Abstract
Background: IspahaniIslamia Eye Institute and Hospital (IIEIH) is a not for profit hospital and a leading Retinopathy
of Prematurity (ROP) screening center in Bangladesh.
Objective: The study had an aim to analyze the characteristics of referred babies and identify possible bottlenecks
in the referral system.
Methods: Electronic records of babies referred to IIEIH for a period of three years (2016-2018) were analyzed
retrospectively. All the babies registered in the electronic file were screened by any of the three consultants with
a keen interest in ROP. Variables of interest were ROP stage, gestational age, birth weight, time to screening, referring
institution and treatment modalities (laser, Anti-VEGF, retina surgery or combination). Data was exported
to SPSS version 23 for Mac for descriptive and correlation analysis. A P-value of less than 0.05 was considered
statistically significant.
Results: Eight hundred and eighty seven babies with ROP stage 1 or above were registered over the 3 years
period, a large majority were referred mostly by neighbouring private institutions (75%), 60% of babies were
moderate pre-terms according to WHO classification, the mean birth weight was 1563±397.1 grams. ROP stage
2 was dominant (37%) and 61% of any stage ROP babies had at least one treatment modality. There was an obvious
delay in screening since only 55% of babies were screened within a period of less than 8 weeks. The younger
the gestational age and the lower the birth weight, the higher the risk of presenting with ROP with advanced
stage. (P-value<0.001).
Conclusions: The majority of babies with ROP came from private institutions and more than half of them needed
at least one treatment modality. The delay in screening was a key bottleneck and needs to be addressed. We
recommend more NICUS and more ROP services in public hospitals
References
Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon
P, Petzold M, Hogan D, et al. Global, regional, and
national estimates of levels of preterm birth in 2014:
a systematic review and modelling analysis. Lancet
Glob Health. 2019;7(1):e37–46.
Nahar N, Badmus SA, Das SK, Malek MIA,
Rahman M, Khan MAM. Retinopathy of prematurity
in Bangladesh: an overview. Comm Eye Health.
;31(101):S25–26.
Banglanews24. ROP-caused blindness increasing.
-11-10 [Internet]. 2014 Nov 10; Available from:
https://m.banglanews24.com/index.php/health/
article/31191/ROP-caused-blindness-increasing.
Gilbert, C. Alistair Fielder, Luz Gordillo, Graham
Quinn, Renato Semiglia PV. Characteristics of
infants with severe retinopathy of prematurity in
countries with low, moderate, and high levels of
development: implications for screening programs.
Pediatrics [Internet]. 2005;115(5):e518–25.
Available from: http://pediatrics.aappublications.
org/cgi/doi/10.1542/peds.2004-1180.
WHO. Preterm birth [Internet]. World Health
Organization. 2018 [cited 2019 Jul 19]. p. 1–5.
Available from: https://www.who.int/news-room/
fact-sheets/detail/preterm-birth.
Onyango O, Sitati S, Amolo L, Murila F, Wariua S,
Nyamu G, et al. Retinopathy of prematurity in Kenya:
Prevalence and risk factors in a hospital with advanced
neonatal care. Pan Afr Med J. 2018;29:1–7.
Padhi TR, Jain L, Behera UC, Pradhan L. Retinopathy
of prematurity profile and trend over the years:
experience from a two tier city in Eastern India.
Indian Pediatr. 2016;53:S76–79.
Hashmi FK, Chaudhry TA, Ahmad K. An evaluation
of referral system for retinopathy of prematurity in
leading health centers across Karachi, Pakistan. J
Pak Med Assoc. 2010;60(10):840–844.
Al-Amro SA, Al-Kharfi TM, Thabit AA, Al-
Mofada SM. Retinopathy of prematurity at a
University Hospital in Riyadh, Saudi Arabia.
Saudi Med J. 2003;24(7):720–724.
Abrishami M, Maemori G-A, Boskabadi H,
Yaeghobi Z, Mafi-Nejad S, Abrishami M. Incidence
and risk factors of retinopathy of prematurity in
Mashhad, Northeast Iran. Iran Red Crescent Med J.
;15(3):229–233.
Akman I, Özek E, Demirel U, Yenice Ö, Ilerisoy
H, Kazokoglu H. Screening criteria for retinopathy
of prematurity in developing countries. Eur J
Ophthalmol. 2010;20(5):931–937.
Ebrahim M, Ahmad RS, Mohammad M. Incidence
and risk factors of retinopathy of prematurity
in Babol, North of Iran. Ophthalmic Epidemiol.
;17(3):166–170.
Beby F, Burillon C, Putet G, Denis P. Rétinopathie
du prématuré : résultats de l’examen du fond d’oeil
chez 94 enfants à risque. J Fr Ophtalmol. 2004;
(4):337 YP – 439.
Anudeep K, Srikanth K, Sindal M, NathJha K. Study
of incidence risk factors and treatment outcomes in
retinopathy of prematurity in a tertiary care center.
J Ophthalmic Sci Res |. 2019;(June):24–26.
Larsson E, Holmström G. Screening for retinopathy of
prematurity: evaluation and modification of guidelines.
Br J Dermatol. 2002;86(July 2000):1399–1402.
Mathew MRK, Fern AI, Hill R. Retinopathy of
prematurity: Are we screening too many babies?
Eye [Internet]. 2002;16(5):538–42. Available from:
http://dx.doi.org/10.1016/j.jaapos.2014.07.076.
Araz-Ersan B, Kir N, Akarcay K, Aydinoglu-
Candan O, Sahinoglu-Keskek N, Demirel A, et
al. Epidemiological analysis of retinopathy of
prematurity in a referral centre in Turkey. Br J
Ophthalmol. 2013;97(1):15–17.
Gilbert C, Shah PK. Severe retinopathy of prematurity
in big babies in India: History repeating itself? Indian
J Pediatr. 2009;76(8):801–804.
Akçakaya AA, Yaylali SA, Erbil HH, Sadigov F,
Aybar A, Aydin N, et al. Screening for retinopathy
of prematurity in a tertiary hospital in Istanbul:
Incidence and risk factors. J Pediatr Ophthalmol
Strabismus. 2012;49(1):21–25.
Hungi B, Vinekar A, Datti N, Kariyappa P, Braganza S,
Chinnaiah S, et al. Retinopathy of prematurity in a rural
neonatal intensive care unit in south India-A prospective
study. Indian J Pediatr. 2012;79(7):911–915.