Yoshihiro Yonekawa1, Wei-Chi Wu2, Shunji Kusaka3, Joshua Robinson4, Daishi Tsujioka3, Kai B Kang5, Michael J Shapiro6, Tapas R Padhi7, Lubhani Jain7, Jonathan E Sears8, Ajay E Kuriyan9, Audina M Berrocal9, Polly A Quiram10, Amanda E Gerber10, R V Paul Chan11, Karyn E Jonas11, Sui Chien Wong12, C K Patel13, Ashkan M Abbey14, Rand Spencer15, Michael P Blair6, Emmanuel Y Chang16, Thanos D Papakostas17, Demetrios G Vavvas18, Robert A Sisk19, Philip J Ferrone20, Robert H Henderson12, Karl R Olsen21, M Elizabeth Hartnett22, Felix Y Chau5, Shizuo Mukai18, Timothy G Murray23, Benjamin J Thomas24, P Anthony Meza25, Kimberly A Drenser26, Michael T Trese26, Antonio Capone27. 1. Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. 2. Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan. 3. Sakai Hospital, Kindai University Faculty of Medicine, Osaka, Japan. 4. Emory Eye Center, Emory School of Medicine, Atlanta, Georgia. 5. Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago, Illinois. 6. Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago, Illinois; Retinal Consultants, Des Plaines, Illinois. 7. L. V. Prasad Eye Institute, Bhubaneswar, India. 8. Cole Eye Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio. 9. Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida. 10. VitreoRetinal Surgery, PA, Minneapolis, Minnesota. 11. Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago, Illinois; Department of Ophthalmology, Weill Cornell Medical College, New York, New York. 12. Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom; Department of Vitreoretinal Surgery, Moorfields Eye Hospital, London, United Kingdom. 13. Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom; Paediatric Vitreoretinal Service, Oxford Eye Hospital, John Radcliffe Hospital, Oxford, United Kingdom. 14. Texas Retina Associates, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical School, Dallas, Texas. 15. Department of Ophthalmology, University of Texas Southwestern Medical School, Dallas, Texas. 16. Retina and Vitreous of Texas, Houston, Texas. 17. Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts. 18. Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. 19. Cincinnati Eye Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio. 20. Long Island Vitreoretinal Consultants, North Shore-Long Island Jewish Medical Center, Great Neck, New York. 21. Retina Vitreous Consultants, University of Pittsburg School of Medicine, Pittsburg, Pennsylvania. 22. John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah. 23. Murray Ocular Oncology and Retina, Miami, Florida. 24. Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Florida Retina Institute, Jacksonville, Florida. 25. Pediatric Anesthesiology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan. 26. Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan. 27. Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan. Electronic address: acaponejr@arcpc.net.
Abstract
PURPOSE: To determine the feasibility and safety of bilateral simultaneous vitreoretinal surgery in pediatric patients. DESIGN: International, multicenter, interventional, retrospective case series. PARTICIPANTS: Patients 17 years of age or younger from 24 centers worldwide who underwent immediate sequential bilateral vitreoretinal surgery (ISBVS)-defined as vitrectomy, scleral buckle, or lensectomy using the vitreous cutter-performed in both eyes sequentially during the same anesthesia session. METHODS: Clinical history, surgical details and indications, time under anesthesia, and intraoperative and postoperative ophthalmic and systemic adverse events were reviewed. MAIN OUTCOME MEASURES: Ocular and systemic adverse events. RESULTS: A total of 344 surgeries from 172 ISBVS procedures in 167 patients were included in the study. The mean age of the cohort was 1.3±2.6 years. Nonexclusive indications for ISBVS were rapidly progressive disease (74.6%), systemic morbidity placing the child at high anesthesia risk (76.0%), and residence remote from surgery location (30.2%). The most common diagnoses were retinopathy of prematurity (ROP; 72.7% [P < 0.01]; stage 3, 4.8%; stage 4A, 44.4%; stage 4B, 22.4%; stage 5, 26.4%), familial exudative vitreoretinopathy (7.0%), abusive head trauma (4.1%), persistent fetal vasculature (3.5%), congenital cataract (1.7%), posterior capsular opacification (1.7%), rhegmatogenous retinal detachment (1.7%), congenital X-linked retinoschisis (1.2%), Norrie disease (2.3%), and viral retinitis (1.2%). Mean surgical time was 143±59 minutes for both eyes. Higher ROP stage correlated with longer surgical time (P = 0.02). There were no reported intraoperative ocular complications. During the immediate postoperative period, 2 eyes from different patients demonstrated unilateral vitreous hemorrhage (0.6%). No cases of endophthalmitis, choroidal hemorrhage, or hypotony occurred. Mean total anesthesia time was 203±87 minutes. There were no cases of anesthesia-related death, malignant hyperthermia, anaphylaxis, or cardiac event. There was 1 case of reintubation (0.6%) and 1 case of prolonged oxygen desaturation (0.6%). Mean follow-up after surgery was 103 weeks, and anatomic success and globe salvage rates were 89.8% and 98.0%, respectively. CONCLUSIONS: This study found ISBVS to be a feasible and safe treatment paradigm for pediatric patients with bilateral vitreoretinal pathologic features when repeated general anesthesia is undesirable or impractical.
