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Retinopathy of prematurity screening criteria in Iran: new screening guidelines
  1. Ramak Roohipoor1,
  2. Reza Karkhaneh1,
  3. Afsar Farahani1,
  4. Nazanin Ebrahimiadib1,
  5. Bobeck Modjtahedi2,
  6. Akbar Fotouhi3,
  7. Mehdi Yaseri3,
  8. Alireza Khodabande1,
  9. Mohammad Zarei1,
  10. Marjan Imani Fuladi1,
  11. Arash Taheri1,
  12. Mohammad Riazi Esfahani1,4,
  13. John Loewenstein2
  1. 1Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
  2. 2Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA
  3. 3Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  4. 4Retina Service, Noor Eye Hospital, Tehran, Iran
  1. Correspondence to Professor Mohammad Riazi Esfahani, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran 1336616351, Iran; riazifahimi{at}


Objective To test the applicability of existing retinopathy of prematurity (ROP) guidelines on Iranian patients and to develop novel ROP screening criteria in Iran.

Methods Both eyes of 1932 infants born ≤37 weeks of gestation and/or weighting ≤3000 g were included in this prospective cohort study that was conducted across nine neonatal intensive care units and a tertiary eye hospital ROP clinic. The patients were examined for ROP and the need for treatment (type 1 ROP or worse). All the patients were screened 4 weeks after birth or at 31 weeks of postmenstrual age, whichever was later. The patients were followed until retinal vascularisation was completed or the patients reached 50 weeks of gestational age (GA) without prethreshold ROP. A receiver operating characteristic curve was used to determine the best screening criteria for ROP. Screening criteria from other countries were applied to our patient data to determine their ability to appropriately detect ROP.

Main outcome measure Patients with ROP requiring treatment.

Results The mean GA±SD and birth weight (BW)±SD of the screened patients were 32±2.7 weeks and 1713±516 g, respectively. Using criteria of GA≤32 weeks or BW ≤2000 yielded sensitivity and specificity of 100% and 26.7%, respectively, for treatment requiring ROP regardless of clinical comorbidities. Using screening recommendations of American Academy of Pediatrics would miss 25.4% of ROP and 8.4%ROP requiring treatment in our cohort.

Conclusions Other countries screening recommendations would result in a significant amount of missed cases of treatment requiring ROP when applied to Iran. As a result, we have proposed new guidelines for premature babies in Iran.

  • Ophthalmology
  • Screening
  • Retinopathy of Prematurity
  • Infant, Iran, neonatal, prematurity, pediatrics.

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