A STUDY OF RISK OF RETINOPATHY OF PREMATURITY IN LOW BIRTH WEIGHT AND PREMATURE INFANTS WITH EXTENDED PROTOCOLS OF SCREENING.

Objective: To evaluate the prevalence and severity of retinopathy of prematurity and its relationship with low birth weight and prematurity with extended protocols of screening. Methods : This is a hospital based observational study, examining all the newborn infants with birth weight ≤ 2000 grams and gestational age ≤ 35 weeks and / or neonates with > 2000 grams birth weight and > 35 weeks with rough neonatal period, brought to Govt. Regional Eye Hospital, Andhra Medical College, Visakhapatnam from January 2017 to December 2017. Results : Three hundred forty two newborns were screened. Two hundred thirty seven newborns were normal and have no ROP. 38 were diagnosed to have stage 1 retinopathy of prematurity, 19 had stage 2 retinopathy of prematurity, 14 had stage 3 retinopathy of prematurity and 1 baby had stage 5 retinopathy of prematurity. The prevalence of retinopathy of prematurity was 21.05%, affecting 72 newborns. The prevalence of Retinopathy of prematurity progressing to threshold ROP was 1.17%


ISSN: 2320-5407
Int. J. Adv. Res. 6(2), 916-921 917 Retinopathy of prematurity is a disorder of the developing retinal blood vessels in premature infants. The main pathology in ROP is the peripheral neovascularization 4 .The outcomes vary from minimal sequelae to bilateral irreversible blindness.
Retinopathy of prematurity, first identified by Terry in 1942, which was previously described as retrolental fibroplasia. As the pathogenesis became better understood later, the term Retinopathy of Prematurity was adopted. This was coined by Heath 2 in 1951.
The incidence of ROP is increasing in India because of improved neonatal survival rate. Out of 26 million annual live births in India, approximately 2 million are <2000 g in weight and are at risk of developing ROP 5 . In India the incidence of ROP is between 38 and 51.9% in low-birth-weight Infants 5,6 .

Methods:-
A hospital based observational study, was conducted at Govt. Regional Eye hospital from January 2017 to December 2017. Informed consent of parents was taken after explaining in detail about methods and procedures involved in the study in their own language.
Preparation of the baby:-Pupils are dilated with Phenylephrine 2.5% and Tropicamide 0.5%. One drop of Tropicamide is instilled every 10-15 min for 4 times starting 1 hour before the scheduled time for examination. Phenylephrine is available in 10% concentration; it should be diluted 4 times before use in neonates. Care was taken to wipe off any eye drops with sterile cotton that come out of eyes to cheeks and not to feed the baby immediately before examination as the child might vomit or aspirate. Repeated instillation of phenylephrine is avoided for the fear of hypertension.
Examination procedure:-Screening of ROP involves indirect ophthalmoscopy using 20 D lens by the experienced author. After instilling a topical anesthetic drop like Proparacaine, a wire speculum is inserted to keep the eyelids apart. First the anterior segment of the eye is examined to look for tunica vasculosa lentis, pupillary dilation, and lens/media clarity; followed by the posterior pole to look for plus disease; followed by sequential examination of all clock hours of the peripheral retina. A scleral depressor is often used to indent the eye externally to examine areas of interest, rotate and stabilize the eye.

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The results showed an overall significant benefit for the early treatment of eyes with high-risk prethreshold disease. Based on results of ETROP, two new terminologies have been suggested:

Results:-
One year hospital based observational study to know correlation between gestational age and birth weight with retinopathy of prematurity at Government Regional Eye Hospital, Andhra Medical College, Visakhapatnam, from January 2017 to December 2017.
Data distribution of the occurrence of retinopathy of prematurity to that of the babies screened in table 1.

Discussion:-
In the present study, the incidence of various stages of retinopathy of prematurity is 21.05%. Retinopathy of prematurity is a bilateral vasoproliferative retinopathy affecting preterm or low birth weight babies which sometimes progresses to cause visual impairment or blindness. It is an avoidable cause of childhood blindness and its control is given priority in WHO's VISION 2020 programme 8 . Its secondary prevention, i.e. its early treatment to prevent blindness, requires a qualified ophthalmologists to screen babies at risk soon after birth.
Our study concluded that retinopathy of prematurity is an important complication of prematurity. Meticulous fundus examination with indirect ophthalmoscopy in all preterm babies with gestational age < 35 weeks and birth weight < 2000 grams and babies whose gestational age >35 weeks and birth weight > 2000 grams with rough neonatal period must undergo noninvasive method for early detection of ROP and its progression. The observed association of low GA or BW with ROP is in agreement with the most of the other studies 9,10 . 31(43%) babies of more than 1500 grams weight and 7 (9.72%) babies of more than 2000 grams developed ROP in our study, which emphasizes the need for extended screening protocols. In our center we include all babies of less than 35 weeks gestation and less than 2000 grams and all the babies regardless of birth weight and gestational age with rough perinatal course referred from neonatologists for ROP screening.