To the Editor:--The report by Lonngvist regarding the successful use of a laryngeal mask airway in general anesthesia in low-weight premature infants undergoing cryotherapy for retinopathy or prematurity was interesting. However, we question why infants with retinopathy with prematurity need to have their surgery performed under general anesthesia.
One of us (G.E.S.) has been performing cryotherapy for retinopathy of prematurity since 1985 under local anesthesia. All surgeries have been performed in the neonatal intensive care unit with the attending neonatologist present. The infants generally have received very mild sedation. Anesthesia consists of installation of a topical anesthesia followed by bus-tenons injection of lidocaine in each of the four quadrants. This anesthesia has been adequate for all of the procedures that have been done, including those in which a conjunctival incision was necessary to reach far posteriorly with a cryoprobe to treat posterior disease.
M. Craig Pinsker, M.D., Ph.D., George E. Sanborn, M.D., F.A.C.S., Richmond Eye and Ear Hospital, 1001 East Marshall Street, Richmond, Virginia 23219.