Retinopathy of Prematurity
Laser Treatment

 

Reviewed by Carl Kuschel, Dana Lui, Shuan Dai (Ophthalmology)
August
2006
Revision to antibiotic eye drops post-treatment
May 2007
Clinical Guidelines Back Newborn Services Home Page
When is Treatment Considered? Preoperative and Intraoperative Care Postoperative Care Related Documents

When is Treatment Considered?

Type 1 ROP
Administer Peripheral Ablation Treatment

Type 2 ROP
Wait and watch for progression

  • Zone 2
    • Plus disease with Stage 2 or 3
  • Zone 1
    • Plus disease with Stage 1, 2 or 3
    • Stage 3 without Plus disease
  • Zone 2
    • Stage 3 without Plus disease
  • Zone 1
    • Stage 1 or 2 without Plus disease

Preoperative and Intraoperative Care

Preoperative
  1. Inform the parents about the need for surgery.  Consent should be obtained by the operating ophthalmologist.
  2. Preparation of the environment:
    1. Move the baby into a single room or evacuate or shield the other babies from the room where the operation is to be performed.
    2. The room is closed to all visitors and staff members not looking after the baby
    3. A sign must be displayed on the doors indicating that a laser procedure is taking place and that no one should enter.
    4. Doors and windows are shielded to prevent the laser ray from exiting the room.
  3. Preparation of the baby:
    1. Check FBC, electrolytes, and glucose to determine biochemical and haematological state, and correct any significant abnormalities.
    2. Baby should be nil by mouth for 4 hours prior to the set time of surgery.  An intravenous infusion should be commenced.
    3. Move baby on to a heat table and place in the supine position.
    4. Intubate and ventilate baby to ensure a safe airway for a sedated infant.
    5. Give medication for sedation and analgesia.  A fentanyl infusion is the preferred medication.  Midazolam and morphine may be used as an alternative.  Muscle relaxation with pancuronium may be required.
    6. Instill eye drops - 1 drop of amethocaine 1% (or 0.4% benoxinate), 1 drop of 0.5% cyclopentolate and 1 drop of 2.5% phenylephrine to each eye 30 minutes prior to surgery, and the repeated 10 minutes later.
    7. Maintain baby on continuous monitoring and hourly recordings of
      • cardiorespiratory status
      • blood pressure
      • SpO2
      • skin temperature
  4. Preparation of attending staff members:
    1. All staff in the room must wear protective goggles throughout the procedure.
    2. Surveillance programmes for staff members involved are unnecessary as the laser spot is only 200 micrometres in size, there is a protective filter on the laser, and all staff should wear protective goggles. 
  5. Preparation of equipment:  The operating ophthalmologist will bring the equipment required for the laser treatment and will be responsible for its safe operation and maintenance. See ADHB Laser Safety Policy.
Intraoperative
  1. Monitor vital signs and possible complications during the procedure.

Postoperative Care

  1. Wean from ventilation as able.
  2. Maintain intravenous fluid therapy as prescribed.  Restart enteral feeds when the baby wakes.  Monitor for signs of feeding intolerance.
  3. Continuous monitoring and hourly recording of cardiorespiratory status, blood pressure, SpO2, and skin temperature.
  4. Baby is nursed with eye shields for at least 8 hours to protect from light if on a heat table, or should be protected from direct light by a cover over the incubator.
  5. Observe for oedema of the eyelids, infection, and intra-ocular bleeding.
  6. Administer eye drops or ointment as prescribed - usually fusidic acid (Fucithalmic) 1% eye drops BD for 3 days.
  7. Keep parents informed of baby's progress.
  8. Follow-up will be arranged by the ophthalmologist - the baby is usually reviewed in one week.


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