International Ophthalmology

, Volume 32, Issue 2, pp 113–117 | Cite as

Intersibling variability of retinopathy of prematurity in twins and its risk factors

  • Gaurav Sanghi
  • Mangat R. dogra
  • Sourabh Dutta
  • Deeksha Katoch
  • Amod Gupta
Original Paper


To study intersibling variability of retinopathy of prematurity (ROP) in twins and determine its risk factors. A retrospective chart review of twin neonates developing ROP at a tertiary center over a 5 year period (January 2004 to December 2008). Twin pairs with intersibling variability of ROP were retrieved based on one of the following criterion: (1) two-stage difference in ROP between siblings, (2) one sibling with treatable ROP and the other with spontaneously regressed ROP, or (3) one sibling with aggressive posterior ROP and the other with staged ROP. Babies with greater severity of ROP were included in group A (case group) and their siblings with less severity in group B (control group).The two groups were compared for birth weight, birth order and putative post-gestational risk factors. Thirty-five twin pairs developed ROP of which 28 pairs (80%) had severe intersibling variability. Twenty-one pairs with complete information about risk factors were analyzed. The birth weight of the case group was 1212.1 ± 248.3 g (mean ± SD) and control group 1172.1 ± 216.5 g (mean ± SD) (p = 0.33). In twelve of the 21 pairs the second born twin had more severe ROP. However, birth order was not a significant predictor (p = 0.664). Various post-gestational risk factors did not differ significantly between the two groups [oxygen administration (p = 1), sepsis (p = 0.625), exchange transfusion (p = 1), blood transfusion (p = 0.325), respiratory distress syndrome (p = 1), anemia (p = 0.125), apnea (0.375), neonatal jaundice (p = 1), patent ductus arteriosus (p = 0.5) and hypoglycemia (p = 1)]. The majority of the twins developing ROP had severe intersibling variability. Birth weight, birth order and post-gestational neonatal risk factor were not predictive of more severe ROP in a twin sibling.


