The prevalence, risk factors and outcomes of retinopathy of prematurity at a tertiary care centre in South Africa.

BACKGROUND

Retinopathy of prematurity (ROP) is a significant cause of preventable blindness in premature infants. The prevalence of ROP is increasing, particularly in resource-constrained settings. Low birthweight (BW), low gestational age (GA) and other neonatal risk factors are identified as key contributors. In South Africa (SA), intravitreal bevacizumab (IVB) is commonly used for treating type 1 ROP due to its accessibility and cost-effectiveness.

OBJECTIVES

To evaluate the prevalence, risk factors and outcomes of ROP in a tertiary hospital in SA infants, with a focus on the use of IVB for type 1 ROP.

METHODS

This retrospective file audit, conducted at Rob Ferreira Hospital, reviewed ROP referrals from January 2020 to December 2023. Infants were screened by a specialist ophthalmologist, and treatment with IVB was administered to those diagnosed with type 1 ROP according to the Early Treatment for Retinopathy of Prematurity study protocol. Follow-up was conducted until full vascularisation, or 60 weeks post menstrual age for the respective groups.

RESULTS

A total of 267 infants were referred, with an ROP prevalence of 27.0%. Type 1 and type 2 ROP accounted for 31.9% and 68.1% of diagnoses, respectively. Of screened infants, 8.6% (n=23/267) required treatment with IVB, with no reported complications. Of the 72 infants diagnosed with any ROP, 40.3% did not return for follow-up until discharge was indicated.

CONCLUSION

This study highlights a similar ROP prevalence rate to other SA studies, but yields a markedly higher ROP treatment rate. IVB proved to be a safe and effective treatment option, with no observed complications. However, a 40.3% attrition rate underscores the need for strengthened follow-up systems and improved care pathways. Addressing follow-up challenges and exploring alternative treatment modalities, such as laser photocoagulation, may help to improve long-term outcomes for at-risk infants.