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Immediate Sequential Bilateral Pediatric Vitreoretinal Surgery: An International Multicenter Study
Yoshihiro Yonekawa1, Wei-Chi Wu2, Shunji Kusaka3
1Associated 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.
Insights
Immediate sequential bilateral vitreoretinal surgery (ISBVS) is a safe and feasible option for pediatric patients with bilateral eye conditions. This approach minimizes anesthesia risks and is effective for various retinal diseases.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Retinal Diseases
Background:
- Bilateral vitreoretinal diseases in children often require surgical intervention.
- Repeated general anesthesia in pediatric patients poses significant risks.
- Immediate sequential bilateral vitreoretinal surgery (ISBVS) offers a potential solution to minimize anesthesia exposure.
Purpose of the Study:
- To evaluate the feasibility and safety of performing bilateral simultaneous vitreoretinal surgery in pediatric patients.
- To assess the incidence of ocular and systemic adverse events associated with ISBVS.
Main Methods:
- A retrospective, international, multicenter case series.
- Review of clinical history, surgical details, and adverse events in pediatric patients (≤17 years) undergoing ISBVS.
- Data collected included indications, surgical time, anesthesia time, and postoperative outcomes.
Main Results:
- 172 ISBVS procedures in 167 pediatric patients were analyzed.
- Common indications included retinopathy of prematurity (ROP), abusive head trauma, and familial exudative vitreoretinopathy.
- No intraoperative ocular complications were reported; low rates of postoperative vitreous hemorrhage (0.6%) and no endophthalmitis.
- Anesthesia-related adverse events were minimal, with low rates of reintubation (0.6%) and oxygen desaturation (0.6%).
- High anatomic success (89.8%) and globe salvage (98.0%) rates were achieved.
Conclusions:
- ISBVS is a feasible and safe surgical approach for pediatric patients with bilateral vitreoretinal conditions.
- This technique is particularly beneficial when repeated general anesthesia is undesirable or impractical.
- ISBVS demonstrates favorable safety profiles and successful outcomes in a pediatric cohort.
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.
