Retinopathy of prematurity (ROP) refers to the developmental disorder of the retina in premature infants and is one of the most serious and most dangerous complications in premature infants. The prevalence of ROP in Iran is different in various parts of Iran and its prevalence is reported to be 1–70% in different regions. This study aims to determine the prevalence and risk factors of ROP in Iran.
This review article was conducted based on the preferred reporting items for systematic review and meta-analysis (PRISMA) protocols. To find literature about ROP in Iran, a comprehensive search was done using MeSH keywords in several online databases such as PubMed, Ovid, Science Direct, EMBASE, Web of Science, CINAHL, EBSCO, Magiran, Iranmedex, SID, Medlib, IranDoc, as well as the Google Scholar search engine until May 2017. Comprehensive Meta-analysis Software (CMA) Version 2 was used for data analysis.
According to 42 studies including 18,000 premature infants, the prevalence of ROP was reported to be 23.5% (95% CI: 20.4–26.8) in Iran. The prevalence of ROP stages 1, 2, 3, 4 and 5 was 7.9% (95% CI: 5.3–11.5), 9.7% (95% CI: 6.1–15.3), 2.8% (95% CI: 1.6–4.9), 2.9% (95% CI: 1.9–4.5) and 3.6% (95% CI: 2.4–5.2), respectively. The prevalence of ROP in Iranian girls and boys premature infants was 18.3% (95% CI: 12.8–25.4) and 18.9% (95% CI: 11.9–28.5), respectively. The lowest prevalence of ROP was in the West of Iran (12.3% [95% CI: 7.6–19.1]), while the highest prevalence was associated with the Center of Iran (24.9% [95% CI: 21.8–28.4]). The prevalence of ROP is increasing according to the year of study, and this relationship is not significant (p = 0.181). The significant risk factors for ROP were small gestational age (p < 0.001), low birth weight (p < 0.001), septicemia (p = 0.021), respiratory distress syndrome (p = 0.036), intraventricular hemorrhage (p = 0.005), continuous positive pressure ventilation (p = 0.023), saturation above 50% (p = 0.023), apnea (p = 0.002), frequency and duration of blood transfusion, oxygen therapy and phototherapy (p < 0.05), whereas pre-eclampsia decreased the prevalence of ROP (p = 0.014).
Considering the high prevalence of ROP in Iran, screening and close supervision by experienced ophthalmologists to diagnose and treat the common complications of pre-maturity and prevent visual impairment or blindness is necessary.
Gergely K, Gerinec A. Retinopathy of prematurity--epidemics, incidence, prevalence, blindness. Bratisl Lek Listy. 2009;111(9):514–7.
Zin A. R etinopathyof P re maturity-I ncidence to day. 2013.
Kliegman RM, Behrman RE, Jenson HB,et al. Nelson textbook of pediatrics E-book: Elsevier health sciences; 2007.
Gibson DL, Sheps SB, Schechter MT, et al. Retinopathy of prematurity: a new epidemic? Pediatrics. 1989;83:486–92. PubMed
Augsburger JJBN. Yanoff M, Duker JS, editors. Ophtalmology. St. Louis, MO: Mosby 2004. p. 1097–102.
Edy Siswanto J, Sauer PJ. Retinopathy of prematurity in Indonesia: Incidence and risk factors. J Neonatal Perinatal Med. 2017;10(1):85-90. https://doi.org/10.3233/NPM-915142.
Naderian GIR, Mohammadizadeh M, Najafabadi FBZ, et al. The frequency of retinopathy of prematurity in premature infants referred to an ophthalmology Clinic in Isfahan. J Isfahan Med Sch. 29(128):126–30.
Gharebagh M, Sadeghi K, Zarghami N, Mostafidi H. Evaluation of vascular endothelial growth factor, leptin and insulin-like growth factor in precocious retinopathy. Urmia Med J. 2012;23(2):183–90.
Gharehbaghi MM, Peirovifar A, Sadeghi K. Plasma leptin concentrations in preterm infants with retinopathy of prematurity (ROP). Iran J Neonatol. 2012;3(1):12–6.
Nakhshab MAA, Dargahi S, Farhadi R, et al. The incidence rate of retinopathy of prematurity and related risk factors: a study on premature neonates hospitalized in two hospitals in sari, Iran, 2014-2015. J Kerman Univ Med Sci. 2016;23(3):296–307.
