• This is usually done in the Treatment Room. 
  • The ophthalmologist will have spoken with the parents and obtained consent for the procedure. 
  • All babies will be intubated, ventilated and paralysed for the procedure and given adequate analgesia. If not already ventilated then allow plenty of time to stabilise the baby before the start of the procedure (at least 2 hours). 

At least 1 hour before procedure

  • Eye drops, Cyclopentolate 0.5% and Phenylephrine 2.5%, 1 drop of each to each eye 60 minutes and 30 minutes before procedure. 
  • Empty stomach, stop feeds 
  • Intravenous access – give 10% glucose infusion. 
  • Arterial access for sampling and blood pressure monitoring. 
  • Morphine – loading dose given just before intubation, followed by infusion 
  • Intubation and ventilation – the majority of these babies have chronic lung disease and ventilator settings must be discussed with the attending consultant. Use elective intubation protocol. 
  • Full level I intensive care monitoring 

 

Just before start of procedure

  • Atropine – used to prevent the bradycardia induced by the oculocardiac reflex. 
  • Vecuronium– ensure baby is stable and blood pressure normal before procedure starts. 
  • Ophthalmologist will instil Cyclopentolate and Oxybuprocaine. 
  • All staff helping must wear protective goggles during the laser procedure. 

 

Following the procedure

  • Vecuronium will be stopped but morphine infusion continued for at least 12 hours or until extubation, whichever is sooner. 
  • The baby can be weaned rapidly from ventilation and decisions on extubation made on blood gas results. 
  • Treatment for 7 - 14 days as advised by ophthalmologist with : 
  • Guttae dexamethasone1 drop qds to both eyes 
  • Guttae cyclopentolate 0.5% 1 drop bd to both eyes 

Screening - click for guidelines 

 

Editorial Information

Last reviewed: 13/07/2023

Next review date: 13/07/2033

Author(s): David Quine.