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LASER THERAPY IN GLAUCOMA. Sun Xiao Dong. Laser Procedures. Laser trabeculoplasty(LTP) Laser peripheral iridotomy(LPI) Cyclophotocoagulation(CPC) Other uses. Laser Trabeculoplasty(LTP).

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Presentation Transcript
laser procedures
Laser Procedures
  • Laser trabeculoplasty(LTP)
  • Laser peripheral iridotomy(LPI)
  • Cyclophotocoagulation(CPC)
  • Other uses
laser trabeculoplasty ltp
Laser Trabeculoplasty(LTP)
  • Apply multiple laser burns to the trabecular meshwork to improve aqueous outflow
  • Lasers

Argon(ALT)

Nd:YAG(SLT)

indications for ltp
Indications for LTP

Supplement to maximum tolerated medical therapy

Poor compliance

Initial therapy(GLT)

laser trabeculoplasty ltp1
Contraindications:

1.Corneal edema

2.Complete angle closure glaucoma

3.Age﹤35 years

4.Some secondary open angle glaucomas(eg uveitic glaucoma,angle recession glaucoma)

Relative contraindication

Laser Trabeculoplasty(LTP)
slide7
ALT

Preoperative treatment:

1 drop of lopidine 1hour before treatment

Postoperative treatment:

1.1 drop of lopidine immediately after treatment

2.Iop check 1-3 hours after treatment and first

postlaser day

3. Pres Forte 1% qid for 4 days

4.Evaluate effect in 4-6 weeks

slide8
ALT

Laser technique:

1.Goldmann 3-mirror or 1-mirror lens

2.Argon laser settings:

300-1200mW(average 800mW)

50 μm

0.1sec

3.50 burns over 180°or100 burns over 360°applied

to junction of pigmented and nonpigmented TM

slide9
ALT
  • Complications:

1. Elevation of IOP

2. Progression of visual field

3. Iritis

4. Peripheral anterior synechiae

5. Corneal epithelial and endothelial damage

slide10
ALT

1.Short-term results

initial success: 65-95%

Reduction in IOP: 20-30%

2.Long-term results

Attrition rate: 5-10% per year

5 year succes rate: 50%

slide11
ALT

Factors influencing response:

1.Pre-treatment IOP

2.Aphakia/pseudophakia

3.Age

4.Race

5.Type of glaucoma

laser trabeculoplasty
Laser Trabeculoplasty

Pathophysiology:

1. Shrinkage of collagen in TM which pulls open the intertrabecular spaces between treatment sites(Wise &Witter)

2. Stimulates trabecular endothelial cells to divide and migrate(Acott)

3. Stimulates trabecular endothelial cells to produce an altered extracellular matrix that is less outflow-obstructing(VanBuskirk)

laser peripheral iridotomy lpi
Laser Peripheral Iridotomy(LPI)

Create a hole in the iris to relieve pupillary block

Lasers

Argon

Nd:YAG

slide17
LPI

Indications:

1. Acute ACG

2. Chronic ACG

3. Aphakic/pseudophakic pupillary block

4. Partial thickness surgical iridectomy

5. Before laser trabeculoplasty in eyes with narrow

angles

6. Pigment dispersion syndrome/pigmentary glaucoma

slide18
LPI

Indications:

Prophylactic laser iridotomy

1.Acute ACG in other eye

2.Symptoms of subacute ACG

3.Appositional closure

4.PAS

5.↑IOP and closure of angle with dilation

6.Inability to be evaluated promptly

7.Patient anxiety regarding risk of ACG

slide19
LPI
  • Contraindications:

1.Significant corneal edema

2.Flat AC

3.Completely closed angle

4.Angle closure glaucoma not caused by pupillary block

slide20
LPI

Preoperative treatment:

1 drop of lopidine and pilocarpine 1 hour before treatment

Postoperative treatment:

1. 1 drop of lopidine immediately after treatment

2. IOP check 1-2 hours after treatment

3. Pred Forte 1% qid for 1 week

slide21
LPI

Laser technique:

1.Abraham or Wise lens

2.Laser settings:

Argon: 700-1500mW

50μm

0.02-0.1 sec

Nd:YAG: 3-7mJ

1-3shots/pulse

slide22
LPI

Laser technique:

1.Select site at 12:00 in base of a peripheral iris crypt

2.Endpoint:

Pigment epithelium storm

Lens capsule visualized

Clear iris transillumination

slide23
LPI
  • Complications:

Hyphema

Iritis

Increased IOP

Corneal epithelial and endothelial burns

Lens opacities

Pupillary distortion

Monocular diplopia and glare

Closure of iridotomy

cyclophotocoagulation cpc
Cyclophotocoagulation(CPC)

Destroy cilary body to reduce the rate of aqueous

production

Lasers

Diode

Nd:YAG

slide25
CPC

Indications:

1.Pain caused by high IOP in eye with little or no visual potential

2.Unable to undergo filtering surgery for medical reasons

3.Failed piror filtering surgery and/or at high risk of failure for repeat filtering surgery

slide26
CPC

Preoperative treatment:

Retrobulbar anesthesia

Postoperative treatment:

1. Patch for 24 hrs

2.Atropine 1% bid and Pred Forte 1% q 2 hrs WA gradually tapered over several weeks

3. Resume glaucoma medications except miotics

slide27
CPC

Postoperative treatment:

Narcotic analgesic prn pain

Retreatment if needed about 1 month after initial procedure

slide28
CPC

Laser technique:

Noncontact,slit lamp system or contact probe,fiberoptic system

Nd:YAG laser settings:

4-8J

30-40 burns over 360°about 1 mm posterior to limbus

slide29
CPC

Laser technique:

Diode laser settings:

1-2W

2.0 sec

18 burns over 270°about 1 mm posterior to limbus

slide30
CPC

Complication:

Iritis

Pain

Conjunctival burns

Visual loss

Phthisis bulbi

Hypotony

Cystoid macular edema

slide31
CPC

Complications:

Corneal graft rejection

Hyphema

Vitreous hemorrhage

Cataract

Suprachoroidal hemorrhage

Serous choroidal effusion

Sympathetic ophthalmia

other uses of laser therapy
Other uses of Laser Therapy

Laser suture lysis

1.Use laser to cut sutures in the trabeculectomy flap to improve filtration in the early postoperative period

2.Laser technique

Hoskins or Ritch lens

Argon laser settings: 300-800 mW

50 μm

0.02-0.1sec

other uses of laser therapy1
Other uses of Laser Therapy

Laser peripheral iridoplasty

1.Use laser to create contradiction burns in the peripheral iris to open an appositionally closed angle (eg plateau iris syndrome,nanophthalmos)

2.Laser technique:

Abraham or Goldmann lens

Argon laser settings: 150-300mW

500μm

0.2-0.5sec