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PRe-Operative Evaluation
You will need a note from your/your
child’s medical doctor before admission to the hospital Please bring
this with you. If the baby is already admitted this note will be
placed in the chart.
Laboratory work may or may not be needed.
This will be done if necessary the day before or the morning of
surgery.
Sometime in the afternoon on the day prior
to surgery you will be contacted by the hospital. The time of the
last feeding prior to surgery will be reviewed. This will depend on
the age of the patient and the time of the surgery. The importance of
an empty stomach prior to anesthesia will be emphasized. All food and
fluid will need to be held after a certain hour. For patients already
admitted this is reviewed with the baby’s nurse.
PURPOSE OF THE SURGERY:
This operation will attempt to stop the
growth of abnormal blood vessels in the retina in order to prevent
structural damage and retinal detachment both of which can lead to
severe visual impairment and/or blindness. The doctor will do this by
attempting to destroy the immature retinal tissue that is signaling
this abnormal blood vessel growth by using a laser to burn the tissue.
The development of the visual system and
of good vision is dependent on a sharp, clear image that is focused on
the retina during the early stages of childhood growth. It is
impossible to assure that this development will occur in my child’s
particular case. WITHOUT THE SURGERY THERE IS A GREATER CHANCE THAT
THE ABNORMAL BLOOD VESSELS CAN BLEED AND SCAR CAUSING RETINAL
DETACHMENT AND BLINDNESS LEAVING NO CHANCE FOR GOOD VISION TO DEVELOP
in some cases.
Lasers are either performed at the bedside
in the neonatal ICU or in the operating room. The choice of the
location of the surgery and the type of anesthesia used is specific to
each case. It is a complex decision that will be made by the
ophthalmologist, neonatologist and anesthesiologist.
Recovery room
Following surgery the patient is taken to
the recovery room or remains at the bedside where special nurses and
equipment are available. Here the recovery from anesthesia is
supervised. When a satisfactory state of consciousness returns the
family can rejoin the patient.
Post-Operative Care
Feeding: Feedings are monitored and
resumed to the same regimen as before surgery with the guidance of the
anesthesiologist and/or neonatologist.
Bandages: The eyes are not covered.
There may be a small amount of discharge. The discharge may be tinged
with blood. Secretions can be gently wiped away with a moist tissue.
Tearing: Tears may occur the first few
days after surgery. If it is bothersome, they can be gently wiped
away with a tissue or other soft material like a towel
Pain: Generally there is little or no
pain.
Activity: The patient is able to use the
eyes the day of surgery. Keep soap and water out of eyes while
bathing.
Medications: Any regular medication that
the patient is taking should be continued after surgery.
Occasionally, special additional medicines will be prescribed. We
sometimes instill an ointment into the eyes after surgery.
Follow up: Generally the first checkup
after surgery is within the first week. Regular visits will then be
scheduled at certain intervals. If there is any problem between
scheduled visits please report that and additional visits will be
arranged.
LONG-TERM COURSE
Parental cooperation in treating the
child after the surgery is of the utmost importance. This treatment
will continue until the visual system is mature (5-10 years of age)
and likely beyond. The expected course will likely include glasses,
the use of a patch, and the use of eye drops and very close medical
supervision. More surgery will likely be necessary. All of this
treatment is IN ADDITION to the laser surgery. General medical and
eye problems may require care by other medical and eye specialists.
In spite of this extended treatment, the final vision in the operated
eye(s) may not be good even though the eye itself appears normal and
all medical advice has been followed carefully.
RISKS
The child’s particular case will be
discussed with the surgeon(s). Laser surgery is the first step in the
attempt to eliminate the abnormal retinal blood vessels and to develop
good sight in the eye(s). There is no guarantee of good sight and
that there is a risk of poor or no sight following the surgery.
Problems of bleeding, infection, reactions of the tissues in the
eye(s) could even lead to complete loss of the eye(s) requiring
surgical removal of the eye(s). IN ADDITION,
this laser DOES NOT ELIMINATE
the risk of retinal detachment. THE child may need to undergo
additional laser and/or retinal surgical procedures IN THE NEAR FUTURE
IN ORDER to attempt to keep the retina(s) attached. These are
accepted risks that can occur after laser surgery. Risks of
anesthesia will be discussed as a separate issue.
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