title: Pain assessment in premature infants treated with intravitreal antiangiogenic therapy for retinopathy of prematurity under topical anesthesia.
abstract: OBJECTIVE
  To evaluate the physiological and behavioral pain response in premature infants receiving intravitreal bevacizumab injection (IVB) for retinopathy of prematurity (ROP) under topical anesthesia.
  
  
  METHODS
  A prospective interventional non-comparative case series. Premature infants with high-risk prethreshold or threshold ROP received IVB using topical anesthesia with tetracaine eye drops. A Premature Infant Pain Profile was used to assess the pain response during the procedure.
  
  
  RESULTS
  Nine premature infants requiring bilateral IVB therapy were included in the study. Mean gestational age was 28.7 ± 1.3 weeks, and birth weight was 1,200 ± 194 grams. The mean total pain score was found to be 8.7 ± 2.4 (range 5-14), indicating generally mild pain during the procedure. Eye squeeze was the most prominent indicator of pain. Most changes occurred at the beginning, with the insertion of the lid speculum and were hardly noted during the rest of the procedure including the injection itself.
  
  
  CONCLUSIONS
  Topical anesthesia with tetracaine is an effective method for the relief of pain associated with intravitreal injections in premature infants with ROP.
authors.affiliation: Retina Service Asociación para Evitar la Ceguera en México, Hospital Luis Sanchez Bulnes I.A.P, Mexico City, Mexico.
authors.forename: Maria Ana Martínez
authors.initials: MA
authors.lastname: Castellanos
authors.forename: Shulamit
authors.initials: S
authors.lastname: Schwartz
authors.forename: Ricardo
authors.initials: R
authors.lastname: Leal
authors.forename: Robison Vernon Paul
authors.initials: RV
authors.lastname: Chan
authors.forename: Hugo
authors.initials: H
authors.lastname: Quiroz-Mercado
mesh_terms: D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D000068258:Bevacizumab; D058447:Eye Pain / Q000175:diagnosis*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D058449:Intravitreal Injections; D008297:Male; D010147:Pain Measurement; D011446:Prospective Studies; D015861:Retinal Neovascularization / Q000188:drug therapy; D012178:Retinopathy of Prematurity / Q000188:drug therapy*; D013748:Tetracaine / Q000008:administration & dosage; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D000779:Anesthetics, Local; D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D013748:Tetracaine; D000068258:Bevacizumab