Retinopathy of prematurity(ROP)is a disease related to low birth weight, prematurity, oxygen administration, and other unidentified factors.
There are several compelling reasons to have screening progamme for retinopathy of prematurity. Firstly, the premature child is not born with ROP and retinal disease is not present at birth. Each such child has a potential for normal vision, even if the retina is immature at birth. Screening aims to identify those infants who have reached or have the potential to reach threshold ROP, which if untreated may cause blindness or visual impairment. This has medicolegal implications. There are indefensible legal repercussions should an infant develop ROP and retinal detachment, but had not received eye examination. Secondly the grief and personal tragedy for the family is tremendous, besides the economic burden of such childhood blindness. Early recognition of ROP by screening provides an opportunity for effective treatment.
While the incidence of retinopathy of prematurity is on the wane in west, thanks to the improvement in neonatal care and screening. In India we are just beginning to face the storm mainly due to increased awareness. The most important determinant of any retinopathy of prematurity management program is an effective screening strategy. So retinopathy of prematurity is becoming a major cause of potentially preventable blindness among children in middle income countries that have introduced neonatal intensive care units for preterm and low birth weight babies.
So the present study would help to diagnose early and later stages of retinopathy of prematurity and to take necessary steps to prevent blindness in early stages and also helps to know about its association with certain risk factors.
Review of Literature
In general, prematurity, low birth weight, a complex hospital course, and prolonged supplemental oxygen are today’s established risk factors for the development of ROP1.
In 1984 the committte for the classification of retinopathy of prematurity2 presented an international classification of retinopathy of prematurity.
According to study done by cryotherapy for retinopathy of prematurity co-operative group3, it supports the efficacy of cryotherapy in reducing the unfavorable retinal outcome from threshold retinopathy of prematurity.
A study conducted by Benner et al4 suggested that both diode and argon laser indirect ophthalmoscopy appear to be equally effective in treating threshold retinopathy of prematurity. But patients with argon laser indirect ophthalmoscopy sustained burns of the tunica vasculosa lentis and anterior lens capsule.
In a study done by Gopal L et al5 a total of 50 infants of less than 2000 gm birth weight were screened for retinopathy of prematurity (ROP) by binocular indirect ophthalmoscopy. The incidence of ROP was found in 19 patients (38%). Of these, 8 patients (16 eyes) had threshold disease. Significantly, occurrence of threshold ROP was seen in both 1600 gm birth weight in one infant and in the absence of oxygen administration in 2 infants. Ten of the 16 eyes underwent therapeutic intervention while 6 eyes did not receive treatment for lack of consent from the parents. The treatment consisted of indirect laser photocoagulation (8 eyes) and transconjunctival cryopexy (2 eyes). Good regression of the disease (favourable outcome) was noted in all the treated eyes.
A study done by rohit charan et al6 showed that Babies with lower birth weights and lower gestation age at birth had a significantly higher incidence of ROP. A study done by Donna M knight-Nanan et al7 showed that refractive error(myopia)fallowing diode laser is less as compared to cryotherapy.
A study conducted by Dr.Clare Gilbert et al8 showed that retinopathy of prematurity is becoming a major cause of potentially preventable blindness among children in middle income countries that have introduced neonatal intensive care services for preterm and low birth weight babies.
A study done by Varugese S et al9 conducted in large maternity unit with a medium size level-3 nursery describes the extent of severity of retinopathy of prematurity. Screening of 79 preterm babies showed that ophthalmic examinations should become an important part of neonatal care.
A study conducted by Parag K Shah et al10 suggested that binocular indirect ophthalmoscope is the gold standard for screening retinopathy of prematurity.
Objectives of the study
To determine the incidence of retinopathy of prematurity in neonates (of less than 36 weeks gestatinal age and/or of less than 2000 grams birth weight).
To determine its association with certain risk factors.
Materials and methods
7.1 Source of Data
All neonates with a gestational age less than 36 weeks and/or a birth weight of less than 2000 grams at Basaveshwar teaching and general hospital and Sangameshwar hospital, Gulbarga.
7.2 Methods of collection of data(including sampling)
7.4 Has ethical clearance been obtained from institution in case of 7.3?
Yes, ethical clearance has been taken from “ethical clearance committee” of the
Stephen J. Ryan. Retina. Fourth edition, volume 2, section 5, chapter 80, page 1464.
The Committee for the Classification of Retinopathy of Prematurity. An International Classification of Retinopathy of Prematurity. Arch Ophthalmol 1984;102:1130-1134.
Cryotherapy for Retinopathy of Prematurity Co-operative Group: Multicentre trial of cryo therapy for retinopathy of prematurity. Preliminary results. Arch Ophthalmol 1988;106:471-479.
BENNER, JEFFREY D, MORSE, LAWRENCE S, HAY, ANDY, LANDERS, MAURICE B. A Comparison of Argon and Diode Photocoagulation Combined With Supplemental Oxygen for the Treatment of Retinopathy of Prematurity. Retina 1993;13(3):222-229.
Gopal L, Sharma T, Ramachandran S, Shanmugasundaram R, Asha V. Retinopathy of prematurity: A study. Indian J Ophthalmol 1995;43:59-61.
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
Donna M Knight-Nanan, Michael O'Keefe. Refractive outcome in eyes with retinopathy of prematurity treated with cryotherapy or diode laser: 3 year follow up. British journal of Ophthalmology 1996;80:998-1001.
Dr Clare Gilbert MD, Jugnoo Rahi FRCOphth, Michael Eckstein FRCOphth, Jane O'Sullivan FRCOphth, Allen Foster FRCOphth. Retinopathy of prematurity in middle-income countries. The Lancet, 5 July 1997; Volume 350, Issue 9070, Pages 12 – 14.
Varughese S, Jain S, Gupta N, Singh S, Tyagi V, Puliyel JM. Magnitude of the problem of retinopathy of prematurity. Experience in a large maternity unit with a medium size level-3 nursery. Indian J Ophthalmol 2001;49:187-8.
Shah PK, Narendran V, Saravanan VR, Raghuram A, Chattopadhyay A, Kashyap M. Screening for retinsopathy of prematurity-a comparison between binocular indirect ophthalmoscopy and RetCam 120. Indian J Ophthalmol 2006;54:35-8.