Tailoring Screening Guidelines For Retinopathy Of Prematurity In Egypt: An Exploratory Multicentric Study

To determine the rate of ROP in Egypt  and  to establish adequately inclusive criteria for screening    through a screening program for high risk preterm infants in hospitals of the general organization for teaching hospitals and institutes (GOTHI).

 1) The Memorial Institute for Ophthalmic Research (MIOR), Giza, Egypt

2) Department of Pediatrics and Neonatology, Ahmed Maher Teaching Hospital, Cairo, Egypt

3) Department of Pediatrics and Neonatology, Mataria Teaching Hospital, Cairo, Egypt

4) Department of Pediatrics and Neonatology, Damanhour Teaching Hospital, Beheira, Egypt

 5) Department of Pediatrics and Neonatology, El-Galaa Teaching Hospital, Cairo, Egypt

 prospective  acquired screening data started by MIOR. The screening began in December 2020 - April 2022. Four large tertiary health-care institutes were also selected . it was an exploratory study to establish  inclusive criteria for screening, we set out to adopt to lowest possible threshold for screening Infants born with GA < 37 wk and/or BW ≤ 2000 g were included in our screening. More mature and heavier infants were included  if they had other risk factors . screening at  age of 4 weeks  .  indirect ophthalmoscopy , 28 D  lens and retcam were  used to examine the fundus. Classification and staging of the disease was based on  the international classification of ROP,    ,Treatment decision was based on  early treatment of ROP trial.

 study  included 768 eyes of 384 screened infants. GA of  examined infants was 34 (32–36) wk, and  median (IQR) BW was 1875 (1555–2410) g.

 (53.6%) 206 did not develop an associated co-morbidity. In those with co-morbidities (178, 46.4%), most common were RDS (132, 34.4%) and neonatal sepsis (77, 20.1%).  (54.8%) 421 eyes   had stage 0 disease, (8.1%) 62 eyes had pre-plus and (4%) 31 eyes had  plus disease. The eyes that had stage 1 or higher disease (347, 45.2%) belonged to infants with a mean (± SD) GA and BW of 33.4 (± 2.6) wk and 1842.3 (± 570.1) g. Forty-three eyes (5.6%) had type I disease and were candidates for intervention . A significantly higher proportion of infants that required treatment (63.6%) had developed co-morbidities. 

we provide a large analysis of incidence and risk factors of ROP in an urban Egypt setting. The incidence rates of ROP and of high-risk disease were comparable to national and international rates, although occurrence of treatment- requiring disease was significantly less than in a large recent study from a rural setting. This exploratory study can serve in tailoring local criteria for ROP screening, and in the future development of national guidelines.   strength of this study is including one of the largest screening samples for ROP to date in Egypt ,  inclusion of multiple urban centers.  limitation of the work is that  number of treatment-requiring infants was insufficient to allow for multivariate regression analysis of risk factors.