Chapter 52 ■ Treatment of Retinopathy of Prematurity 373

(2) Administers topical anesthetic

(3) Ensures that all personnel present at the treatment are wearing laser safety goggles

(4) Performs the laser

(5) Watches for and treats ocular complications that

may arise during and after the procedure

(6) Follows the baby postoperatively until ROP is

resolved

b. Neonatology fellow, attending neonatologist, or

pediatric anesthesiologist

(1) Administers systemic sedative agents (midazolam, fentanyl, ketamine, or a combination)

(2) Monitors patient for and treats any systemic

complications that develop during or after treatment

(3) Provides information to the ophthalmologist

regarding the patient’s overall condition throughout the procedure

c. Assistant to the ophthalmologist

(1) Helps with laser and instruments

(2) Records the treatment parameters used during

treatment

d. Neonatal nurse

(1) Instills dilating drops several times in the hour

preceding treatment

(2) Immobilizes the patient during treatment

4. Equipment

a. Cardiorespiratory, blood pressure, and pulse oximeter

b. Appropriate respiratory support (ventilator, laryngoscope and endotracheal tubes, face mask, self-inflating resuscitation bag, suction, and oxygen source)

c. Emergency medications (atropine, epinephrine,

bicarbonate, calcium, phenobarbital)

Note: Precalculation of weight-appropriate doses

is helpful.

d. Topical ocular anesthetic (e.g., tetracaine, proparacaine)

e. Cycloplegic/mydriatic eye drops: Cyclomydril (Alcon

Laboratories, Fort Worth, Texas) (cyclopentolate

hydrochloride 0.2% and phenylephrine hydrochloride 1%) or 0.5% cyclopentolate and 1% or 2.5%

phenylephrine

f. Calcium alginate-tipped nasopharyngeal applicators

or Flynn depressor (Fig. 52.4), for scleral depression

g. Balanced salt solution for rewetting cornea during

procedure

h. Neonatal eyelid speculum (Fig. 52.4)

i. 28- and 20-diopter lenses

Fig. 52.3. Dilation and tortuosity of iris vessels may be seen in

severe threshold retinopathy of prematurity.

Fig. 52.2. Dilated, tortuous vessels end in vascular shunts at a

thickened ridge of fibrovascular tissue. Avascular retina lies anterior to the ridge.

Fig. 52.4. Lid speculae and Flynn depressor.