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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 57  |  Issue : 1  |  Page : 24-26

Study of incidence, risk factors, and treatment outcomes in retinopathy of prematurity in a tertiary care center


1 Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidhyapeeth, Puducherry, India
2 Vitreo-Retina Services, Aravind Eye Hospital, Puducherry, India

Date of Web Publication10-Jun-2019

Correspondence Address:
Dr. Krishnagopal Srikanth
Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidhyapeeth, Pilliyarkuppam, Puducherry - 607 402
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_10_19

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  Abstract 


Aim: The primary aim of the study is to determine the association between incidence, risk factors, and treatment outcomes in retinopathy of prematurity (ROP). Subjects and Methods: A longitudinal observational study was carried out on 65 babies who fulfilled the criteria for ROP screening at a tertiary center. Results: Of the 65 babies screened, 24 (36.9%) developed some stage of ROP with 12 developing Type 1 ROP. Mean birth weight, mean gestational age (GA), and duration of oxygen therapy were significantly associated with the development of ROP (P = 0.047, P < 0.001, and P < 0.001, respectively). One-third of the babies had maternal risk factors also. Of the 24 babies with ROP, zone 3 was involved in 13 (54.1%) babies and zone 2 was involved in 11 (45.8%) babies; 7 (29.1%) had stage 1, 9 (37.5%) had stage 2, and 8 (33.3%) had stage 3. Of 24 babies with ROP, 12 (50%) required treatment with laser photocoagulation and all these babies showed regression of ROP following treatment. Conclusion: Birth weight <1.70 kg, GA <32 weeks, and oxygen therapy were associated with development of ROP. ROP regressed with laser photocoagulation.

Keywords: Laser photocoagulation, retinopathy of prematurity, treatment outcomes


How to cite this article:
Anudeep K, Srikanth K, Sindal MD, Jha KN. Study of incidence, risk factors, and treatment outcomes in retinopathy of prematurity in a tertiary care center. TNOA J Ophthalmic Sci Res 2019;57:24-6

How to cite this URL:
Anudeep K, Srikanth K, Sindal MD, Jha KN. Study of incidence, risk factors, and treatment outcomes in retinopathy of prematurity in a tertiary care center. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2019 Nov 11];57:24-6. Available from: http://www.tnoajosr.com/text.asp?2019/57/1/24/259865




  Introduction Top


Out of 26 million annual live births in India, nearly 2 million are < 2000 g in weight and are at risk of developing retinopathy of prematurity (ROP).[1] In India, the incidence of ROP is between 38% and 51.9% in low-birth-weight babies.[2] Advances in neonatal care have improved survival of preterm babies. ROP is one of the foremost causes of blindness in preterm babies.[3] Oxygen supplementation is identified to be an important risk factor for the development of ROP.[4] ROP can develop without oxygen supplementation and babies who have received oxygen do not develop ROP necessarily.[5] This suggests there are other risk factors for ROP such as early gestational age (GA), low-birth weight, hyperoxia, apnea, intraventricular hemorrhage, blood transfusions, and maternal bleeding. Impaired vision, large refractive error mainly myopia, strabismus, and blindness may occur following severe ROP.[6] Treatment of ROP includes cryotherapy, laser photocoagulation, and intravitreal injection of anti-VEGF. Each has their merits and demerits. The purpose of the study was to find the association between incidence, risk factors, and treatment outcomes in ROP at a medical college-associated tertiary hospital in South India.

Aim

The aim is to study the incidence, risk factors, and treatment outcomes in ROP.

Objectives

  1. To assess the incidence of ROP
  2. To find the association among different factors influencing ROP
  3. To assess the outcome after treatment of ROP.



