title: Immediate Sequential Bilateral Pediatric Vitreoretinal Surgery: An International Multicenter Study.
abstract: To determine the feasibility and safety of bilateral simultaneous vitreoretinal surgery in pediatric patients.
  
  
  
  International, multicenter, interventional, retrospective case series.
  
  
  
  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.
  
  
  
  Clinical history, surgical details and indications, time under anesthesia, and intraoperative and postoperative ophthalmic and systemic adverse events were reviewed.
  
  
  
  Ocular and systemic adverse events.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Associated 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.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yonekawa
authors.affiliation: Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
authors.forename: Wei-Chi
authors.initials: WC
authors.lastname: Wu
authors.affiliation: Sakai Hospital, Kindai University Faculty of Medicine, Osaka, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Kusaka
authors.affiliation: Emory Eye Center, Emory School of Medicine, Atlanta, Georgia.
authors.forename: Joshua
authors.initials: J
authors.lastname: Robinson
authors.affiliation: Sakai Hospital, Kindai University Faculty of Medicine, Osaka, Japan.
authors.forename: Daishi
authors.initials: D
authors.lastname: Tsujioka
authors.affiliation: Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago, Illinois.
authors.forename: Kai B
authors.initials: KB
authors.lastname: Kang
authors.affiliation: Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago, Illinois; Retinal Consultants, Des Plaines, Illinois.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Shapiro
authors.affiliation: L. V. Prasad Eye Institute, Bhubaneswar, India.
authors.forename: Tapas R
authors.initials: TR
authors.lastname: Padhi
authors.affiliation: L. V. Prasad Eye Institute, Bhubaneswar, India.
authors.forename: Lubhani
authors.initials: L
authors.lastname: Jain
authors.affiliation: Cole Eye Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Sears
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Ajay E
authors.initials: AE
authors.lastname: Kuriyan
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Audina M
authors.initials: AM
authors.lastname: Berrocal
authors.affiliation: VitreoRetinal Surgery, PA, Minneapolis, Minnesota.
authors.forename: Polly A
authors.initials: PA
authors.lastname: Quiram
authors.affiliation: VitreoRetinal Surgery, PA, Minneapolis, Minnesota.
authors.forename: Amanda E
authors.initials: AE
authors.lastname: Gerber
authors.affiliation: Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago, Illinois; Department of Ophthalmology, Weill Cornell Medical College, New York, New York.
authors.forename: R V
authors.initials: RV
authors.lastname: Paul Chan
authors.affiliation: Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago, Illinois; Department of Ophthalmology, Weill Cornell Medical College, New York, New York.
authors.forename: Karyn E
authors.initials: KE
authors.lastname: Jonas
authors.affiliation: Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom; Department of Vitreoretinal Surgery, Moorfields Eye Hospital, London, United Kingdom.
authors.forename: Sui Chien
authors.initials: SC
authors.lastname: Wong
authors.affiliation: Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom; Paediatric Vitreoretinal Service, Oxford Eye Hospital, John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: C K
authors.initials: CK
authors.lastname: Patel
authors.affiliation: Texas Retina Associates, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical School, Dallas, Texas.
authors.forename: Ashkan M
authors.initials: AM
authors.lastname: Abbey
authors.affiliation: Department of Ophthalmology, University of Texas Southwestern Medical School, Dallas, Texas.
authors.forename: Rand
authors.initials: R
authors.lastname: Spencer
authors.affiliation: Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago, Illinois; Retinal Consultants, Des Plaines, Illinois.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Blair
authors.affiliation: Retina and Vitreous of Texas, Houston, Texas.
authors.forename: Emmanuel Y
authors.initials: EY
authors.lastname: Chang
authors.affiliation: Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Thanos D
authors.initials: TD
authors.lastname: Papakostas
authors.affiliation: Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Demetrios G
authors.initials: DG
authors.lastname: Vavvas
authors.affiliation: Cincinnati Eye Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sisk
authors.affiliation: Long Island Vitreoretinal Consultants, North Shore-Long Island Jewish Medical Center, Great Neck, New York.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Ferrone
authors.affiliation: Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom; Department of Vitreoretinal Surgery, Moorfields Eye Hospital, London, United Kingdom.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Henderson
authors.affiliation: Retina Vitreous Consultants, University of Pittsburg School of Medicine, Pittsburg, Pennsylvania.
authors.forename: Karl R
authors.initials: KR
authors.lastname: Olsen
authors.affiliation: John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Hartnett
authors.affiliation: Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago, Illinois.
authors.forename: Felix Y
authors.initials: FY
authors.lastname: Chau
authors.affiliation: Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Shizuo
authors.initials: S
authors.lastname: Mukai
authors.affiliation: Murray Ocular Oncology and Retina, Miami, Florida.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Murray
authors.affiliation: Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Florida Retina Institute, Jacksonville, Florida.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Thomas
authors.affiliation: Pediatric Anesthesiology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
authors.forename: P Anthony
authors.initials: PA
authors.lastname: Meza
authors.affiliation: Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Drenser
authors.affiliation: Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Trese
authors.affiliation: Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan. Electronic address: acaponejr@arcpc.net.
authors.forename: Antonio
authors.initials: A
authors.lastname: Capone
mesh_terms: D000293:Adolescent; D000758:Anesthesia / Q000379:methods; D002386:Cataract / Q000150:complications; D002387:Cataract Extraction; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D038622:Internationality; D008297:Male; D061646:Operative Time; D054514:Persistent Hyperplastic Primary Vitreous / Q000150:complications / Q000601:surgery; D012164:Retinal Diseases / Q000150:complications / Q000151:congenital / Q000601:surgery; D012178:Retinopathy of Prematurity / Q000150:complications / Q000601:surgery; D041441:Retinoschisis / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D012591:Scleral Buckling / Q000379:methods*; D014821:Vitrectomy / Q000379:methods*; D057586:Vitreoretinal Surgery; D018630:Vitreoretinopathy, Proliferative / Q000150:complications / Q000601:surgery