Retinopathy of prematurity in multiple gestation preterm infants: A retrospective analysis from a tertiary care eye hospital in Pakistan

Objective: To investigate the incidence of Retinopathy of Prematurity (ROP) and association of gender differences in the severity and treatment warranted-ROP in multiple gestation premature infants.

Methodology: A 04-year retrospective comparative analysis was conducted on premature infants from multiple gestation who underwent ROP screening from January 2021 to December 2024 in a tertiary care eye hospital. The incidence rates of any ROP, severe ROP and treatment warranted ROP was assessed. Gender-based variation in the stage and severity of ROP was also analyzed using SPSS 26.0.

Results: A total of 224 premature infants underwent ROP screening,including 92 sets of twins, 12 triplets and one set of quadruplets. In this study, the overall incidence of ROP was found to be 33% (n=74), with severe ROP (i.e., stage 4 or 5) occurring in 7.1% of infants (n=16). A significant gender difference was observed, with male infants predominating (p value <0.05). Treatment was required for 28 infants, with greater odds of requiring treatment in male infants (p=0.02, OR=1.4).

Conclusion: A strong association between male gender and retinopathy of prematurity exists in multiple gestation premature infants. Males are more prone to develop ROP and require treatment more often and earlier than their female counterparts. Furthermore, in contrast to the International Classification of Retinopathy of Prematurity (ICROP), screening in Pakistan is conducted in infants with a gestational age of ≤35 weeks. This screening window, defined as ≥31 (in ICROP) and ≤35 weeks, yields significant findings and warrants further exploration to guide national-level policy.

Dr. Rabeeah Zafar embarked on her ophthalmology career in 2014 as a resident trainee, later earning her FCPS- General Ophthalmology in 2019 and FCPS- Pediatric Ophthalmology and Strabismus in 2025 from the College of Physicians & Surgeons Pakistan. She is also Fellow of International Council of Ophthalmology (FICO) from UK. Currently, she is serving as an Assistant Professor in Children Eye Hospital, Al-Shifa Trust Rawalpindi, contributing significantly to pediatric eye care in Pakistan. Dr. Zafar's dedication extends to research, with notable publications and presentations in national and international forums. She also plays a vital role as a reviewer for leading ophthalmology journals. Committed to professional development, she holds memberships in prestigious medical bodies and actively engages in philanthropic initiatives, including her role as a founding and executive member of The Saving Smiles Foundation. Dr. Zafar's multifaceted contributions underscore her commitment to advancing ophthalmology and improving eye healthcare for children in Pakistan and beyond.