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    Lasers in Glaucoma

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    Anumeha Jindal
    Laser therapy can be used to treat glaucoma in several ways: 1. Laser trabeculoplasty (LTP) applies laser burns to the trabecular meshwork to improve aqueous outflow. The most common types are argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). 2. Laser peripheral iridotomy (LPI) creates a hole in the iris to relieve pupillary block and treat acute or chronic angle closure glaucoma. 3. Cyclophotocoagulation (CPC) destroys the ciliary body to reduce aqueous production and is used when filtering surgeries have failed or are too risky.

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    Lasers in Glaucoma

    Uploaded by

    Anumeha Jindal
    82 views33 pages
    Laser therapy can be used to treat glaucoma in several ways: 1. Laser trabeculoplasty (LTP) applies laser burns to the trabecular meshwork to improve aqueous outflow. The most common types are argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). 2. Laser peripheral iridotomy (LPI) creates a hole in the iris to relieve pupillary block and treat acute or chronic angle closure glaucoma. 3. Cyclophotocoagulation (CPC) destroys the ciliary body to reduce aqueous production and is used when filtering surgeries have failed or are too risky.

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    Lasers in Glaucoma

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    Laser therapy can be used to treat glaucoma in several ways: 1. Laser trabeculoplasty (LTP) applies laser burns to the trabecular meshwork to improve aqueous outflow. The most common types are argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). 2. Laser peripheral iridotomy (LPI) creates a hole in the iris to relieve pupillary block and treat acute or chronic angle closure glaucoma. 3. Cyclophotocoagulation (CPC) destroys the ciliary body to reduce aqueous production and is used when filtering surgeries have failed or are too risky.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    82 views33 pages

    Lasers in Glaucoma

    Uploaded by

    Anumeha Jindal
    Laser therapy can be used to treat glaucoma in several ways: 1. Laser trabeculoplasty (LTP) applies laser burns to the trabecular meshwork to improve aqueous outflow. The most common types are argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). 2. Laser peripheral iridotomy (LPI) creates a hole in the iris to relieve pupillary block and treat acute or chronic angle closure glaucoma. 3. Cyclophotocoagulation (CPC) destroys the ciliary body to reduce aqueous production and is used when filtering surgeries have failed or are too risky.

    Copyright:

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    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 33

    LASER THERAPY IN GLAUCOMA

    Sun Xiao Dong

    Laser Procedures

    Laser trabeculoplasty(LTP) Laser peripheral iridotomy(LPI) Cyclophotocoagulation(CPC) Other uses

    Laser Trabeculoplasty(LTP)

    Apply multiple laser burns to the trabecular meshwork to improve aqueous outflow Lasers Argon(ALT) Nd:YAG(SLT)

    Indications for LTP


    Supplement to maximum tolerated medical therapy Poor compliance Initial therapy(GLT)

    Laser Trabeculoplasty(LTP)
    Contraindications: 1.Corneal edema 2.Complete angle closure glaucoma 3.Age35 years 4.Some secondary open angle glaucomas(eg uveitic glaucoma,angle recession glaucoma)

    Relative contraindication

    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

    ALT
    Laser technique: 1.Goldmann 3-mirror or 1-mirror lens 2.Argon laser settings: 300-1200mW(average 800mW) 50 m 0.1sec 3.50 burns over 180or100 burns over 360applied to junction of pigmented and nonpigmented TM

    ALT

    Complications: 1. Elevation of IOP 2. Progression of visual field 3. Iritis 4. Peripheral anterior synechiae 5. Corneal epithelial and endothelial damage

    ALT
    1.Short-term results initial success: Reduction in IOP: 2.Long-term results Attrition rate: 5 year succes rate:

    65-95% 20-30%
    5-10% per year 50%

    ALT
    Factors influencing response: 1.Pre-treatment IOP 2.Aphakia/pseudophakia 3.Age 4.Race 5.Type of glaucoma

    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)

    SLT
    Author/Year Latina,1998 Lanzetta, 1999 Gracner, 2001 Eyes 53 8 50 88% Response Rate 70% IOP Decrease 23.5% 39.5% 21.6%

    Melamed, 2003 Cvenkel,2004

    45
    44

    96%
    62%

    30%
    17.1%

    ALT vs SLT
    Author/Year Eyes IOP Decrease

    Damji,1999

    18 ALT 18 SLT Popiela,2000 27 ALT 27 SLT Martinez-de-la- 20 ALT casa,2004 20 SLT

    22% 21% 13.0% 13.4% 19.5% 22.2%

    Laser Peripheral Iridotomy(LPI)


    Create a hole in the iris to relieve pupillary block Lasers Argon Nd:YAG

    Pupillary Block

    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

    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

    LPI

    Contraindications: 1.Significant corneal edema 2.Flat AC 3.Completely closed angle 4.Angle closure glaucoma not caused by pupillary block

    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

    LPI
    Laser technique: 1.Abraham or Wise lens 2.Laser settings: Argon: 700-1500mW 50m 0.02-0.1 sec Nd:YAG: 3-7mJ 1-3shots/pulse

    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

    LPI

    Complications: Hyphema Iritis Increased IOP Corneal epithelial and endothelial burns Lens opacities Pupillary distortion Monocular diplopia and glare Closure of iridotomy

    Cyclophotocoagulation(CPC)
    Destroy cilary body to reduce the rate of aqueous production Lasers Diode Nd:YAG

    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

    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

    CPC
    Postoperative treatment: Narcotic analgesic prn pain Retreatment if needed about 1 month after initial procedure

    CPC
    Laser technique: Noncontact,slit lamp system or contact probe,fiberoptic system Nd:YAG laser settings: 4-8J 30-40 burns over 360about 1 mm posterior to limbus

    CPC
    Laser technique: Diode laser settings: 1-2W 2.0 sec 18 burns over 270about 1 mm posterior to limbus

    CPC
    Complication: Iritis Pain Conjunctival burns Visual loss Phthisis bulbi Hypotony Cystoid macular edema

    CPC
    Complications: Corneal graft rejection Hyphema Vitreous hemorrhage Cataract Suprachoroidal hemorrhage Serous choroidal effusion Sympathetic ophthalmia

    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 m 0.02-0.1sec

    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

    500m 0.2-0.5sec

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