  Subjects and Methods Top


This was a prospective longitudinal observational study done on preterm babies in the neonatal intensive care unit of our hospital. The study was approved by the Institutional Human Ethics Committee and adhered to the principles in the Declaration of Helsinki. Informed consent was obtained. Babies with birth weight <1700 g, GA <34 weeks at birth, exposure to oxygen, multiple gestations, respiratory distress syndrome, sepsis, intraventricular hemorrhage, and with maternal complications such as gestational diabetes mellitus (GDM), gestational hypertension (GHTN), and antepartum hemorrhage were identified in the neonatal intensive care unit of our hospital.[2] Detailed obstetric history and postnatal course were noted. For fundus examination, pupils were dilated using half strength tropicamide 0.8% with phenylephrine 5% eye drops by diluting commercially available drops (AUROMIDE PLUS) with tear substitutes. Fundus evaluation was done using indirect ophthalmoscope and +28D lens with Alphonse speculum and scleral indentation by fellowship-trained vitreoretinal specialists. High-risk babies and babies with features of ROP were screened at weekly intervals. Babies who required treatment were treated with laser photocoagulation with an 810-nm diode laser. Follow-up of treated babies was done at weekly intervals until ROP had regressed or retina was mature. Statistical analysis was performed using the SPSS Ver 2.0 SPSS, version 2.0 (IBM, Armonk, New York, U.S.A) year manufacturer. Continuous variables were described in terms of percentage, mean, standard deviation, and analyzed with the Chi-square test. Pearson's correlation was used to compare the risk factors and its effect on treatment outcomes.


  Results Top


Of the 65 preterm babies screened, 24 (37%) developed ROP and 41 (63%) did not develop ROP.

The mean birth weight in babies with ROP was 1.63 ± 0.479 kg, and in babies without ROP was 1.94 ± 0.662 kg. Mean GA in babies with ROP was 30.88 ± 2.383 weeks, and in babies without ROP was 33.66 ± 2.623 weeks. The mean duration of oxygen therapy in babies with ROP was 11 days, and in babies without ROP was 3.37 days. [Table 1] and [Table 2] show relationship between ROP and the associated risk factors. There was a significant relationship between the occurrence of ROP and birth weight (0.047), GA (<0.001), duration of oxygen therapy (<0.001), postconceptional age (0.002), and respiratory distress syndrome. Relationship between the occurrence of ROP and maternal risk factors such as antepartum hemorrhage, GDM, GHTN, and multiple pregnancies was not significant.
Table 1: Relationship between retinopathy of prematurity and risk factors

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Table 2: Other risk factors associated with retinopathy of prematurity

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Of the 65 babies screened, 24 (37%) developed ROP, 3 (12.5%) had zone 2 stage 1, 2 (8.3%) had zone 2 stage 2, 6 (25%) had zone 2 stage 3, 4 (16.7%) had zone 3 stage 1, 7 (29.2%) had zone 3 stage 2, and 2 (8.3%) had zone 3 stage 3; 12 (50%) had plus disease. There were no cases of stage 4 or 5 ROP [Table 3].
Table 3: Stages of retinopathy of prematurity

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Of the 24 babies with ROP, 12 (50%) babies required intervention with laser photocoagulation, three babies in zone 2 stage 1, two babies in zone 2 stage 2, six babies in zone 2 stage 3, and 1 baby in zone 3 stage 3. All these 12 babies had plus disease, and these cases showed improvement on follow-up. The other 12 (50%) cases regressed spontaneously without intervention [Table 4].
Table 4: Treatment of retinopathy of prematurity with laser photocoagulation

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  Discussion Top


In this study, out of 65 preterm babies, 24 (37%) developed ROP. While other investigators have shown an incidence between 28% and 37%.[7],[8],[9]

In this study, we found that low-birth weight was the most common risk factor for the development of ROP followed by duration of oxygen therapy and low-GA. This is in correlation with other studies.[7],[10],[11] Although multiple gestations, GDM, GHTN, and intraventricular hemorrhage were considered as risk factors for the development of ROP. The present study did not find them as significant risk factors. Other studies have shown multiple gestation as an independent risk factor for the development of ROP.[2],[12]

In this study, zone 3 stage 2 7 (29.2%) was the most common area involved followed by zone 2 stage 3 6 (25%). This may be due to meticulous screening protocol and our cohort was older babies. Other study has shown that zone 2 being the most commonly involved area.[7] None of the babies had zone 1 as our cohort was older babies. Stage 4 or 5 ROP was not seen as all cases were screened in timely manner in this study. In this study, out of 24 babies with ROP, 12 (50%) required intervention with laser photocoagulation. Laser photocoagulated eyes showed regression of the disease, and the results were extremely satisfactory. Other studies have also shown that laser therapy gives better outcomes.[13],[14]

Other studies have compared laser with anti-vascular endothelial growth factor as it has been used in severe forms of ROP, and they have shown that bevacizumab gives good results in stage 3+ ROP in zone 1 but not in zone 2.[15],[16] We have not compared the treatment outcomes with bevacizumab as there were no babies with zone 1 ROP.

