Al Habsi AA, Al Mandhari HK, Ganesh AS, Al Zuhaibi SS, Al Habsi NS, Al-Farsi NH. Systemic outcomes of anesthesia method in anti-vascular endothelial growth factor therapy for retinopathy of prematurity: General vs topical. World J Clin Pediatr 2026; 15(3): 118321 [DOI: 10.5409/wjcp.118321]
Corresponding Author of This Article
Nouf H Al-Farsi, MD, Chief Physician, FRCS, Department of Ophthalmology, Sultan Qaboos University Hospital, University Medical City, P.O. Box 38 P.C. 123 Al-Khoud, Muscat 123, Oman. noufalfarsi@gmail.com
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Ophthalmology
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Al Habsi AA, Al Mandhari HK, Ganesh AS, Al Zuhaibi SS, Al Habsi NS, Al-Farsi NH. Systemic outcomes of anesthesia method in anti-vascular endothelial growth factor therapy for retinopathy of prematurity: General vs topical. World J Clin Pediatr 2026; 15(3): 118321 [DOI: 10.5409/wjcp.118321]
World J Clin Pediatr. Sep 9, 2026; 15(3): 118321 Published online Sep 9, 2026. doi: 10.5409/wjcp.118321
Systemic outcomes of anesthesia method in anti-vascular endothelial growth factor therapy for retinopathy of prematurity: General vs topical
Asaad A Al Habsi, Hilal K Al Mandhari, Anuradha S Ganesh, Sana S Al Zuhaibi, Nasra S Al Habsi, Nouf H Al-Farsi
Asaad A Al Habsi, Department of Ophthalmology, Oman Medical Specialty Board, Muscat 123, Oman
Hilal K Al Mandhari, Anuradha S Ganesh, Sana S Al Zuhaibi, Nouf H Al-Farsi, Department of Ophthalmology, Sultan Qaboos University Hospital, University Medical City, Muscat 123, Oman
Nasra S Al Habsi, Department of Ophthalmology, Al Nahda Hospital, Ministry of Health, Muscat 123, Oman
Author contributions: Al Habsi AA collected the data, wrote the paper, analyzed the data; Al-Farsi NH formatted the idea, collected the data, analyzed the data, supervised the paper; Al Mandhari HK, Genesh AS, Al Zuhaibi SS, Al Habsi NS reviewed the manuscript; Al Habsi AA data collection, manuscript writing, statistical analysis.
Institutional review board statement: This study was reviewed and ethically approved by the Sultan Qaboos University Hospital Review Board and ministry of health-Oman Review Boards.
Informed consent statement: Informed consent was obtained for each participant as part of regular procedure consent (anti-VEGF injection procedure) as per hospital-based protocol.
Conflict-of-interest statement: There was no commercial, personal, political, intellectual, or religious conflict of interest in this study.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Anonymous data.
Corresponding author: Nouf H Al-Farsi, MD, Chief Physician, FRCS, Department of Ophthalmology, Sultan Qaboos University Hospital, University Medical City, P.O. Box 38 P.C. 123 Al-Khoud, Muscat 123, Oman. noufalfarsi@gmail.com
Received: December 29, 2025 Revised: February 6, 2026 Accepted: March 24, 2026 Published online: September 9, 2026 Processing time: 215 Days and 4.6 Hours
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.
Core Tip: To date, no studies have compared the short-term systemic effects of general anesthesia (GA) in infants undergoing Anti- vascular endothelial growth factor injections vs those treated at bedside with topical anesthesia. This study addressed this gap by retrospectively analyzing outcomes under GA and comparing them to prospective data from bedside procedures under topical anesthesia. Topical anesthesia as compared to GA is associated with a significantly reduced need for oxygen and/or respiratory support within 48 hours post-procedure. In addition, topical anesthesia showed better performance in duration, cost, and surgeon preference.
