Parulekar M V, Chen S D M, Patel C K
Oxford Eye Hospital, Oxford, UK.
Eye (Lond). 2008 Mar;22(3):375-9. doi: 10.1038/sj.eye.6702642. Epub 2007 Mar 30.
To evaluate the safety and efficacy of sub-Tenon's local anaesthesia (LA) for laser treatment of threshold retinopathy of prematurity (ROP).
A cohort of 18 eyes of 10 neonates with threshold ROP was treated with diode laser peripheral retinal ablation over 14 treatment sessions using oral sedation and sub-Tenon's anaesthesia. Treatment was performed in a neonatal unit. The heart and respiratory rate, trans-cutaneous oxygen saturation, and physical activity were continuously monitored for signs of neonatal distress. Cardio-respiratory stability during and after the procedure was scored for each eye treated using a Cardio-respiratory index described previously.
In all cases, the planned dose of laser was delivered. One out of 18 eyes developed stage 4b tractional retinal detachment over a follow-up of at least 6 months for all babies. Systemic complications during treatment included transient bradycardia and apnoea requiring stimulation in two babies and excessive head mobility in three babies. Treatment duration varied between 20 and 80 min. Ocular complications were conjunctival haemorrhage and chemosis. The mean cardio-respiratory index was 1.13, which compared favourably with the standard published.
Sub-Tenon's LA with oral sedation appears to be a safe and effective alternative to general anaesthesia for laser treatment of ROP, with the potential for lower morbidity.
评估球后局部麻醉（LA）用于激光治疗阈值性早产儿视网膜病变（ROP）的安全性和有效性。
10例患有阈值性ROP的新生儿的18只眼组成的队列，在14次治疗过程中使用口服镇静剂和球后麻醉，接受二极管激光周边视网膜光凝治疗。治疗在新生儿病房进行。持续监测心率、呼吸频率、经皮血氧饱和度和身体活动，以寻找新生儿窘迫的迹象。使用先前描述的心肺指数对每只接受治疗的眼睛在手术期间和术后的心肺稳定性进行评分。
在所有病例中，均给予了计划剂量的激光。在对所有婴儿至少6个月的随访中，18只眼中有1只发生了4b期牵拉性视网膜脱离。治疗期间的全身并发症包括2例婴儿出现短暂性心动过缓和呼吸暂停需要刺激，3例婴儿出现头部过度活动。治疗时间在20至80分钟之间。眼部并发症为结膜出血和球结膜水肿。平均心肺指数为1.13，与已发表的标准相比情况良好。
球后局部麻醉联合口服镇静剂似乎是ROP激光治疗中全身麻醉的一种安全有效的替代方法，且具有较低发病率的潜力。
