Screening for retinopathy of prematurity in neonates

Mitul Kasundra, Purvi Patel, Mehariya K. M.


Background: Retinopathy of prematurity (ROP) is a vaso-proliferative disorder of the retina among preterm infants. Neonates born at less than 32 weeks of gestation are at risk of developing ROP. However preterm infants born at 32 weeks or later can also develop severe ROP if they had turbulent NICU course or required prolonged oxygen therapy. Aims of the study were to determine incidence, risk factors of ROP in neonates and to determine the association of birth weight, gestational age and incidence of ROP.

Methods: Prospective analytic study done in indoor patients in neonatal intensive care unit at a tertiary care center from June 2015 to May 2016.

Results: Overall incidence of retinopathy of prematurity in preterm neonates is 18.4%. Incidence increases with decreasing gestational age. In preterm <28 weeks of gestational age, incidence of ROP is 35%. Incidence also increases with decreasing birth weight. Incidence of ROP in neonates with birth weight less than 1.25kg is 50%. Risk factors include prematurity, oxygen therapy, septicemia, intraventricular hemorrhage, anemia needing blood transfusion. Most patients of ROP have stage-1 disease (76%). The twenty one cases having ROP underwent laser ablative therapy. Earlier detection by screening leads to early intervention and prevention of blindness.

Conclusions: The timely retinal screening of high-risk preterm infants is important to prevent the development of advanced ROP. Since ROP may produce serious sequel up to complete blindness, all efforts must be made to prevent the development of advanced ROP through elimination of preterm births, changes in the neonatal care and improvement in detection of threatening ROP markers.


Birth weight, Blindness, Prematurity, ROP

Full Text:



Chaudhari S, Patwardhan V, Vaidya U, Kadam S, Kamat A. Retinopathy of Prematurity in a Tertiary care centre – Incidence and Risk factors and Outcome. Indian pediatric. 2009;33:399-1003.

Chawla D, Agarwal R, Deorari AK, Pasul VK. Retinopathy of Prematurity. Indian J. Pediatric. 2008:75:73-6.

Flynn JT. Retinopathy of Prematurity. Pediatric Clin N Am. 1987:34:1483.

Dutta S, Narang S, Narang A, Dogra M, Gupta A. Risk factors of threshold retinopathy of prematurity. Indian Pediatr. 2004;41:665-71.

American Academy of Pediatrics Section on Ophthalmology, American Academy of Ophthalmology and American Association for Pediatric Ophthalmology and Strabismus. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatr. 2006;117:572-6.

Murthy KR, Nagendra, Babu K, Benakappa N, Niranjan, Murthy PR. Analysis of risk factors for the development of ROP in preterm infants at a tertiary referral hospital in South India. ActaMedica Litunica. 2006;13:147-51.

Shah VA, Yeo CL, Ling YL, Ho LY. Incidence, risk factors of retinopathy of prematurity among very low birth weight infants in Singapore. Ann Acad Med Singapore. 2005;34:169-78.

Taqui AM, Syed R, Chaudhry TA, Ahmad K, Salat MS. Retinopathy of Prematurity: Frequency and Risk Factors in a Tertiary Care Hospital in Karachi, Pakistan. J Pak Med Assoc. 2008;58:186-90.

Chen Y, Li XX, Yin H, Gilbert C, Liang JH, Jiang YR, et al. Risk factors for retinopathy of prematurity in six neonatal intensive care units in Beijing China. Br J Ophthalmol. 2008;92:326-30.

Kim TI, Sohn J, Pi SY, Yoon YH. Postnatal risk factors of retinopathy of prematurity. Paediatr Perinat Epidemiol. 2004;18:130-4.

Akkoyun I, Oto S, Yilmaz G, Gurakan B, Tarcan A, Anuk D, et al. Risk factors in the development of mild and severe retinopathy of prematurity. J AAPOS. 2006;10:449-53.

Dammann O, Brinkhaus MJ, Bartels DB, Dördelmann M, Dressler F, Kerk J, et al. Immaturity, perinatal inflammation, and retinopathy of prematurity: A multi-hit hypothesis. Early Hum Dev. 2009;85:325-9.

Shah VA, Yeo CL, Ling YL, Ho LY. Incidence, risk factors of retinopathy of prematurity among very low birth weight infants in Singapore. Ann Acad Med Singapore. 2005;34:169-78.

Karna P, Muttineni J, Angell L, Karmaus W. Retinopathy of prematurity and risk factors: A prospective cohort study. BMC Pediatr. 2005;5:18

Fortes Filho JB, Barros CK, Lermann VL, Eckert GU, Costa MC, Procianoy RS. Prevention of blindness due to retinopathy of prematurity at Hospital de Clinicas de Porto Alegre, Brazil: Incidence, risk factors, laser treatment and outcomes from 2002 to 2006. Acta Medica Lituanica. 2006;13:130-6.

Flores-Santos R, Hernández-Cabrera MA, Henández-Herrera RJ, Sepúlveda-Cañamar F. Screening for retinopathy of prematurity: Results of a 7-year study of underweight newborns. Arch Med Res. 2007;38:440-3.

Vinekar A, Dogra MR, Sangtam T, Narang A, Gupta A. Retinopathy of prematurity in Asian Indian babies weighting greater than 1250 gram at birth; ten years data from tertiary care center in a developing country. Indian J Ophthalmol. 2007;55:331-6.

Chawla D, Agarwal R, Deorari A, Paul VK, Chandra P, Azad RV. Retinopathy of Prematurity. Indian J Pediatr. 2012;79:501-9.

Coats DK, Miller AM, Hussein MA, McCreery KM, Holz E, Paysse EA. Involution of Retinopathy of Prematurity after Laser Treatment: Factors Associated with Development of Retinal Detachment. Am J Ophthalmol. 2005;140:214-22.

Hirano K, Morinobu T, Kim H, Hiroi M, Ban R, Ogawa S, et al. Blood transfusion increases radical promoting non-transferrin bound iron in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2001;84:188-93.

Palmer EA, Hardy RJ, Dobson V, Phelps DL, Quinn GE, Summers CG, et al. Cryotherapy for retinopathy of prematurity cooperative group. Outcomes following threshold retinopathy of prematurity. Final results from the multicenter trial of Cryotherapy for Retinopathy of Prematurity. Arch Ophthalmol. 2005;123:311-18.