Aims: To establish the frequency and stage of ROP in preterm babies examined in a tertiary eye center and the outcomes of treatment.
Methods: Retrospective review of medical records of preterm infants attending WGGA eye center (June 2016-August 2019). Information on birth weight (BW), gestational age (GA), postmenstrual age at presentation, age at first examination, diagnosis and stage of ROP, and treatment outcomes were analyzed.
Results: 66 infants were included. 28 (42.4%) had ROP: 17 (25.8%) had vision-threatening ROP (any Zone I disease (n=1), Stage 2 or 3 in Zone II with plus disease (n=5), aggressive posterior ROP (n=1), or Stage 4 or 5 (n= 10)). The mean GA of these 17 infants was 28.4±1.6 (range 26-32) weeks; mean BW was 1172.7±259.6 (range 680–1800)g. Treatment was as follows: anti-VEGF injection 5; laser 1; anti-VEGF and laser 1; lens-sparing vitrectomy 1; laser, then lensectomy with vitrectomy 1. In 16 cases ROP regressed (10 spontaneously; 6 after treatment), and one failed follow up. One progressed to stage 4 despite extensive treatment. Ten (10/66, 15.2%) were blind or visually impaired.
Conclusions: Preterm infants at risk of ROP are now surviving in Ethiopia. There is a need to establish ROP screening and treatment services and to increase awareness. Wide criteria should be used initially to delineate the population at risk of vision threatening ROP in this context.
impairment and estimates of retinopathy of prematurity at regional and global levels for
2010. Pediatr Res 2013; 74 Suppl 1: 35-49.
2. Volker S, Otwen P-C. Risk factors in retinopathy of prematurity, a multivariate statistical analysis. Ophthalmologia. 2000;214:131 -5.
3. Kinsey VE. Retrolental fibroplasia: cooperative study of retrolental fibroplasias and the use of oxygen. Arch Ophthalmol. 1956;56:481 – 543.
4. Terry TL. Extreme prematurity and fibroplastic overgrowth of persistent vascular sheath behind each crystalline lens I. Preliminary report. Am J Ophthalmol. 1942. 25:203-4.
5. World Health Organization and the International Agency for the Prevention of Blindness Joint Initiative. Vision 2020: Global initiative for the elimination of avoidable blindness: action plan 2006-2011.Geneva: World Health Organization, 2007. Access at: http:// www.who.int/blindness/Vision2020_report.pdf.
6. Blencowe H, Cousens S, Oestergaard MZ, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379:2162–2172.
7. Gilbert C, Malik A.N.J, Nahar N, et al. Epidemiology of ROP update - Africa is the new frontier. Semin Perinatol. 2019;43(6):317-322.
8. Wang D, Duke R, Chan P, Campbell JP. Retinopathy of prematurity in Africa: a systematic review. Ophthalmic Epidemiol. 2019;26(4):223-230.
9. Gilbert C. Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control. Early Hum Dev.2008;84(2):77–82.
10. Gilbert C, Rahi J, Eckstein M, et al. Retinopathy of prematurity in middle-income countries Lancet 1997; 350: 12–14.
11. Ethiopia: Profile of preterm and low birth weight prevention and care. Updated May 2017. Access at www.EveryPremie.org.
12. Kello AB, Gilbert C. Causes of severe visual impairment and blindness in children in schools for the blind in Ethiopia. Br J Ophthalmol. 2003;87:526–530.
13. Asferaw M, Woodruff G, Gilbert C. Causes of severe visual impairment and blindness in students in schools for the blind in Northwest Ethiopia. BMJ Glob Health 2017;2:e000264.
14. An International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol. 2005; 123: 991-999.
15. Early treatment for Retinopathy of prematurity cooperative group. Revised indications for the treatment of Retinopathy of prematurity. Results of early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol. 2003; 121:1684 – 96.
16. Darlow BA, Husain S. Primary prevention of ROP and the oxygen saturation targeting trials. Semin Perinatol. 2019 ;43(6):333-340.
17. Gilbert CE. Screening for ROP: Does one size fit to all? Arch Dis Child Fetal Neonatal Ed 2016;101:F280–F281.
18. Vinekar A, Gilbert C, Dogra M, et al. The KIDROP model of combining strategies for providing retinopathy of prematurity screening in underserved areas in India using wide-field imaging, tele-medicine, non-physician graders and smart phone reporting. Indian J Ophthalmol. 2014 ; 62(1): 41–49.