Since ROP is essentially asymptomatic in the early stages, careful timed retinal examination of at risk infants will minimize the development of ROP and subsequent visual loss in these infants. Limitations of this study were small sample size and single-center study.


  Conclusion Top


The incidence of ROP among preterm babies is 37%. Low-birth weight, prematurity, duration of oxygen therapy and respiratory distress syndrome remain as predominant risk factors in the development of ROP. Laser photocoagulation is effective in the treatment of ROP.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Sen P, Rao C, Bansal N. Retinopathy of prematurity: An update. Sci J Med Vis Res Found 2015;XXXIII:93-6.  Back to cited text no. 1
    
2.
Jalali S, Anand R, Kumar H, Dogra MR, Azad R, Gopal L, et al. Programme planning and screening strategy in retinopathy of prematurity. Indian J Ophthalmol 2003;51:89-99.  Back to cited text no. 2
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Terry TL. Fibroblastic overgrowth of persistent tunica vasculosa lentis in infants born prematurely: II. Report of cases-clinical aspects. Trans Am Ophthalmol Soc 1942;40:262-84.  Back to cited text no. 3
    
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Alajbegovic-Halimic J, Zvizdic D, Alimanovic-Halilovic E, Dodik I, Duvnjak S. Risk factors for retinopathy of prematurity in premature born children. Med Arch 2015;69:409-13.  Back to cited text no. 4
    
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Owen LA, Hartnett ME. Current concepts of oxygen management in retinopathy of prematurity. J Ophthalmic Vis Res 2014;9:94-100.  Back to cited text no. 5
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Murthy KR, Murthy PR, Shah DA, Nandan MR, S NH, Benakappa N, et al. Comparison of profile of retinopathy of prematurity in semiurban/rural and urban NICUs in Karnataka, India. Br J Ophthalmol 2013;97:687-9.  Back to cited text no. 8
    
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Mutlu FM, Altinsoy HI, Mumcuoglu T, Kerimoglu H, Kiliç S, Kul M, et al. Screening for retinopathy of prematurity in a tertiary care newborn unit in Turkey: Frequency, outcomes, and risk factor analysis. J Pediatr Ophthalmol Strabismus 2008;45:291-8.  Back to cited text no. 9
    
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Alizadeh Y, Zarkesh M, Moghadam RS, Esfandiarpour B, Behboudi H, Karambin MM, et al. Incidence and risk factors for retinopathy of prematurity in North of Iran. J Ophthalmic Vis Res 2015;10:424-8.  Back to cited text no. 10
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Isaza G, Arora S, Bal M, Chaudhary V. Incidence of retinopathy of prematurity and risk factors among premature infants at a neonatal intensive care unit in Canada. J Pediatr Ophthalmol Strabismus 2013;50:27-32.  Back to cited text no. 11
    
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Sood V, Chellani H, Arya S, Guliani BP. Changing spectrum of retinopathy of prematurity (ROP) and variations among siblings of multiple gestation. Indian J Pediatr 2012;79:905-10.  Back to cited text no. 12
    
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Iu LP, Lai CH, Fan MC, Wong IY, Lai JS. Screening for retinopathy of prematurity and treatment outcome in a tertiary hospital in Hong Kong. Hong Kong Med J 2017;23:41-7.  Back to cited text no. 13
    
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Celebi AR, Petricli IS, Hekimoglu E, Demirel N, Bas AY. The incidence and risk factors of severe retinopathy of prematurity in extremely low birth weight infants in Turkey. Med Sci Monit 2014;20:1647-53.  Back to cited text no. 14
    
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Mintz-Hittner HA, Kennedy KA, Chuang AZ; BEAT-ROP Cooperative Group. Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity. N Engl J Med 2011;364:603-15.  Back to cited text no. 15
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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