Main Article Content
Retinopathy of prematurity (ROP) is a proliferative disease of the ocular retinal vasculature in premature infants, being a leading cause of preventable childhood blindness. The COVID-19 pandemic serves as an additional barrier to access to care and referral, potentially leading to more cases of advanced stage ROP. Although surgery can be done, ROP at this stage is highly associated with poor functional outcome irrespective of surgery. This case series aims to report advanced stage (stage 5) ROP in premature infants during the COVID-19 pandemic.
A retrospective case series of medical records of paediatric patients with ROP was performed at Cipto Mangunkusumo National Referral Hospital between March 1, 2020 and December 31, 2021. This case series included new patients that presented to our clinic from March 2020 to December 2021 with stage 5 ROP.
A total of 19 eyes of 10 patients with stage 5 ROP were included in this study. Mean chronologic age at presentation to our referral centre was 7.0 4.0 months. Upon presentation, all had stage 5 ROP with negative blink reflex to light, and none of the eyes in this cohort underwent surgical intervention. Mean gestational age was 30.3 3.2 weeks and mean birth weight was 1,276.7 366.4 g.
There was an observable surge of stage 5 ROP at our referral centre with irreversible blindness. This highlights the need for proper ROP screening in all hospitals in Indonesia to prevent delay in detection and care of advanced stage ROP.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The journal allows the authors to hold the copyright without restrictions and allow the authors to retain publishing rights without restrictions.
Sitorus RS. POKJA Nasional ROP dan Bayi Prematur, pedoman nasional: Skrining dan terapi ROP pada bayi prematur di Indonesia. Jakarta: FKUI, PERDAMI, IDAI; 2011. Indonesian.
Siswanto JE, Widodo NH, Sauer PJJ. Eleven years of retinopathy of prematurity in one neonatal intensive care unit in Jakarta, Indonesia. Arch Dis Child 2018;103:619-21. doi:10.1136/archdischild-2017-314094.
Siswanto JE, Bos AF, Dijk PH, et al. Multicentre survey of retinopathy of prematurity in Indonesia. BMJ Paediatrics Open 2021;5:e000761. doi: 10.1136/bmjpo-2020-000761.
Chiang MF, Quinn GE, Fielder AR, et al. International classification of retinopathy of prematurity, Third Edition. Ophthalmology 2021; 128:e51-e68. doi:10.1016/j.ophtha.2021.05.031.
Hong EH, Shin YU, Cho H. Retinopathy of prematurity: a review of epidemiology and current treatment strategies. Clin Exp Pediatr 2022;65:115-26. doi:10.3345/cep.2021.00773.
Mahendradhata Y, Andayani NLPE, Hasri ET, et al. The capacity of the Indonesian healthcare system to respond to COVID-19. Front Public Health 2021 ;9:649819. doi: 10.3389/fpubh.2021.649819.
Osaguona VB, Osahon AI, Uhumwangho OM. Impact of COVID-19 on ophthalmic outpatient services in an eye care center in Southern Nigeria. Niger J Clin Pract 2021;24:1338-42. doi:10.4103/njcp.njcp_668_20.
Sanjay S, Leo SW, Au Eong KG, et al. Global ophthalmology practice patterns during COVID-19 pandemic and lockdown. Ophthalmic Epidemiol 2022;29:233-44. doi:10.1080/09286586.2021.1934037.
Muralikrishnan J, Christy JS, Srinivasan K, et al. Access to eye care during the COVID-19 pandemic, India. Bull World Health Organ 2022;100:135-43. doi:10.2471/blt.21.286368.
Muhit M, Karim T, Islam J, et al. The epidemiology of childhood blindness and severe visual impairment in Indonesia. Br J Ophthalmol 2018;102:1543-9. doi: 10.1136/bjophthalmol-2017-311416.
