Blindness in infants presenting with advanced and untreated ROP: a single-centre study in Pakistan

Purpose To describe the ocular features and characteristics of young children presenting with advanced, untreated retinopathy of prematurity and to determine appropriate screening guidelines for retinopathy of prematurity (ROP) in Pakistan. Material and methods A retrospective case series of young children with stage5A or 5B or cicatricial changes (4B or 4A ROP) was undertaken in the Department of Ophthalmology, Lahore General Hospital, Lahore, Pakistan, from August 2017 to July 2019. Information was obtained from interviewing parents and from neonatal care discharge summaries, if available. An assessment of visual function and a dilated fundus examination were performed. Results 51 children presented at mean age of 9.7 (1.5-36) months. Their mean gestational age (GA) was 28.84 (26-38) weeks, and mean birth weight (BW) was 1229 (800-2100) g. Four children (7.8%) had a GA of >31 weeks plus a BW of >1501 g. 40 (76.4%) children were blind and 11 (23.6%) had impaired vision. Sixty-five eyes (63.7%) had stage 5B; 13 (12.7%) eyes had stage 5A; 18 (17.6%) had falciform macular folds (4B ROP) and 6 eyes (5.9%) had macular dragging (4A ROP). 39 (76.5%) children had bilateral stage 5A/5B. Half (47%) of the children lived outside the capital city of Lahore, and 15 came from small cities (population <1 million). Conclusion The third epidemic of blindness due to ROP has arrived in Pakistan, and premature babies are going blind even in smaller cities. Initial screening guidelines of a GA of ≤35 weeks and BW of ≤2000 g seem reasonable. There is an urgent need to improve the quality of neonatal care and to increase the coverage of ROP screening and treatment services across the country.