We read with interest the article by Vinekar et al.1 Authors deserve congratulations for highlighting an important aspect of diagnosis and management of retinopathy of prematurity (ROP) in an excellent manner. We have certain observations to make.
- Authors excluded babies with hydrops ′to avoid erroneously exaggerated birth weight′. We feel even these babies should have been included and analyzed. Mandal et al., found overexpression of vascular endothelial growth factor in a relatively large baby with unusual severity of ROP.2 Large babies for the age might have some pathology like hepatosplenomegaly, hydrocephalus, hydrops (immune as well nonimmune types) in addition to maternal and genetic factors. Implications of these factors in the pathogenesis of ROP need to be studied.
- According to them 11 babies (17.7%) with threshold or worse ROP would have been missed had they applied the guidelines recommended by the American Academy of Ophthalmology (AAO). Authors screened babies with birth weights 1700 g or less and gestational age 32 weeks or less. According to AAO babies with a birth weight of less than 1500 g or with a gestational age of 32 weeks or less and selected babies between 1500 and 2000 g or gestational age of more than 32 weeks with an unstable clinical course and who are believed to be at high risk by their attending pediatrician or neonatologist should have retinal screening examination to detect ROP.3 It would have been interesting to note the number of babies left without screening using these guidelines.
- Yanovitch et al., in a study analyzed 259 infants with birth weight 1250 to 1800 g. They identified risk factors for the development of ROP in these large babies. They found that all infants with birth weight >1500 g who developed ROP had greater than or equal to two of these risk factors.4 A similar strategy can avoid unnecessary examination and at the same time can identify babies who are more likely to have severe ROP.
- They found ′outborn′ as the most significant risk factor for the development of ROP in these large babies. The subgroup analysis of these ′outborn′ babies would have given an insight into the factors that make them prone for the development of ROP.
1. Vinekar A, Dogra MR, Sangtam T, Narang A, Gupta A. Retinopathy of prematurity in Asian Indian babies weighing greater than 1250 grams at birth: Ten year data from a tertiary care center in a developing country Indian J Ophthalmol. 2007;55:331–6
2. Mandal K, Drury JA, Clark DI. An unusual case of retinopathy of prematurity J Perinatol. 2007;27:315–6
3. Section on Ophthalmology, American Academy of Pediatrics, American Academy of Ophthalmology and American Association for Pediatric Ophthalmology and Strabismus.. Screening Examination of Premature Infants for Retinopathy of Prematurity Pediatrics. 2006;117:572–6
4. Yanovitch TL, Siatkowski RM, McCaffree M, Corff KE. Retinopathy of prematurity in infants with birth weight >or = 1250 grams-incidence, severity and screening guideline cost-analysis J AAPOS. 2006;10:128–34