the impact of each variable on the occurrences of any stage and severe ROP. Receiver operating characteristic (ROC) curves were used to determine the best sensitivity and specificity values for the score. All variables were entered into an Excel spreadsheet (Microsoft) for practical use by ophthalmologists during screening sessions.

Results

The sample included 474 patients. The area under the ROC curve for the score was 0.77 and 0.88 to predict any stage and severe ROP, respectively. These values were significantly higher for the score than for BW (0.71) and GA (0.69) when measured separately.

Conclusions

ROPScore is an excellent index of neonatal risk factors for ROP, which is easy to record and more accurate than BW and GA to predict any stage ROP or severe ROP in preterm infants. The scoring system is simple enough to be routinely used by ophthalmologists during screening examination for detection of ROP.     

Retinopathy of prematurity, a decrease in frequency and severity. Trends over 16 years in a Danish county

PURPOSE: To analyse the trends over 16 years (1982-97) in a Danish county regarding the clinical appearance of retinopathy of prematurity (ROP). METHODS: The data for birth years 1993-97 regarding the regular ophthalmic surveillance for ROP in the region have been analysed. With gestational age (GA) 32 weeks and/or a birthweight (BW) 1750 g as attempted screening limits a total of 177 premature infants were surveyed. Comparison was made with studies of a similar set-up from the preceding four 3-year periods comprising a total of 814 subjects. RESULTS: The number of survivors regarded at a higher risk of developing ROP (GA and BW both <32 weeks/1750 g, n=478) showed an even increase over the five investigation periods. The ROP frequency, however, fell from a level of 39% to 10%, there were fewer with severe sequels to ROP, and the children surveyed 'above limits' eventually avoided ROP. CONCLUSIONS: Using the ROP profile as a yardstick for the quality of the neonatal service given to the most immature newborns over the period 1982-97, the risk limits regarding GA and BW have gone down. More and more of the heavier preterm babies now escape ROP. A significant decrease in frequency of ROP in the more immature groups has been observed, and fewer cases have progressed to visual impairment.     

The Utility of Non-ophthalmologist Examination of Eyes at Risk for Serious Retinopathy of Prematurity

Background: Retinopathy of Prematurity (ROP) is the main cause of preventable blindness in premature babies. Currently, there is a shortage of trained ophthalmologists, which has resulted in an alarming increase in cases of vision loss and related complications. This study’s aim was to determine the utility of examinations conducted by non-ophthalmologist physicians to assess posterior pole vessel abnormalities in eyes at risk for ROP.

Method: Non-ophthalmologist physicians (pediatrician and neonatologist) were trained to use an indirect ophthalmoscope to view the posterior pole of babies at risk for ROP. Examinations were conducted on both eyes of premature infants born before 35 weeks gestational age (GA) starting at the third week after birth and weekly thereafter. The presence of Plus disease was identified by the non-ophthalmologist and results compared to the clinical examination by a pediatric ophthalmologist experienced in ROP detection and treatment. Chi-square was used for proportions and the Mann Whitney U test for medians. Fagan’s nomogram was determined for diagnostic usability. The Kappa index was used to rate inter-observer agreement.

Results: Results of 228 examinations performed on 150 premature infants were analyzed to determine the correlation of the non-ophthalmologist findings and the eye examination. For any vascular change in posterior pole diagnostic, findings were 87% and 87% accuracy for pediatrician and neonatologist, 82% and 83% sensitivity, 90% and 90% specificity respectively. There was no significant difference found in the detection of Plus disease for the examinations performed by the ophthalmologist compared to those performed by the non-ophthalmologist (P?<?0.05).

Conclusions: After training in the use of an indirect ophthalmoscope, non-ophthalmologist physicians can reliably detect posterior pole retinal vessel changes for ROP diagnosis.     

Demographic Profile of Infants with Stage 5 Retinopathy of Prematurity in North India: Implications for Screening

Purpose: To study demographic profile of infants presenting as stage 5 retinopathy of prematurity (ROP) at a tertiary referral center of North India

Methods: A retrospective review of consecutive infants with stage 5 ROP from 1999–2008. Various parameters retrieved included the inborn (born at level III nursery of our institute) /outborn (born outside study center) status, birth weight, gestational age, age at presentation, screening details,treatment details and reasons for consultation

Results: Sixty -six infants are included. All infants were outborn (born outside study center). Mean birth weight was 1250.23?±?486.45?g and gestational age at birth was 28.5?±?2.2 weeks. Ten (15.1%) infants were above 1500g birth weight. Median age at presentation was 7 month (range, 2–84 months). Fifty-seven (86.4 %) infants were never screened for ROP and 2(3%) were lost to follow-up after single screening. Seven (10.6%) infants had screening and treatment. Forty-nine (74.2%) infants were self-referred (i.e brought by parents on their own) and 17(25.8%) were referred by ophthalmologists. Pediatricians referred none of the infants.

Conclusion: Our study shows that lack of screening is responsible for stage 5 ROP in outborn infants. More needs to be done to spread awareness about the disease. Broader screening guidelines are needed to ensure screening for infants>1500?g birth weight.     

Analysis of risk factors for retinopathy of prematurity

AIM: To analyze the incidence and risk factors for retinopathy of prematurity (ROP). METHODS: A retrospective analysis was conducted on 568 premature infants from September 2005 to December 2010 with birth weight(BW) equal to or less than 2 500g or a gestational age(GA) at birth of 34 weeks or less. All of the members were examined by indirect binocular ophthalmoscopy. RESULTS: ROP occurred with an incidence rate of 10.7% among 568 premature infants, and stages 3 and above ROP occurred with an incidence rate of 2.5%. This study showed the infants were more prone to develop ROP with short geststional age, low BW, long time of oxygen inhalation, and severe infants diseases. Twins had a significantly higher rate of ROP(18.3%) than singleton babies(9.8%), ROP were severer in twins than singleton babies . CONCLUSION: Short GA, low BW, long time of oxygen inhalation, severe infants diseases, and non-singleton babies were the most significant risk factors associated with ROP.