374 Section IX ■ Miscellaneous Procedures

j. Portable argon or diode laser (9) with indirect (headlamp) delivery system

k. Appropriate laser safety goggles

5. Precautions and Complications (Table 52.2)

a. Ensure that laser is fully functional.

b. If the infant is at high risk for an adverse event that

would terminate treatment prematurely, treat the

more advanced eye first (assuming both have threshold ROP).

c. Discontinue feedings at least 4 hours before the procedure, or empty the stomach with an orogastric tube.

d. Establish IV access for infusions of medications and

IV fluids.

e. Observe oxygen saturation monitor carefully, and

adjust administered oxygen appropriately.

Table 52.2 Complications of Laser for Retinopathy

Complication Treatment/Action

Systemic: Intra- and immediately postop

Bradycardia Interrupt treatment.

Assess airway, oxygen delivery.

Atropine 0.1 mg IV

Hypoxia/cyanosis Evaluate airway.

Administer supplemental oxygen.

Apnea Evaluate airway.

Gentle stimulation.

Administer supplemental oxygen.

Hand-ventilate (self-inflating resuscitation bag, face mask).

Tachycardia Assess pain control.

Administer additional analgesic.

Monitor blood pressure and perfusion.

Hypertension Assess pain control.

Administer additional analgesic.

If moderate, observe.

If severe, consider hydralazine 0.1 mg/kg IV

Arrhythmia Manage as appropriate for arrhythmia.

Seizure (mechanism uncertain: ?

anticholinergic effect)

Supportive care.

Phenobarbital.

Ocular: Intraop

Closure of central artery Relieve pressure on globe (stop scleral depression).

Corneal clouding/abrasion Rinse with balanced salt solution/saline.

Interrupt treatment.

Retinal/vitreous/choroidal hemorrhage Gentle pressure on globe (until arterial pulsations visible).

Avoid lasering blood.

May have to terminate treatment if extensive.

Ocular: Postop

Conjunctival hemorrhage Observation.

Conjunctival laceration Antibiotic ointment t.i.d. for 3–4 d.

Corneal abrasion Antibiotic ointment t.i.d. for 3–4 d.

Follow with slit lamp exam with fluorescein.

Hyphema Topical cycloplegic and steroids.

Follow intraocular pressure closely.

Consider washout if high pressure, no resolution in 7–10 d.

Retinal/vitreous/choroidal hemorrhage Close follow-up.

Ocular: Late

Amblyopia, strabismus, myopia Pediatric ophthalmology assessment 3–4 mo after treatment(s).

Educate parents prior to discharge regarding need for regular

ophthalmology follow-up.

t.i.d., three times per day.