(ROP) in The Rural Areas of Uttar Pradesh Dr. Lokesh Jain - India ...

COMMUNITY / SOCIAL OPHTHALMOLOGY SESSION
155
COMMUNITY / SOCIAL OPHTHALMOLOGY
Chairman: Dr. N.S. Bhide, Co-Chairman: Dr. H. R. Mohanty
Convenor: Dr. Asim Kumar Sil, Moderator: Dr. G.S. Titiyal
AUTHORS’S PROFILE:
Dr. LOKESH JAIN: MBBS (‘99), MS (2005), Fellowship in Vitreo-Retina (2007). Recipient of
Best Poster Award, AOSC Conference, Oct. 2006 and DOS Conference, April 2007. Presently
Vitre-retinal Consultant, Jain Eye Hospital, Shahdara, Delhi and Visiting Assistant Prof.
Subharti Medical College, Meerut, UP.
E-mail: drlokeshjain@yahoo.com
Incidence of Retinopathy of Prematurity (ROP) in The Rural Areas
of Uttar Pradesh
Dr. Lokesh Jain, Dr. A.K. Sood, Dr. Charu Jain
(Presenting Author: Dr. Lokesh Jain)
Retinopathy of Prematurity (ROP) is a
vasoproliferative condition of the retina and
is one of the major causes of blindness and visual
morbidity in surviving premature infants.
In India with rapid advances in the field of
neonatology more and more premature babies
are surviving possibly with an increased risk of
chronic illnesses including ROP. 1 ROP may
regress completely or leaves sequel from mild
myopia to bilateral total blindness. As ROP is a
preventable cause of blindness, so proper
screening, follow up and treatment according to
stage of the disease is essential for preterm and
low birth weight babies. The multicenter trial on
cryotherapy for ROP has demonstrated that,
timely cryotherapy of peripheral avascular retina
reduces the incidence of an unfavorable
outcome. 2 The international classification of ROP
has helped in uniform documentation and
staging of ROP. 3
With the development of neonatal intensive care
units even in rural areas, premature babies with
extremely low birth weights are surviving and
are at highest risk of developing ROP. There is no
data on incidence of ROP in rural areas only
isolated reports are available in literature from
North and South India. So present study was
undertaken to evaluate the incidence of
Retinopathy of Prematurity in the Neonatal
intensive care units of Medical College at the
Rural area of Uttar Pradesh.
Material and Methods
The study was a prospective hospital based
interventional study. All neonates admitted in
neonatal care unit of Subharti Medical College,
Meerut(Uttar Pradesh) between September 2007
to March 2009 and who fulfilled the ROP
screening criteria were included in the study.The
study included all babies with birth weight less
than or equal to 1700 gms and/or gestational age
at birth less than or equal to 34 weeks for
screening. The initial examination was carried
out between 2nd and 4th week after birth with
proper aseptic precautions. Detailed history
included birth weight, gestational age, postnatal
problems and their management including
oxygen administration, neonatal sepsis. Relevant
maternal history was also noted. All the
ophthalmic examination was done by retina
specialist of the eye department of the medical
college hospital in the neonatal intensive care
unit, one hour after the feed, preferably in
presence of neonatologist.
The anterior segment of eye was evaluated by
+20D lens with binocular indirect
ophthalmoscope. Pupillary dilatation was done
with a mixture of 2.5% phenylephrine and 1%
tropicamide instilled twice at interval of 15
minutes. The baby was kept comfortable with
warm clothes and draped with white sheet thus
restraining hands and feet. A paediatric eye
speculum was used to separate the lids and

