Title: Study of Retinopathy of Prematurity in a Tertiary Care Hospital
Authors: Dr S.K.Valinjkar, Dr Gangadhar Kale, Dr Vikas
DOI: http://dx.doi.org/10.18535/jmscr/v4i7.66
Abstract
OBJECTIVES
1. To study the incidence of Retinopathy of Prematurity (ROP) in a tertiary care hospital, in a metropolitan city.
2. To study associated etiological risk factors for development of Retinopathy of Prematurity.
3. To study the outcome of Retinopathy of Prematurity, those treated with laser photocoagulation.
STUDY DESIGN: Prospective observational study which was conducted in a tertiary care center in a metropolitan city over a period of 2 years
METHODS: In this study 200 preterm babies were enrolled with gestational age less than 34 weeks or birth weight less than 1500 grams with or without risk factors admitted in our Neonatal intensive care unit which is a tertiary care hospital. The study aimed at studying risk factors, incidence and outcome of retinopathy of prematurity especially in those patients who were treated with laser photocoagulation.
RESULTS: The incidence of ROP was 24 % (48/200). Incidence was comparatively more in babies with gestational age less than 28 weeks and birth weight less than 1000 grams. Incidence of ROP was more in Small for gestational age (SGA) babies than in appropriate for gestational age (AGA) babies.
In this study group, gestational age less than 28 weeks, birth weight less than 1000 grams, oxygen therapy, apnea, septicemia and use of blood products were found to be significant risks factors by univariate analysis. Oxygen therapy, septicemia and use of blood products were significant risk factors for ROP by multiple analysis (stepwise logistic regression).
All 48 cases of ROP had symmetrical or bilateral involvement of eyes, 7.5% (15/200) had severe ROP and required laser therapy (five neonates with zone I and rest with zone II). Severe ROP who required laser therapy 9 (23.70%) were less than 28 weeks, and 7 (19.44%) were less than 1000 grams. The percentage of laser treatment increases in gestational age less than 28 weeks and birth weight less than 1000 grams.
After laser therapy, at corrected age of 6 months eyes were examined for structural outcome, only 1(6.67) infant had sequelae with discmacular drag. No any infants lost to follow up after laser and the disease had regressed in all 14 (93.33) cases. Outcomes were good after laser therapy.
Keywords: Retinopathy of prematurity, Laser photocoagulation, Prematurity, Oxygen therpy.
References
1. Hussan N, Clire J , Bhandhari V, current incidence of Retinopathy of prematurity. Pediatrics 1999; 104 1-8.
2. Termote J ,Schalji-Delfos NE, Brouwers HAA, Donders ART, Cats BP, New development in neonatology ; less severe Retinopathy of prematurity. J pediatric Ophthalmology and strabismus 2000; 37:142-148.
3. Gilbert C, Foster A. Childhood blindness in the context of vision 2020- the right to sight, Bull WHO 2001; 79:227-32.
4. Flynn JT. The premature retina: a model for the in vivo study of molecular genetics?Eye1992; 6:161-5.
5. Kushner BJ, Essner D, Cohen IJ, Flynn JT. Retrolental Fibroplasia. II. Pathologic-correlation. Arch Ophthalmology 1977; 95:29-38.
6. Chan-Ling T, Tout S, Hollander H, Stone J. Vascular changes and their mechanismsin the line model of retinopathy of prematurity. Invest Ophthalmology Vis Sci 1992;33:2128-47.
7. Chan-Ling T, Gock B, Stone J. The effect of oxygen on vasoformative cell division. Evidence that 'physiological hypoxia' is the stimulus for normal retinal vasculogenesis. Invest Ophthalmology Vis Sci 1995; 36:1201-14.
8. Hammer ME, Mullen PW, Fergusson JG, Poi S, and Cosbox C. Jackson KL. Logisticanalysis of risk factors in acute retinopathy of prematurity. Am J Ophthalmology 1986;102: 1-6.76
9. Seiberth V, Linderkamp O. Risk factors in retinopathy of prematurity. A multivariate statistical analysis.Ophthalmological 2000; 214:131-135.
10. Chawla D, Agarwal R, Deorari AK, Paul VK. Retinopathy of prematurity. Indian J Pediatric 2008; 75: 73-76.
11. Section on Ophthalmology American Academy of Pediatrics, American Academy of Ophthalmology, American association for Pediatrics Ophthalmology and Strabismus, Screening examination of premature infants for retinopathy of prematurity.Pediatrics.2006;117:572–576
12. The International Classification of Retinopathy of Prematurity Revisited.Arch Ophthalmology.2005; 123:991–99.
13. Wagner RS. Increased incidence and severity of retinopathy of prematurity in developing nations. J Pediatr Ophthalmol Strabismus. 2003 Jul-Aug;40(4):193.
14. Gogate P, Gilbert C, Zin A. Severe Visual Impairment and Blindness in Infants: Causes and Opportunities for Control. Middle East African Journal of Ophthalmology. 2011;18(2):109-114. doi:10.4103/0974-9233.80698.
15. Janson U. Normal and deviant behavior in blind children with ROP. Acta Ophthalmol Suppl. 1993;(210):20-6. PubMed PMID: 8329947.
16. Sabzehei MK, Afjeh SA, Dastjani Farahani A, Shamshiri AR, Esmaili F. Retinopathy of prematurity: incidence, risk factors, and outcome. Arch Iran Med. 2013 Sep;16(9):507-12.
17. Pulido JS, Byrne SF, Clarkson JG, Di Bernardo CL, Howe CA. Evaluation of eyes with advanced stages of retinopathy of prematurity using standardized echography. Ophthalmology. 1991 Jul;98(7):1099-104
18. Subhani M, Combs A, Weber P, et al. Screening guidelines for retinopathy of prematurity: the need for revision in extremely low birth weight infants. Pediatrics. 2001 Apr. 107(4):656-9.
19. Boggs W. Lower risk of very high myopia with vevacizumab for retinopathy of prematurity. Reuters Health Information. August 14, 2014.
20. Hubbard, G Baker Surgical management of Retinopathy of prematurity. Current opinion in ophthalmology, 2008 19 (5): 384-390