| Summary: | <b>Background: </b> Retinopathy of prematurity (ROP) is an important cause of childhood blindness in developing countries. <b> Aim:</b> To report the spectrum of ROP and associated risk factors in babies weighing > 1250 g at birth in a developing country. <b> Setting and Design: </b> Institutional, retrospective, non-randomized, observational clinical case series. <b> Materials and Methods</b> : Retrospective analysis (10 years) of 275 eyes (138 babies) with ROP. <b> Statistical Analysis: </b> Qualitative data with the Chi-square test. Quantitative data using the unpaired t test or the ANOVA and further tested using multivariate logistic regression.<b> Results:</b> The mean birth weight was 1533.9 g (range 1251 to 2750 g) and the mean period of gestation was 30.9 weeks (range 26 to 35). One hundred and twenty-four of 275 eyes (45.1%) had threshold or worse ROP. Risk factors for threshold or worse disease were, ′outborn babies′ (<i> P</i> < 0.001), respiratory distress syndrome (<i> P</i> = 0.007) and exchange transfusion (<i> P</i> = 0.003). The sensitivity of the American and British screening guidelines to pick up threshold or worse ROP in our study group was 82.4% and 77.4% respectively. <b> Conclusions</b> : Severe ROP is often encountered in babies weighing greater than 1250 g at birth in developing countries. Western screening guidelines may require modifications before application in developing countries.
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