Immediate Sequential Bilateral Pediatric Vitreoretinal Surgery

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 haemorrhage (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.

Surgical outcomes of immediate sequential bilateral vitreoretinal surgery for advancing retinopathy of prematurity

“…Immediate sequential bilateral vitreoretinal surgery (ISBVS) is emerging as a preferred approach to overcome these issues. [3] Timely management of both eyes in a single sitting leads to faster recovery and better anatomical and functional outcomes. [4] This has the advantage of only single exposure to GA for both eyes, which is safer for these small babies.…”

“…[4] This has the advantage of only single exposure to GA for both eyes, which is safer for these small babies. [34] Though bilateral simultaneous surgeries pose the risk of bilateral endophthalmitis, ROP is possibly one of the very few pediatric eye diseases where bilateral surgery in same sitting seems justified.…”

Prediction Model for Determination of Indications for Laser or Surgical Treatment for Aggressive Posterior Retinopathy of Prematurity at the Manifestation Stage

“…В таких ситуациях сложно принять решение о дальнейшей тактике ведения пациентов. Проведение транспупиллярной ЛКС заведомо не является патогенетически обоснованным лечением, а возможность первичной витрэктомии вызывает у офтальмологов вопросы и разногласия [11,12].…”

Factors influencing the decision-making of carers of children with bilateral cataract in Nepal

“…Surgery for both eyes during the same admission, either simultaneous or sequential, should be also considered, to eliminate the financial and distance barriers of accessing care twice, as has been used in several studies for childhood cataract and other eye conditions. [16][17][18] This would have the additional advantage of reducing dense amblyopia in the second eye.…”