Badfar G, Shohani M, Nasirkandy MP, et al. Epidemiology of hepatitis B in pregnant Iranian women: a systematic review and meta-analysis. Arch Virol. 2018;163(2):319-330. https://doi.org/10.1007/s00705-017-3551-6.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097. Epub 2009 Jul 21 CrossRefPubMedPubMedCentral
Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis. 2011. Available: www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 25 Nov 2012.
Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions, vol. 4. Hoboken: Wiley; 2011.
Ades A, Lu G, Higgins J. The interpretation of random-effects meta-analysis in decision models. Med Decis Mak. 2005;25(6):646–54. CrossRef
Borenstein M, Hedges LV, Higgins J, Rothstein HR. Meta-Regression. Introduction to meta-analysis; 2009. p. 187–203. CrossRef
Ophthalmology AAoPSo. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2013;131(1):189–95. CrossRef
Isaza G, Arora S. Incidence and severity of retinopathy of prematurity in extremely premature infants. Can J Opthalmol. 2012;47:296–300. CrossRef
Hwang JH, Lee EH, Kim EA. Retinopathy of prematurity among very-low-birth-weight infants in Korea: incidence, treatment, and risk factors. J Korean Med Sci. 2015;30(Suppl 1):S88S94. CrossRef
Bas AY, Koc E, Dilmen U; ROP Neonatal Study Group. Incidence and severity of retinopathy of prematurity in Turkey. Br J Ophthalmol. 2015;99(10):1311-4. https://doi.org/10.1136/bjophthalmol-2014-306286.
Group ETfRoPC. The incidence and course of retinopathy of prematurity: findings from the early treatment for retinopathy of prematurity study. Pediatrics 2005;116(1):15–23.
Vakilian K, Ranjbaran M, Khorsandi M, et al. Prevalence of preterm labor in Iran: a systematic review and meta-analysis. Int J Reprod Biomed. 2015;13(12):743–8. CrossRef
Tabarez-Carvajal AC, Montes-Cantillo M, Unkrich KH, et al. Retinopathy of prematurity: screening and treatment in Costa Rica. Br J Ophthalmol. 2017;101(12):1709–13. https://doi.org/10.1136/bjophthalmol-2016-310005. [Epub ahead of print] CrossRefPubMed
Ratra D, Akhundova L, Das MK. Retinopathy of prematurity like retinopathy in full-term infants. Oman J Ophthalmol. 2017;10(3):167-172. https://doi.org/10.4103/ojo.OJO_141_2016.
Shah VA, Yeo CL, Ling YL, et al. Incidence, risk factors of retinopathy of prematurity among very low birth weight infants in Singapore. Ann Acad Med Singap. 2005;34:169–78. PubMed
Badriah C, Amir I, Elvioza SR, et al. Prevalence and 325 risk factors of retinopathy of prematurity. Paediatr Indones. 2012;52:138–44. 327 CrossRef
Rizalya D, Rudolf T, Rohsiswatmo R. Screening for 328 retinopathy of prematurity in hospital with limited facil- 329 ities. Sari Pediatri. 2012;14:185–90.
Yau GS, Lee JW, Tam VT, et al. Incidence and risk factors of retinopathy of prematurity from 2 neonatal intensive care units in a Hong Kong Chinese population. Asia Pac J Ophthalmol. 2016;5(3):185–91. https://doi.org/10.1097/APO.0000000000000167. CrossRef
Naderian G, Parvaresh M, Rismanchiyan A, et al. Refractive errors after laser therapy for retinopathy of prematurity. Int J Ophthalmol. 2009;15(1):13–8.
Hosseini H, Farvardin M, Attarzadeh A, et al. Advanced retinopathy of prematurity at Poostchi ROP clinic, Shiraz. Bina J Ophthalmol 2009; 15(1):19–25.
Karkhaneh RER, Ghojehzadeh L, Kadivar M, et al. Incidence and risk factors of retinopathy of prematurity. Bina J Ophthalmol. 2005;11(1):81–90.
Nadeian GMH, Hadipour M, Sajjadi H. Prevalence and rsskfactor for retinopathy of prematuority in isfahan. Bina J Ophthalmol. 2010;15(3):208–13.
Mansouri MRKM, Karkhaneh R, Riazi Esfahani M, et al. Prevalence and risk factors of retinopathy of prematurity in very low birth weight or low gestational age infants. Bina J Ophthalmol. 2007;12(4):428–34.
Nakhshab MBG, Amiri A, Ashaghi M. Prevalence of preterm infant retinopathy in neonatal intensive care unit Buali Sari Hospital. J Mazandaran Univ Med Sci. 2003;13(39):63–70.