Dou GR, Li MH, Zhang ZF, et al. Demographic profile and ocular characteristics of stage 5 retinopathy of prematurity at a referral center in Northwest China: implications for implementation. BMC Ophthalmol 2018;18:307. doi: 10.1186/s12886-018-0975-z.
Siswanto JE, Dijk PH, Bos AF, et al. How to prevent ROP in preterm infants in Indonesia? Health Sci Rep 2021;4:e219. doi:10.1002/hsr2.219.
Muether PS, Kribs A, Hahn M, et al. No advanced retinopathy of prematurity stages 4 or 5 in a large high-risk German cohort. Br J Ophthalmol 2012; 96:400. doi: 10.1136/bjo.2011.203125.
Quinn GE, Ying G, Bell EF, et al. Incidence and early course of retinopathy of prematurity: secondary analysis of the postnatal growth and retinopathy of prematurity (G-ROP) study. JAMA Ophthalmol 2018;136:1383–9. doi: 10.1001/jamaophthalmol.2018.4290.
Lundgren P, Kistner A, Andersson EM, et al. Low birth weight is a risk factor for severe retinopathy of prematurity depending on gestational age. PLoS ONE 2014;9:e109460. doi: 10.1371/journal.pone.0109460.
Wade KC, Ying GS, Baumritter A, Gong A, Kemper AR, Quinn GE. Factors in premature infants associated with low risk of developing retinopathy of prematurity. JAMA Ophthalmol 2019;137:160-6. doi: 10.1001/jamaophthalmol.2018.5520.
Gunay M, Celik G, Tuten A, Karatekin G, Bardak H, Ovali F. Characteristics of severe retinopathy of prematurity in infants with birth weight above 1500 grams at a referral center in Turkey. PLoS ONE 2016;11:e0161692. doi: 10.1371/journal.pone.0161692.
Anvekar A, Athikarisamy S, Rao S, et al. Time to regain birth weight - a marker to predict the severity of retinopathy of prematurity? BMC Pediatr 2021;21:540. doi: 10.1186/s12887-021-03027-x.
Azad R, Chandra P, Gangwe A, Kumar V. Lack of screening underlies most stage-5 retinopathy of prematurity among cases presenting to a tertiary eye center in India. Indian Pediatr 2016;53 Suppl 2:S103-6.
Hartnett ME, Lane RH. Effects of oxygen on the development and severity of retinopathy of prematurity. J AAPOS 2013;17:229-34. doi: 10.1016/j.jaapos.2012.12.155.
Choo MM, Grigg J, Barnes EH, et al. Comparative cohorts of retinopathy of prematurity outcomes of differing oxygen saturation: real-world outcomes. BMJ Open Ophthalmol 2021;6:e000626. doi: 10.1136/bmjophth-2020-000626.
Vinekar A, Azad R, Dogra MR, et al. Preferred practice guidelines for retinopathy of prematurity screening during the COVID-19 pandemic. World J Clin Pediatr 2022;11:215-20. doi: 10.5409/wjcp.v11.i3.215.
AlBathi L, Abouammoh N, AlSwaina N, et al. Pitfalls of advanced retinopathy of prematurity presentation: a content analysis of medical records. Risk Manag Health Policy 2021;14:3873-82. doi: 10.2147/rmhp.S326757.
Repka MX, Tung B, Good WV, et al. Outcome of eyes developing retinal detachment during the Early Treatment for Retinopathy of Prematurity Study (ETROP). Arch Ophthalmol 2006;124:24-30. doi: 10.1001/archopht.124.1.24.
Sen P, Jain S, Bhende P. Stage 5 retinopathy of prematurity: an update. Taiwan J Ophthalmol 2018;8:205-15. doi: 10.4103/tjo.tjo_61_18.
Rajan RP, Kannan NB, Sen S, et al. Clinico-demographic profile and outcomes of 25-gauge vitrectomy in advanced stage 5 retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol 2021;259:1695-701. doi:10.1007/s00417-020-05063-2.