156 AIOC 2010 PROCEEDINGS
fundus was examined with binocular indirect
ophthalmoscope with +20 D lens. Scleral
depression was performed using a modified
paper clip and was carried out transconjuctivally
under topical anaesthesia. The findings were
noted in a prescribed proforma. Pulse rate and
respiratory rate were recorded throughout the
examination.
Infants with normal vascularization of the
fundus up to the periphery were reexamined
only once at 40 weeks of post conceptional age.
Infants with peripheral avascular retina but no
clinical ROP and those with prethreshold ROP
were re-examined at weekly intervals. The
prethreshold ROP cases were followed until they
progressed to threshold ROP in which case they
were treated or until there was total regression.
Threshold ROP was treated when found either at
initial examination or within 72 hours of
detection. Infants progressing rapidly and in
presence of plus disease were treated before
development of threshold disease.
Indirect ophthalmoscopic green laser
photocoagulation was the modality of treatment
done under topical anesthesia in the presence of
neonatologist. The avascular retina anterior to the
ridge was treated, carefully avoiding treatment
of the ridge itself. After treatment child was
followed up at or after 72 hours and then weekly
till ROP regressed completely. If no signs of
regression were present, then re-treatment was
done in skipped areas within 2 weeks.
Results
A total of 102 neonates were screened between
September 2007 to March 2009.The birth weight
ranged from 950 to 1670 grams with mean of
1310grams.The gestational age ranged from 24 to
34 weeks with mean of 30 weeks.55 cases(54%)
were males and 47(46%) cases were females. Out
of 102 neonates, 37 (36.27%) were found to have
some stage of ROP. The disease was symmetrical
in 27 cases and asymmetrical in 10 cases. Of the
102 cases screened 64 cases had a history of
oxygen administration. The maximum stage of
ROP noted during entire follow up was StageI
ROP in 10 cases (27%), Stage II in 7cases(18.9%),
Stage III in 14cases (37.83%), Stage IV in 4
cases(10.8%) and Stage V in 2 cases(5.4%). Plus
disease was documented in 17 cases(45.9%). All
the infants having plus disease had a birth weight
less than 1250grams and gestational age less than
32 weeks. Laser photocoagulation was advised in
20 cases but could be done in 14 cases and
surgical intervention was advised in 4 cases but
only 2 cases opted for it. 4 patients needed two
sittings of Laser photocoagulation and out of
these 1 case further deteriorated and another
baby expired. Follow up period varied from 0-52
weeks.
Discussion
The published reports reveal Terry was the first
to report retrolental fibroplasia in premature
infants 4 . Heath introduced the term retinopathy
of prematurity, which is applicable to all the
stages of the disease unlike retrolental
fibroplasias that was applicable to only to the
StageV disease. The international classification
for ROP has been accepted as the standard for
documenting and describing this disease. 5
In rural areas routine evaluation of preterm
infants at risk is not being done due to lack of
awareness of this potentially blinding problem.
With improving neonatal care and increasing
survival of low and very low birth weight
children, the incidence is on the rise and is
expected to increase in near future. Till now, by
the time most of the cases which are referred to
the ophthalmologist, StageV ROP has already
developed and only choice is surgical
intervention, which is successful only in small
number of cases. The aim of screening premature
babies for ROP is to detect all treatable cases with
minimal expense of time and resources. Apart
from two critical factors- birth weight and
gestational age other factors contributing to
development of ROP like exposure to oxygen,
respiratory distress syndrome, sepsis, multiple
blood transfusion, multiple birth, apnoeic spell,
bradyspells, intraventricular hemorrhages,
metabolic acidosis, necrotizing enterocolitis,
seizures were also considered. The incidence of
ROP in various western studies is reported to
vary from 21% to 65.8% 6 and some Indian
studies reported the incidence of ROP from 38%
to 51.89%. 1,7,8 In our study the incidence of ROP
was 36.27%. In our study, incidence of ROP was
more common in lower birth weight and
gestational age group. Symmetrical involvement
of ROP in both eyes was more common than
asymmetrical involvement. It was also noted that

COMMUNITY / SOCIAL OPHTHALMOLOGY SESSION
157
plus disease is more common in low birth weight
and gestational age. Fielder et al 6 and Charan et
al1 had also reported similar observation. In
conclusion incidence of ROP is high in rural areas
1. Charan R,Dogra MR,Gupta A,Narang A.The
incidence of retinopathy of prematurity in a neonatal
care unit. Indian J Ophthalmol 1995;43:123-6.
2. Cryotherapy for Retinopathy of Prematurity
Cooperative Group.Multicentre trial of cryotherapy
for retinopathy of prematurity- 3½ years outcome
for both structure and function. Arch Ophthalmol
1993;111:339-45.
3. Committee for the classification of Retinopathy Of
Prematurity: An International Classification of
Retinopathy of Prematurity. Arch Ophthalmol
1984;102:1130-4.
4. Terry TL. Extreme prematurity and fibroblastic
overgrowth of persistent vascular sheath behind
each crystalline lens. I Preliminary report. Am J
Ophthalmol 1942;25:203-4.
References
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