Daraie G, Nooripoor S, Ashrafi AM, et al. Incidence of retinopathy of prematurity and some related factors in premature infants born at amir–al-momenin hospital in Semnan. Iran Koomesh. 2016;17(2):297–303.
Fayazi AHM, Fayzollazade M, GHolzar A, et al. Prevalence of retinopathy in preterm infants admitted to neonatal intensive care unit of Alzahra hospital in Tabriz. J Tabriz Univ Med Sci. 2009;30(4):63–6.
Sadeghi KHA, Hashemi F, Haydarzade M, et al. Prevalence and risk factors of retinopathy in preterm infants. J Tabriz Univ Med Sc. 2008;30(2):73–7.
Khatami SF, Yousefi A, Bayat GF, et al. Retinopathy of prematurity among 1000-2000 gram birth weight newborn infants. Iran J Pediatr. 2008;18(2):137–42.
Sabzehei MK, Afjeh SA, Farahani AD, et al. Retinopathy of prematurity: incidence, risk factors, and outcome. Arch Iran Med. 2013;16(9):507. PubMed
Saeidi R, Hashemzadeh A, Ahmadi S, et al. Prevalence and predisposing factors of retinopathy of prematurity in very low-birth-weight infants discharged from NICU. Iran J Pediatr. 2009;19(1):59–63.
Azinfar MAM, Pasha Z, Amad M. Prevalence of premature newborns discharged from NICU and infants in Shafizadeh Ami Children's hospital [dissertation]. Babol, Iran; Babol Univ Med; 2005.
Karkhanehyousefi NRA, Mekaniki A. Prevalence of retinopathy in immature newborns referred to eye Clinic of Shahid Beheshti Hospital in Babol [dissertation]. Babol, Iran; Babol Univ Med; 2009.
Ebrahimzade MKR, Esfahani M, Kadpour M, et al. The prevalence of retinopathy in preterm infants in preterm infants referred to Farabi hospital from the beginning of the year 2002 to the beginning of 2008 and the evaluation of short-term laser therapy results [dissertation]. Tehran: Islamic Azad Univ Med; 2009.
Mirzaee SA, Mohagheghi P. Determine the prevalence of retinopathy (ROP) in infants admitted to the NICU department of Milad Hospital [dissertation]. Tehran: Islamic Azad Univ Med; 2010.
Foladinezhad MMM, GHarib M, SHishari F, Soltani M. Frequency, severity and some risk factors of retinopathy in premature infants of Taleghani Hospital in Gorgan. J Gorgan Univ Med Sc. 2009;11(2):51–4.
Mousavi SZKR, Riazi-Esfahani M, Mansouri MR, et al. Incidence, severity and risk factors for retinopathy ofPrematurity in premature infants with late retinal examination. Bina J Ophthalmol. 2008;13(4):412–7.
Sadeghzadeh M, Khoshnevisasl P, Parvaneh M, et al. Early and late outcome of premature newborns with history of neonatal intensive care units admission at 6 years old in Zanjan. Northwestern Iran Iran J Child Neurol. 2016;10(2):67. PubMed
Karkhaneh R, Shokravi N. Assessment of retinopathy of prematurity among 150 premature neonates in Farabi eye hospital. Acta Med Iran. 2001;39(1):35–8.
Babaei H, Ansari MR, Alipour AA, et al. Incidence and risk factors for retinopathy of prematurity in very low birth weight infants in Kermanshah. Iran World Appl Sci J. 2012;18(5):600–4.
Mousavi SZ, Karkhaneh R, Roohipoor R, et al. Screening for retinopathy of prematurity: the role of educating the parents. J Ophthalmol. 2010;22(2):13–8.
MousavibS Zb EM, Roohipoor R, Jabbarvand M, et al. Characteristics of advanced stages of retinopathy of prematurity. J Ophthalmol. 2010;22(2):19–24.
Ahmadpour-kacho M, Zahed Pasha Y, Rasoulinejad SA, et al. Correlation between retinopathy of prematurity and clinical risk index for babies score. J Tehran Univ Med S. 2014;72(6):404–11.
Khalesi N, Shariat M, Fallahi M, et al. Evaluation of risk factors for retinopathy in preterm infant: a case-control study in a referral hospital in Iran. Minerva Pediatr. 2015;67(3):231–7. PubMed
- Prevalence and risk factors of retinopathy of prematurity in Iran: a systematic review and meta-analysis
Afsar Dastjani Farahani
- BioMed Central
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