On the question of choosing the optimal method of anesthesia for laser coagulation of the retina in infants with retinopathy of prematurity

2021 ◽  
pp. 5-10
Author(s):  
A.V. Konstantinov ◽  
◽  
S.V. Chistyakov ◽  
I.G. Trifanenkova ◽  
◽  
...  
Keyword(s):  
Heart Rate ◽  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Laser Photocoagulation ◽  
State Institution ◽  
Laryngeal Mask ◽  
Federal State ◽  
Laser Coagulation ◽  
Central Position ◽  
Airway Patency

Purpose. To evaluate the method of anesthesia used in the Kaluga branch of the Fyodorov Eye Microsurgery Federal State Institution for retinal laser photocoagulation in premature infants with retinopathy of prematurity. Materials and methods. The data of children diagnosed with retinopathy of prematurity was analyzed for the period 2017– 2019. These children underwent retinal laser photocoagulation under general anesthesia at the Kaluga branch of the Fyodorov Eye Microsurgery Federal State Institution. As an anesthetic aid, inhalation monoanesthesia with sevoflurane by the method of «bolus» induction was carried out starting from 6–8 vol% with a Mapleson circuit filled with a gas-narcotic mixture of oxygen and air. Induction with using a face mask with reaching the surface level of the surgical stage of anesthesia was fixed by 4–5 minutes. Then, for better airway patency, the laryngeal mask was fixed. Results. With «bolus» induction, the surgical stage of anesthesia occurred within 3–4 minutes. The patient was in the optimal anesthetic condition for laser surgery during the entire surgical process. The eyeballs had a fixed central position, muscle tone was reduced, breathing was even, and there was no reaction to pain stimulus. No significant changes in the heart rate were revealed when monitoring the parameters of the state of the cardiovascular system during induction was being performed. In children with profound prematurity, a slight increase in heart rate was determined (10–15%) in the intraoperative period. The heart rate returned to its original values at the end of anesthesia. The exit from the narcotic state was characterized by smoothness and was carried out immediately after the elimination of the anesthetic within 4–8 minutes. Severe complications from vital systems and pronounced changes in behavioral reactions were not observed, in the immediate postoperative period. Conclusion. The use of this technology makes it possible to provide high-quality anesthetic treatment for premature infants during laser treatment of ROP, minimize the negative impact of anesthesia on the patient's body and optimize the work of an anesthesiologist. Key words: retinopathy of prematurity, retinal laser photocoagulation, anesthetic aid, sevoflurane, Mapleson's contour, laryngeal mask.

scholarly journals Visual Functions in Children in Remote Postoperative Period after Laser Treatment of Threshold Stages of Retinopathy of Prematurity

2018 ◽  
Vol 15 (2S) ◽  
pp. 18-23
Author(s):  
M. V. Pshenichnov ◽  
O. V. Kolenko ◽  
V. V. Egorov ◽  
E. L. Sorokin
Keyword(s):  
Visual Acuity ◽  
Postoperative Period ◽  
Retinopathy Of Prematurity ◽  
Vision Loss ◽  
State Institution ◽  
Laser Coagulation ◽  
Visual Functions ◽  
Functional Changes ◽  
Continuous Sampling ◽  
High Degree

Purpose.Analysis of visual functions in children in remote postoperative period after laser coagulation (LC) of threshold stages of retinopathy of prematurity (ROP).Patients and methods. In 2017, we selected and investigated 18 children, who previously had an LC of threshold stages of ROP in 2008–2009 in the Khabarovsk branch of the S.N. Fyodorov State Institution Eye Microsurgery Complex (continuous sampling method). There were 5 boys and 13 girls aged from 8 to 9 years at the time of LC. Anterior and posterior eye segments of the eyes (biomicroscopy, ophthalmoscopy), visual acuity, clinical refraction, concomitant pathology were evaluated.Results. We have revealed that regressive ROP after LC is characterized by the presence of serious anatomical and functional changes in the eyes. First, these are refractive disorders, which revealed in 90.5% of cases. Most often revealed: myopic refraction — 61% of all cases, of which more than half (53%) is its high degree; or its combination with compound myopic astigmatism (77% eyes); anisometropia was detected in 39% children. These refractive disorders led to the development of strabismus (61% children) and mixed amblyopia (60%). Despite the combined ophthalmologic pathology, 17% children developed visual functions with achievement of binocular vision, in most children visual functions still continue to develop, although they are not high due to amblyopia. High visual acuity (from 0.8 and above) in both eyes was formed in 22% children; visual acuity in the range of 0.5–0.7 in both eyes was formed in 17% children. Unfortunately, 44.5% children at the time of examination had low visual functions (in the range of 0.05–0.4) in both eyes. Extremely low visual acuity (from 0.01 to 0.04) in both eyes was identified in 11% children; absolute blindness in one of the eyes was in 11% children.Conclusions. LC is reliable way to prevent vision loss from retinal detachment in children with threshold stages of ROP. 

