Treatment of ROP with laser

• 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 

• 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. 

• 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