Screening based on incidence of severe retinopathy of prematurity in a tertiary care center in India: are Indian infants different?

Umamaheswari Balakrishnan, Shafi Jan Mohammad Shaik Shaik, Nivetha Manian, Muthayya Muthukumar, Mary Thomas, Prakash Amboiram, Binu Ninan, Ashok Chandrasekaran, Saravanan Ramaswamy


Background: Incidence of retinopathy of prematurity (ROP) and screening criteria among the preterm infants varies widely. The incidence of ROP and severe ROP in different Birth Weight (BW) and Gestational Age (GA) groups were studied. The aim of the study was to review the existing screening criteria for ROP based on the highest birth weight and or gestational age of infants who developed severe ROP.

Methods: This is a retrospective descriptive study of neonates with GA of ≤ 34 weeks and/or BW of ≤ 1750 gm screened for ROP by experienced ophthalmologist from January, 2011 to December, 2015. End point was either complete vascularisation or need for laser therapy as per ETROP guidelines. Severe ROP was defined as ROP needing treatment. Highest BW and or GA of infants who developed severe ROP were taken as cut off points for revising the existing screening criteria for ROP.

Results: Among 1366 infants included in this study, 252 (18.4%) and 86 (6.2%) developed ROP and severe ROP, respectively. Mean GA was 29.2±1.4 weeks and 28.7±2.3 among infants with ROP and severe ROP, respectively. Stratified analysis showed a significant increase in the incidence of ROP with decreasing BW and GA (p <0.001). A threshold of BW ≤ 1750 gm and or GA ≤34 weeks would not miss any infant with severe ROP. Applying screening criteria of developed nations would miss 9.3 to 11.6% of infants with severe ROP.

Conclusions: We suggest screening for ROP in all premature infants born with GA of ≤32 weeks and or BW of ≤1750 gm, as this screening criteria has detected all infants with severe ROP.


Retinopathy of prematurity, Screening criteria, Incidence, India, Severe retinopathy of prematurity

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