Retinopathy of prematurity ROP Twins Multiple gestation 


  1. 1.
    Palmer EA, Flynn JT, Hardy RJ, Phleps DL, Phillips CL, Schaffer DB, Tung B (1991) Incidence and early course of retinopathy of prematurity. Ophthalmology 11:1628–1640Google Scholar
  2. 2.
    Kinsey VE, Arnold HJ, Kalina RE, Stern L, Stahlman M, Odell G, Driscoll JM Jr, Elliott JH, Payne J, Patz A (1977) PaO2 levels and retrolental fibroplasia: a report of the cooperative study. Pediatrics 60:655–668PubMedGoogle Scholar
  3. 3.
    Pratt L, Arnold RW, Jack J (2009) Frequent ROP associated with hypoxic protocol. J Pediatr Ophthalmol Strabismus 46:253PubMedCrossRefGoogle Scholar
  4. 4.
    Shohat M, Reisner SH, Krikler R, Nissenkorn I, Yassur Y, Ben-Sira I (1983) Retinopathy of prematurity: incidence and risk factors. Pediatrics 72:159–163PubMedGoogle Scholar
  5. 5.
    Dani C, Reali MF, Bertini G, Martelli E, Pezzati M, Rubaltelli FF (2001) The role of blood transfusions and iron intake on retinopathy of prematurity. Early Hum Dev 62:57–63PubMedCrossRefGoogle Scholar
  6. 6.
    Dutta S, Narang S, Narang A, Dogra M, Gupta A (2004) Risk factors of threshold retinopathy of prematurity. Indian Pediatr 41:665–671PubMedGoogle Scholar
  7. 7.
    Chen Y, Li XX, Yin H, Gilbert C, Liang JH, Jiang YR, Zhao MW (2008) Risk factors for retinopathy of prematurity in six neonatal intensive care units in Beijing. China Br J Ophthalmol 92(3):326–330CrossRefGoogle Scholar
  8. 8.
    Yanovitch TL, Siatkowski RM, McCaffree M, Corff KE (2006) Retinopathy of prematurity in infants with birth weight > or =1250 grams—incidence, severity, and screening guideline cost-analysis. J AAPOS 10(2):128–134PubMedCrossRefGoogle Scholar
  9. 9.
    Ben-Sira I, Nissenkorn I, Dremer I (1988) Retinopathy of prematurity. Surv Ophthalmol 33:1–16PubMedCrossRefGoogle Scholar
  10. 10.
    Schaffer DB, Palmer EA, Plotsky DF, Metz HS, Flynn JT, Tung B, Hardy RJ (1993) Prognostic factors in the natural course of retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group. Ophthalmology 100:230–237PubMedGoogle Scholar
  11. 11.
    Blumenfeld LC, Siatkowski RM, Johnson RA, Feuer WJ, Flynn JT (1998) Retinopathy of prematurity in multiple-gestation pregnancies. Am J Ophthalmol 125:197–203PubMedCrossRefGoogle Scholar
  12. 12.
    Friling R, Rosen SD, Monos T, Karplus M, Yassur Y (1997) Retinopathy of prematurity in multiple-gestation, very low birth weight infants. J Pediatr Ophthalmol Strabismus 34:96–100PubMedGoogle Scholar
  13. 13.
    Fellows RR, McGregor ML, Bremer DL, Rogers GL, Miller D (1995) Retinopathy of prematurity in discordant twins. J Pediatr Ophthalmol Strabismus 32:86–88PubMedGoogle Scholar
  14. 14.
    Hall JG, Freedman SF, Kylstra JA (1995) Clinical course and systemic correlates of retinopathy of prematurity in quintuplets. Am J Ophthalmol 119:658–660PubMedGoogle Scholar
  15. 15.
    Holmström G, Broberger U, Thomassen P (1998) Neonatal risk factors for retinopathy of prematurity–a population-based study. Acta Ophthalmol Scand 76:204–207PubMedCrossRefGoogle Scholar
  16. 16.
    Committee for the Classification of Retinopathy of Prematurity (1984) An international classification of retinopathy of prematurity. Arch Ophthalmol 102:1130–1134CrossRefGoogle Scholar
  17. 17.
    An International Committee for the Classification of Retinopathy of Prematurity (2005) The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 123:991–999CrossRefGoogle Scholar
  18. 18.
    Early Treatment for Retinopathy of Prematurity Cooperative Group (2003) Revised indications for the treatment of retinopathy of prematurity. Arch Ophthalmol 121:1684–1696PubMedCrossRefGoogle Scholar
  19. 19.
    Friling R, Axer-Siegel R, Hersocovici Z et al (2007) Retinopathy of prematurity in assisted versus natural conception and singleton versus multiple births. Ophthalmology 114:321–324PubMedCrossRefGoogle Scholar
  20. 20.
    Young BK, Suidan J, Antoine C, Silverman F, Lustig I, Wasserman J (1985) Differences in twins: the importance of birth order. Am J Obstet Gynecol 151:915–921PubMedGoogle Scholar
  21. 21.
    Fick AL, Feldstein VA, Norton ME, Wassel Fyr C, Caughey AB, Machin GA (2006) Unequal placental sharing and birth weight discordance in monochorionic diamniotic twins. Am J Obstet Gynecol 195:178–183PubMedCrossRefGoogle Scholar
  22. 22.
    Lewi L, Cannie M, Blickstein I, Jani J, Huber A, Hecher K, Dymarkowski S, Gratacós E, Lewi P, Deprest J (2007) Placental sharing, birthweight discordance, and vascular anastomoses in monochorionic diamniotic twin placentas. Am J Obstet Gynecol 197:587PubMedCrossRefGoogle Scholar
  23. 23.
    Mohamed S, Schaa K, Cooper ME, Ahrens E, Alvarado A, Colaizy T, Marazita ML, Murray JC, Dagle JM (2009) Genetic contributions to the development of retinopathy of prematurity. Pediatr Res 65:193–197PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Gaurav Sanghi
    • 1
  • Mangat R. dogra
    • 1
  • Sourabh Dutta
    • 2
  • Deeksha Katoch
    • 1
  • Amod Gupta
    • 1
  1. 1.Department of Ophthalmology, Advanced Eye CenterPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of PediatricsPostgraduate Institute of Medical Education and ResearchChandigarhIndia

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