Systematic review and meta-analysis of the negative outcomes of retinopathy of prematurity treated with laser photocoagulation

2018 ◽  
Vol 29 (2) ◽  
pp. 223-228 ◽  
Author(s):  
Jing Liang
Keyword(s):  
Confidence Interval ◽  
Laser Treatment ◽  
Retinopathy Of Prematurity ◽  
Odds Ratio ◽  
Laser Photocoagulation ◽  
Meta Analysis ◽  
Anterior Chamber Depth ◽  
Mean Difference ◽  
Laser Coagulation ◽  
Spherical Equivalent

Introduction: Retinopathy of prematurity is a leading cause of potentially avertable childhood blindness around the world. And laser photocoagulation is currently performed as a gold standard for retinopathy of prematurity treatment, but it may contribute to elevated myopia and decreased visual field. Therefore, the objective of this meta-analysis is to explore the negative impact of laser photocoagulation for retinopathy of prematurity in terms of anatomic outcomes and structural outcomes. Methods: Studies were retrieved through literature searches in PubMed and EMBASE from 1990 to 2017 in English. Case-control studies that reported anatomic and structural changes or significant complications after laser coagulation or cryotherapy for retinopathy of prematurity were eligible. Results: This meta-analysis included eight original studies related to laser treatment for retinopathy of prematurity at any stages. A total of 1422 infants were participated, of which 1156 documented subthreshold or threshold retinopathy of prematurity without laser treatment were selected as comparison group and the rest treated with diode or argon laser coagulation were chosen for experiment group. Taking all included studies into account, spherical equivalent (mean difference −2.53, 95% confidence interval: –5.23 to 0.18, I2 = 96%, P < 0.00001), anterior chamber depth (mean difference −0.52, 95% confidence interval: −0.76 to −0.28, I2 = 55%, P = 0.11), astigmatism (odds ratio 3.19, 95% confidence interval: 1.61 to 6.32, I2 = 0%, P = 0.54), and myopia (odds ratio 8.08, 95% confidence interval: 3.79 to 17.23, I2 = 37%, P = 0.21) were associated with laser treatment for retinopathy of prematurity. Axial length (mean difference −0.01, 95% confidence interval: –0.28 to 0.27, I2 = 0%, P = 0.62) and anisometropia (odds ratio 4.21, 95% confidence interval: 0.54 to 33.17, I2 = 1%, P = 0.31) had no statistical significance on laser coagulation for retinopathy of prematurity. Conclusion: This meta-analysis showed that spherical equivalent, anterior chamber depth, astigmatism, and myopia were associated with the negative outcomes of laser coagulation, while axial length and anisometropia had no statistical importance on the defects of laser coagulation. Therefore, patients treated with laser coagulation should follow periodic cycloplegic refraction and receive early optical correction.

Choosing optimal anesthetic and method of general anesthesia for laser surgery retinopathy of prematurity

2021 ◽  
pp. 196-201
Author(s):  
S.I. Utkin ◽  
◽  
M.V. Stolyarov ◽  
D.Y. Ignatenko ◽  
E.A. Bachinin ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Laser Surgery ◽  
Breathing Circuit ◽  
Face Mask ◽  
Laser Coagulation ◽  
Efficacy And Safety ◽  
Continuous Sampling ◽  
Low Concentrations

