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Hugo Quiroz-Mercado, Jose Luis Guerrero-Naranjo, Gerardo Garcia-Aguirre, Benjamin J. Ernst, Cirag C. Patel, Paul R. Chan, Maria Ana Martinez-Castellano; Methods and Techniques for Intravitreal Antiangiogenic Therapy (IAT) in Retinopathy of Prematurity (ROP) : A 196 Cases Experience. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3169.
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To describe methods and techniques for the treatment of ROP with IAT in three scenarios: operating room, NICU and in-office
We performed a retrospective analysis of 196 treatments with off-label Avastin or Lucentis for ROP in Mexico City from September 2005 to November 2010. Location of the procedure, type of anesthesia, and method of injection were recorded. Each record was reviewed for any ocular complications.
: Three different methods were identified: 1) IAT under general anesthesia 6 eyes (3%), 2) IAT under sedation 17 eyes (8.6%) and 3) IAT using only topical anesthesia 173 eyes (88.2%). Twenty-three patients underwent systemic anesthesia, 6 with general anesthesia and intubation and 17 with sedation and only mask ventilation. Sedation was performed with intravenous nalbuphine (0.3mg/kg) or midazolam (0.5mg/kg). Under topical anesthesia (tetracaine 0.5% eye drops) 150 eyes (90%) were treated in the NICU and 17 eyes (10%) in-office. Pars plicata injection was performed in all cases at 1mm from the limbus. For the initial 23 cases with systemic anesthesia, a paracentesis was performed following IAT of 1.25 mg Avastin in 0.05 ml. For the rest of the cases 0.03 ml of Avastin (0.75 mg) or Lucentis (0.3 mg) were injected without paracentesis. Two calibers of needles were used, 30 gauge and 32 gauge. In most of the cases (190 eyes, 96%) injection was performed the inferotemporal quadrant and in 6 eyes (3%) nasally to avoid proliferative processes in the temporal retina. For the group with topical anesthesia, the eye was stabilized by a cotton tip. Use of conjuntival forceps induced vagal response, and Bell's phenomenon facilitated inferotemporal injection with cotton tip alone for stabilization. No ocular complications were identified as a result of IAT.
Treatment with IAT in the NICU under topical anesthesia alone was performed most commonly and without ocular complications related to injection technique. Systemic anesthesia did not seem to be necessary to perform safe intravitreal injections in neonates.
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