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LETTER TO EDITOR
Year : 2005  |  Volume : 53  |  Issue : 4  |  Page : 295

Are the Indian retinopathy of prematurity criteria appropriate for Indian babies?


The Eye Super-Specialities and L V Prasad Eye Institute, Collaborating Center, 201, Punit-Plaza, Next to Rajawadi Post Office, Ghatkopar (East), Mumbai 400 075, India

Correspondence Address:
Nikunj J Shah
The Eye Super-Specialities and L V Prasad Eye Institute, Collaborating Center, 201, Punit-Plaza, Next to Rajawadi Post Office, Ghatkopar (East), Mumbai 400 075
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.18917

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How to cite this article:
Shah NJ. Are the Indian retinopathy of prematurity criteria appropriate for Indian babies?. Indian J Ophthalmol 2005;53:295

How to cite this URL:
Shah NJ. Are the Indian retinopathy of prematurity criteria appropriate for Indian babies?. Indian J Ophthalmol [serial online] 2005 [cited 2019 Dec 7];53:295. Available from: http://www.ijo.in/text.asp?2005/53/4/295/18917

Dear Editor,

The international criteria for screening of retinopathy of prematurity (ROP) have been the standard guideline towards management of these patients.[1] However, it has to match with the socioeconomic and health scenario in different countries. In India, the progress in science and technology has seen an increase in the survival rate of premature babies. The incidence of ROP could be expected to increase[2] which could be ascertained only if meticulous screening regimen is followed. A population-based study of incidence of ROP in a developing country has various social and financial constraints in addition to the lack of awareness amongst the paediatricians and ophthalmologists. Hence, a clinic (NICU)-based model could be a better guideline towards this increasing problem.

Purpose of the present study was to find out the appropriateness of the ROP criteria suggested by Jalali et al[3] when applied to Indian conditions.

We assessed 523 consecutive babies admitted at a NICU in the city of Mumbai during a period between August 2002 and August 2003 using the ROP criteria suggested by Jalali et al .[3] Ten babies fulfilled the criteria and were examined and followed up according to the above criteria. All the medical and paramedical staff of NICU was educated about the criteria. On admission, a baby was allotted the category as to whether examination was essential or not. All those eligible for examination were allotted a date for preliminary fundus examination at 31 weeks or at 2 weeks of birth whichever was earlier. None of the babies missed the screening.

All subjects were examined by a single vitreo-retinal surgeons (NS) trained in managing these cases. The pupils were dilated with 2.5% phenylephrine (commercially available 10% phenylephrine was diluted with hydroxy methyl cellulose eye drops) and 1% tropicamide eye drops alternating every 15 min instilled thrice. Examination was carried out in the NICU by indirect ophthalmoscopy. An infant wire speculum and lens spatula were used for a better exposure and scleral indentation respectively. Distilled water was used to prevent corneal drying during examination. Screening was considered complete once the retina reached maturity or threshold disease requiring treatment.

The babies were treated according to the international ROP study guidelines with 532 nm laser photocoagulation with emphasis on managing them in the NICU, if admitted, thus avoiding unnecessary delay in the treatment. Surgical modalities such as scleral buckling and vitrectomy were resorted to for advanced cases (stages IV and V ROP).

Ten of 523 premature babies (1.91%) admitted to the NICU were found eligible for examination according to the criteria by Jalali et al .[3] The gestational age ranged from 28 to 32 weeks (mean 29.5 weeks). There were eight males (80%) and two females (20%). The maternal age ranged from 24 to 30 years (mean 27.7 years). The mean birth weight was 1.31 kg (1.1-1.6 kg). All these babies progressed to ROP in both eyes, and 9 of 10 patients developed threshold ROP and one had pre-threshold disease that regressed spontaneously. All eyes with threshold disease received laser treatment. Of these, one eye each of two patients (2/18 treated eyes, 11%) required buckling and another required vitrectomy. The retina was attached in all the patients (100%) at the end of one year of follow up. The criteria suggested by Jalali et al .[3] were true (100%) for detecting ROP in our study population group and more so threshold ROP (90%). The screening and/or treatment for all babies were uneventful. None of the babies, who were ineligible for screening returned to the Paediatricians' clinic with visual loss.

Thus, criteria suggested by Jalali et al .[3] were appropriate in detecting ROP in all cases. The screening criteria were more descriptive than discretionary, as suggested by Andruscavage and colleague.[4]

 
  References Top

1.
Committee for classification of Retinopathy of Prematurity. An International classification of retinopathy of prematurity. Arch Ophthalmol 1984;102:1130-4.  Back to cited text no. 1
    
2.
Gilbert C, Rahi J, Eckstein M, Osullivan J, Foster K. ROP in middle income countries. Lancet 1997;350:12-4.  Back to cited text no. 2
    
3.
Jalali S, Anand R, Kumar H, Dogra MR, Azad R, Gopal L. Program planning and screening strategy in Retinopathy of prematurity. Indian J Ophthalmol 2003;51:89-99.  Back to cited text no. 3
[PUBMED]    
4.
Andruscavage L, Weissgold DJ. Screening for retinopathy of prematurity. Br J Ophthalmol 2002;86:1127-30.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  



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