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Friday, December 15, 2023

 


376 Section IX ■ Miscellaneous Procedures

neovascular disease (1.25 mg), and may represent a

several-fold increase in drug delivered/body weight

over adults (17).

c. No protocol for near- and long-term monitoring of

bevacizumab in neonates has been developed.

d. The informed consent process for the use of intravitreal bevacizumab for ROP must reflect the uncertain status of the treatment, the off-label use of the

drug, and the lack of long-term results, including

the possibility of unknown systemic side effects.

3. Indications

a. Threshold ROP in posterior Zone 1 disease. An

early report showed benefit over laser in posterior

(Zone 1) disease (13).

b. In unstable infants in whom laser may be contraindicated

(1) Intravitreal injection does not require systemic

sedation/anesthesia; in this regard, the procedure

may be preferable to laser in unstable infants.

c. As salvage therapy if laser treatment has not been

effective (16).

4. Contraindications

a. Infection in or around the eyes

b. Lethal medical illness

c. Failure of consensus between parent(s), treating

physicians, and hospital personnel about the uncertain nature of intravitreal bevacizumab in ROP and

the risks of intravitreal injection (informed consent)

5. Personnel

a. Ophthalmologist

(1) Determines the need for treatment

(2) Participates in informed consent process

(3) Administers topical anesthetic

(4) Performs the injection

(5) Performs indirect ophthalmoscopy after the

injection(s)

Table 52.3 Ocular Complications of

Intravitreal Injection

Complication Treatment

Immediate

Closure of central

retinal artery

Paracentesis (withdrawal of fluid from anterior

chamber with needle)

Conjunctival hemorrhage

Observation

Vitreous hemorrhage Observation and re-evaluation (with ultrasonography if hemorrhage obscures view of retina)

in 3–5 d

Within days/weeks

Infection/endophthalmitis

Prompt treatment with intravitreal antibiotics

(vancomycin and ceftazidime)

Vitreous hemorrhage As above

Retinal detachment Incisional surgery (vitrectomy)

(6) Follows the baby for ocular complications and

resolution of ROP

b. Neonatologist

(1) Provides information about the status of the

infants to the treating ophthalmologist

(2) Participates in the informed consent process

(3) Monitors infant for systemic complications during and after treatment

c. Nurse/assistant at bedside

(1) Helps prepare the baby for injection (i.e., swaddles the baby)

(2) Helps prepare the instruments at the bedside

6. Equipment

a. Topical anesthetic

b. Sterile lid speculum (one per eye)

c. Caliper (one per eye)

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