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Glaucoma Laser

Glaucoma is a progressive eye condition characterized by increased intraocular pressure, leading to damage of the optic nerve and potential vision loss. As one of the leading causes of blindness worldwide, early detection and effective treatment are paramount in managing this disease. Among the various treatment options available, laser therapy has emerged as a pivotal technique in the management of glaucoma, offering a minimally invasive solution to help control intraocular pressure and preserve vision.

Selective laser trabeculoplasty (SLT)

Selective Laser Trabeculoplasty (SLT) is a revolutionary outpatient procedure designed to lower intraocular pressure in patients with open-angle glaucoma. Unlike traditional forms of laser surgery, SLT specifically targets the trabecular meshwork, the drainage system of the eye, utilizing a low-energy, short-duration laser pulse that selectively affects the pigmented cells within the meshwork. This selectivity minimizes damage to surrounding tissues, promoting healing and reducing inflammatory responses. Since its introduction, SLT has gained recognition for its effectiveness in decreasing eye pressure, often resulting in a significant reduction in the need for antiglaucoma medications. As a first-line treatment option, SLT exemplifies the evolution of glaucoma management, illustrating how innovative technology can enhance patient outcomes and quality of life.

Indication : 

  • POAG, PXG, high risk OHT  

  • *Initial Treatment

  • *Add-on, Replace

Contraindication : 

  • ACG

  • Neovascular Glaucoma

  • Angle recession

  • Uveitis Glaucoma

Pre-op 

  • Pilocarpine  q 5 min* 3 times until constrict pupil  

  • Topical anesthesia

  • Alphagan-P 1 hr before laser and immediately afterward

  • If IOP high : Diamox, Timolol  

Laser setting

  • Power : 0.4-1.2 mJ ( Start with low)

  • Spot size : 400 micron

  • Exposure : 3nsec fix

  • Target spot : 100 non overlap 360 degree 

Post-op

  • Measure IOP 1 hr

  • NSAID * qid 7 days

  • Follow up 1 week , Effective 4-8 week

Complication

  • IOP rising

  • Mild inflammation

  • Endothelial damage

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Laser peripheral iridotomy (LPI)

Laser Peripheral Iridotomy (LPI) is a commonly employed laser treatment aimed primarily at managing angle-closure glaucoma. This procedure involves creating a small hole in the peripheral iris, allowing for improved aqueous humor drainage and effectively relieving intraocular pressure. By facilitating better fluid circulation within the eye, LPI can prevent the formation of the narrow-angle situation that is characteristic of angle-closure glaucoma, thus thwarting potential vision loss. The procedure is typically performed in an outpatient setting and is known for its quick execution and minimal discomfort.

Laser LPI

Indication : 

  • Angle closure ( High risk PACS,PAC,PACG)

  • Treat AACG, Pupillary block, Plateau iris syndrome

Pre-op 

  • Pilocarpine  q 5 min* 3 times until constrict pupil  

  • Topical anesthesia

  • Alphagan-P 1 hr before laser and immediately afterward

  • If IOP high : Diamox, Timolol  

Laser setting

Argon 532 (Pretreatment)

  • Power : 200-300 mJ

  • Spot size : 400  micron

  • Duration : 0.2 sec 

ND: YAG 

  • Power : 1-5 mJ

  • Spot size : 50-70 micron

  • Pulse per burt : 1-3 

  • Focus on iris stroma  

*Not over 5 mJ , 2 mJ can damage lens capsule

Post op 

  • Check patent immediately

  • Check IOP 1-3 hr

  • Pred Forte qid*1week

Complication 

  • Bleeding

  • Visual disturbance : Glare,halo

  • IOP rising 

  • CME, aqueous misdirection rare

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