Systemic outcomes of anesthesia method in anti-vascular endothelial growth factor therapy for retinopathy of prematurity: General vs topical

Why clinicians should know about it

• Picked for Neonatology (paper of the day, 24 August 2026): General vs topical anesthesia outcomes for ROP therapy

Abstract

BACKGROUND: The type of anesthesia needed while performing an anti-vascular endothelial growth factor (VEGF) injection in preterm infants with retinopathy of prematurity is not well standardized. In Oman, general anesthesia (GA) remained the first choice by ophthalmologists treating retinopathy of prematurity (ROP) infants at the time of starting the study. Short-term systemic outcome in GA vs topical anesthesia (TA) is the primary outcome of this study. AIM: To analyze the short-term systemic outcomes of GA in infants undergoing anti-VEGF injections vs bedside injections under TA. METHODS: This is an observational study with historical comparison. Estimated sample size is 36 (18 in each group), based on the anticipated rate of difference in the outcome between the two cohorts of 50%, type I error (α) probability of 5%, power of 80%, and the allocation ratio of 1:1. The statistical test considered was Fisher's exact test. The calculation was done using the G*Power version 3.1.9.2. Infants were from two main tertiary hospitals in Oman. RESULTS: A total of 36 infants with retinopathy of prematurity were enrolled in the study: 18 in the retrospective (GA) cohort and 18 in the prospective (TA) cohort. The Primary outcome-the need for oxygen and/or respiratory support during the 48 hours post-procedure-occurred in 27.8% of the GA cohort, as compared to none of TA cohort (P value = 0.045). Cost and duration of the procedure, including anesthesia, were noted to be higher in the GA group. Surgeons' preference revealed that 70% prefer topical vs 30% general in terms of safety, 75% topical vs 25% general in terms of logistics, and 100% prefer topical in terms of cost and staff efforts. CONCLUSION: TA is associated with a reduced need for oxygen and/or respiratory support within 48 hours post-procedure, and better performance in duration, cost, and surgeon preference compared to GA.

Abstract as published, via PubMed.