PURPOSE: To determine the feasibility and safety of bilateral simultaneous vitreoretinal surgery in pediatric patients. DESIGN: International, multicenter, interventional, retrospective case series. PARTICIPANTS: Patients 17 years of age or younger from 24 centers worldwide who underwent immediate sequential bilateral vitreoretinal surgery (ISBVS)-defined as vitrectomy, scleral buckle, or lensectomy using the vitreous cutter-performed in both eyes sequentially during the same anesthesia session. METHODS: Clinical history, surgical details and indications, time under anesthesia, and intraoperative and postoperative ophthalmic and systemic adverse events were reviewed. MAIN OUTCOME MEASURES: Ocular and systemic adverse events. RESULTS: A total of 344 surgeries from 172 ISBVS procedures in 167 patients were included in the study. The mean age of the cohort was 1.3±2.6 years. Nonexclusive indications for ISBVS were rapidly progressive disease (74.6%), systemic morbidity placing the child at high anesthesia risk (76.0%), and residence remote from surgery location (30.2%). The most common diagnoses were retinopathy of prematurity (ROP; 72.7% [P < 0.01]; stage 3, 4.8%; stage 4A, 44.4%; stage 4B, 22.4%; stage 5, 26.4%), familial exudative vitreoretinopathy (7.0%), abusive head trauma (4.1%), persistent fetal vasculature (3.5%), congenital cataract (1.7%), posterior capsular opacification (1.7%), rhegmatogenous retinal detachment (1.7%), congenital X-linked retinoschisis (1.2%), Norrie disease (2.3%), and viral retinitis (1.2%). Mean surgical time was 143±59 minutes for both eyes. Higher ROP stage correlated with longer surgical time (P = 0.02). There were no reported intraoperative ocular complications. During the immediate postoperative period, 2 eyes from different patients demonstrated unilateral vitreous hemorrhage (0.6%). No cases of endophthalmitis, choroidal hemorrhage, or hypotony occurred. Mean total anesthesia time was 203±87 minutes. There were no cases of anesthesia-related death, malignant hyperthermia, anaphylaxis, or cardiac event. There was 1 case of reintubation (0.6%) and 1 case of prolonged oxygen desaturation (0.6%). Mean follow-up after surgery was 103 weeks, and anatomic success and globe salvage rates were 89.8% and 98.0%, respectively. CONCLUSIONS: This study found ISBVS to be a feasible and safe treatment paradigm for pediatric patients with bilateral vitreoretinal pathologic features when repeated general anesthesia is undesirable or impractical.
Authors: Randall P Flick; Juraj Sprung; Tracy E Harrison; Stephen J Gleich; Darrell R Schroeder; Andrew C Hanson; Shonie L Buenvenida; David O Warner Journal: Anesthesiology Date: 2007-02 Impact factor: 7.892
Authors: Dana Darwish; Ru-Ik Chee; Samir N Patel; Karyn Jonas; Susan Ostmo; J Peter Campbell; Michael F Chiang; R V Paul Chan Journal: Asia Pac J Ophthalmol (Phila) Date: 2018-05-29