Purpose. Comparative analysis of clinical efficacy and safety of inhalational general anesthesia (GA) with halothane and sevoflurane in premature infants with retinopathy of prematurity (ROP) during laser coagulation (LC) of the avascular retina. Material and methods. The clinical material included 284 children who underwent laser surgery of ROP in the period from 2008 to 2017 (method of continuous sampling). Introduction to anesthesia and maintenance of anesthesia was performed by inhalation of anesthetic (halothane or sevoflurane) with O2 using face mask and Mapleson breathing circuit. Two groups were formed: in the 1st group (167 people) halothane was used at anesthetic at oxygen concentration of 0.3 vol%, in the 2nd group (117 people) – sevoflurane at concentration of 1–1.5 vol%. Results. In case of GA with halothane in children of the 1st group, in 68 children (40.7%) developed negative reactions during anesthesia in the form of of respiratory depression, in several cases – up to pronounced bradypnea, bradycardia, prolonged awakening after surgery. In the 2nd group with GA with sevoflurane, negative reactions in the form of moderate bradycardia and bradypnea were observed only in 14 children (11.9%). All complications and reactions were promptly eliminated in all cases. Conclusion. Based on the obtained results, the optimal inhalation anesthetic for LC of retina in premature infants is sevoflurane in low concentrations (at the sedation level) using the Mapleson breathing circuit and face mask. With this method of anesthesia, the frequency of side effects of sevoflurane, negative reactions during anesthesia and the degree of their severity are extremely low. Key words: premature infants, retinopathy of premature, sevoflurane, general anesthesia, laser coagulation of the retina.

Clinical-epidemiological and therapeutic aspects of prematurity retinopathy

2019 ◽  
pp. 26-36
Author(s):  
Sergey V. BELIKOV ◽  
Andrey P. GOYDIN ◽  
Oleg L. FABRIKANTOV ◽  
Pavel L. VOLODIN
Keyword(s):  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Laser System ◽  
Laser Coagulation ◽  
Laser Exposure ◽  
Medical Systems ◽  
Optimal Method ◽  
Advantages And Disadvantages ◽  
Long Term Treatment ◽  
Eye Retina

Relevance of the study . Blindness and hypovision due to retinopathy of prematurity dominate in the structure of the causes of visual impairment from childhood in both developed and developing countries, despite all the achievements of science and practical medicine. A huge role in preventing blindness from retinopathy of prematurity belongs to the effectiveness of treatment. The most discussed topic among global ophthalmology community is readings and the time of laser coagulation of the eye retina. Aim of the study . To evaluate the advantages and disadvantages of laser coagulation various methods in retinopathy of prematurity, to determine the most optimal method in the treatment of active phases of the disease. Materials and methods . We consider retinopathy of prematurity modern methods of diagnosis and treatment, also we carry out advantages and disadvantages comparative analysis. We consider the organization statistics of ophthalmic care for premature infants in the Tambov Region and the long-term treatment results of premature infants with retinopathy of prematurity. Results and discussion . The generally accepted standard methodology applied for screening examination, is the reverse binocular ophthalmoscopy (possible in humidicrib) when medication dilate pupils. If necessary, an examination is carried out using the retinal pediatric camera “RetCam Shuttle” (Clarity Medical Systems Inc., USA), which allows to document and save the survey results in a database. To date, timely and sufficient laser coagulation of the avascular zone of the retina is the only proven effective method of active retinopathy of prematurity treatment. The most modern method of retinal laser coagulation is the technology of pattern scanning laser coagulation, which automated the procedure for applying coagulants. The main trends in the retinopathy of prematurity treatment are earlier implementation of laser coagulation and over dosed coagulation, according to the ETROP recommendations. When using a pattern laser system, laser pulses are delivered in sequence at the highest speed. The result of the use of this technology is a high accuracy of coagulation, so that the eye retina receives the least energy impact, compared with the classical laser coagulation. Conclusion. 1. Timely and adequate laser coagulation of the avascular areas of the eye retina reduces the risk of severe anatomical and functional outcomes of active retinopathy of prematurity. 2. The use of the technology of transpupillary scanning pattern laser coagulation of the eye retina (PASCAL) can significantly reduce the duration of laser exposure and anesthesia for a premature baby, improve the efficiency and safety of treatment.

The Effect of Laser Photocoagulation on Intraocular Pressure in Premature Infants With Retinopathy of Prematurity

2017 ◽  
Vol 26 (2) ◽  
pp. e74-e78
Author(s):  
Damla Erginturk Acar ◽  
Ugur Acar ◽  
Zuhal Ozen Tunay ◽  
Ozdemir Ozdemir
Keyword(s):  
Intraocular Pressure ◽  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Laser Photocoagulation

