LASER THERAPY IN GLAUCOMA.ppt

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) 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 μm 0.1sec 3.50 burns over 180°or100 burns over 360°applied 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: 65-95% Reduction in IOP: 20-30% 2.Long-term results Attrition rate: 5-10% per year 5 year succes rate: 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 ou