Does general anesthesia or intravitreal injection affect neurodevelopment in children undergoing ophthalmic procedures?

PURPOSE OF REVIEW: To review recent studies on potential neurodevelopmental impacts on the pediatric population through general anesthesia events or intravitreal anti-vascular endothelial growth factor (VEGF) injection.

RECENT FINDINGS: Studies on this topic have been extensive with varied reported neurodevelopmental outcomes. Initial investigations in rodents and primates showed negative impact of anesthetics on neurodevelopment. Subsequent retrospective human reviews had mixed results whereas more recent sibling and prospective studies have been published without evidence of clinically significant impact. A similar narrative has more recently come to play regarding the long-term effects of intravitreal injections used in neonates with retinopathy of prematurity. Publications initially indicated a negative correlation whereas later reviews have found no difference between those receiving injections versus laser treatment.

SUMMARY: Given that recent data on both general anesthesia events and intravitreal anti-VEGF injections do not show a long-term negative neurodevelopmental impact, ocular procedures needed to improve a pediatric patient's vision or quality of life should not be delayed.