Prospects for the treatment of retinopathy of prematurity

2021 ◽  
pp. 50-56
Author(s):  
E.I. Sidorenko ◽  
◽  
E.E. Sidorenko ◽  
◽  
Keyword(s):  
Fatty Acids ◽  
Genetic Engineering ◽  
Polyunsaturated Fatty Acids ◽  
Retinopathy Of Prematurity ◽  
Laser Photocoagulation ◽  
Review Article ◽  
Laser Coagulation ◽  
Omega 3 ◽  
Substitution Therapy ◽  
Preterm Baby

The review article is devoted to the prospects for the treatment of retinopathy of prematurity. Cryocoagulation, laser photocoagulation, infrasonic vacuum pneumomassage and their effectiveness in the treatment of retinopathy of prematurity, as well as modern substitution therapy, regulation of the level of insulin-like factor in the blood of a preterm baby and weight dynamics are considered as important risk mechanisms for the development of retinopathy of prematurity. The possibility of using omega-3 polyunsaturated fatty acids and genetic engineering in the treatment of retinopathy of prematurity was evaluated. Key words: retinopathy of prematurity, cryocoagulation, laser coagulation, infrasound vacuum pneumomassage, genetic engineering.

Update in the Treatment of Retinopathy of Prematurity

2020 ◽  
Author(s):  
Aldo Bancalari ◽  
Ricardo Schade
Keyword(s):  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Laser Photocoagulation ◽  
Standard Treatment ◽  
Treatment Strategies ◽  
Current Evidence ◽  
Key Points ◽  
Zone Ii ◽  
Endothelial Growth Factor ◽  
Oral Propranolol

Retinopathy of prematurity (ROP) is an alteration in the development of the immature retina vascularization that frequently occurs in premature infants and is one of the leading causes of childhood blindness worldwide. In threshold stage retinopathy, laser photocoagulation is the standard treatment, particularly in those located in zone II. However, this therapy destroys parts of the retina and can lead to significant eye complications later in life. For this reason, in the last few years, antivascular endothelial growth factor agents are being used as monotherapy or as coadjuvant with laser, especially in retinopathy located in zone I. More recently, the administration of oral propranolol has been used as prevention and/or treatment of prethreshold retinopathy with encouraging results. This review provides an overview of the current evidence on newer treatment strategies for ROP. Key Points

scholarly journals Preferences and Trends in Practices Caring Premature Infants for Retinopathy of Prematurity (ROP): A Web-based Survey

2018 ◽  
Vol 1 (1) ◽  
pp. 49-61
Author(s):  
Swati Agarwal-Sinha ◽  
Sarina Amin ◽  
Amanda Way
Keyword(s):  
Premature Infants ◽  
Retinopathy Of Prematurity ◽  
Laser Photocoagulation ◽  
Practice Patterns ◽  
Treatment Preferences ◽  
Web Survey ◽  
Web Based ◽  
Type 1 Rop

Objectives: To study preferences in treatment, follow-up and conclusion of examination in infants treated with and without bevacizumab (IVB) and/or laser photocoagulation for retinopathy of prematurity (ROP).Methods: A 22 question web survey was administered to physicians to understand practice patterns for treatment of type1 ROP, determine timeframe of conclusion of examinations with and without IVB/laser, and to approximate incidence of ROP recurrence post-treatment.Results: The survey revealed that 73% pediatric ophthalmologists reported not personally performing injections and 54.1% reported not performing laser. In infants with persistent avascular retina without pre-threshold disease, 54.2% continued examination > 50 weeks PMA, 23.3% discontinued at 50 weeks PMA, 3.2% preferred prophylactic laser and 5.1% fluorescein angiography and laser prior to concluding exams. 46.3% of physicians preferred IVB as primary monotherapy, 37.3% laser, and 16.4% both IVB and laser in type 1 ROP. Of those who preferred IVB, 20.4% concluded examination at ? 55 weeks PMA, whereas 79.6% continued evaluation >55 weeks PMA (60 to ? 80 weeks). Of those who preferred both IVB and laser, 50.6% concluded examination at ? 50 weeks PMA, whereas 49.4% continued > 50 weeks (60 to ? 80 weeks). 21.1 % of respondents reported recurrence with IVB and 8.8% with dual therapyConclusions: Treatment preferences and conclusion of examination in ROP varies considerably without and with treatment. Though a longer follow-up is recommended with IVB, this survey reveals extended examinations beyond 50 weeks PMA in infants with persistent avascular retina requiring no treatment and in the laser treated subgroup. The survey highlights low rates of performing treatments personally by pediatric ophthalmologists, and distinctlyvariable practice patterns in ROP care

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