Operation Glaucoma: Laser Treatment: When you are and what are the side effectsOpen angle:
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glaucoma can be operated by the argon laser or more recently by the SLT laser (Selective). It consists of making impacts in the angle between the iris and the cornea, more precisely on the trabeculae. It has the effect of widening the meshes of the trabecular allowing it to be more permeable to the aqueous humor and thus reduce the ocular tension.
The operation is carried out without hospitalization, it is of simple technical realization and can be made in the office of the ophthalmologist. Anesthetic eye drops are instilled on the eye and a contact lens is placed on the eye in order to practice the laser.
The follow-up of the Glaucoma operation by laser treatment is simple. There is at most an irritation of the eye which lasts a few hours. An anti-inflammatory treatment is then prescribed for about one week. This treatment is effective because it reduces the eye pressure by about 30%, which makes it possible to stop the drops or to decrease the prescribed number.
But its efficiency is transitory. Eye strain may rise after a few years in nearly 40% of cases.
The main advantage of the Selective laser with respect to the Argon is the possibility due to its absence of thermal effects and its safety to reprocess the patient with the laser after a few years.
Medical treatment can also be reinstated after a few years.
Closed-angle glaucoma can be treated by the laser. It consists of making an opening of the iris in order to prevent it from blocking the trabecular when it is released. The operation of closed-angle glaucoma is carried out without hospitalization according to the same sequences and modalities as in the laser operation for open-angle glaucoma but with another laser: the YAG laser.
The Laser SLT
Developed in 1995 and approved by the FDA (Foods and Drugs Administration USA) in 2001, SLT is a new type of laser that treats glaucoma by regenerating the trabecula of the iridocorneal angle.
More than 3,000 centers are equipped in the world of which 1700 in the USA and a hundred in France including the Clinique Vision Laser Paris Ouest.
The SLT laser, which has demonstrated its efficacy and safety, is a new reference treatment in open-angle glaucoma.
A hundred international scientific publications have confirmed its effectiveness and its place in this operation of glaucoma.
The data of our study are based on these publications and the synthesis presented by Professor Philippe Denis of the Hospices Civils de Lyon.
Action plan
The trabecula is one of the structures of the iridocorneal angle allowing the filtration of the aqueous humor.
The SLT laser allows regeneration of the trabecular mesh without creating tissue burns as is the case with the Argon laser.
It provides a blood pressure drop identical to that obtained with Argon trabeculectomy without the undesirable thermal effects nor fibrosis.
The decrease in blood pressure is nearly 30% of the initial pressure, which in terms of effectiveness, places it favorably compared to the eye drops used in monotherapy.
It is a low-energy treatment (almost 100 times less than with Argon laser) and therefore non-invasive and reassuring, which allows the reprocessing (which still distinguishes it from Argon's thermal lasers).
Results: decreased eye tension
The Laser SLT allows a drop in eye tension of 20 to 30% of the initial pressure, which places it favorably compared to a medical monotherapy.
The higher the initial pressure, the more efficient the laser.
The effect will be judged at 1 month.
It retains its effectiveness over the long term since studies suggest that the pressure drop would still be 20% at 5 years.
A therapeutic exhaust is nevertheless often observed but it will then be advisable to do it again because it retains the same effectiveness in the case of reprocessing.
Restorations to SLT are harmless as this is a non-invasive method.
Possible Side Effects
Sometimes a pain or rather a transient ocular gene after the treatment is sometimes observed, sometimes a moderate postoperative ocular inflammation prevented, if necessary, by anti-inflammatory eye drops.
Immediate postoperative pressure peak and short duration rare.
No side effects in the long term.
Contraindications
Congenital glaucoma,
juvenile,
Post uveitis,
Neovascular,
And closed or very narrow-angle.
Conducting a glaucoma operation during an SLT laser session
The session takes place in a clinic or a doctor's office.
The patient is awake, a few drops of anesthetic eye drops are instilled in the eye just before the session.
Preparatory eye drops are prescribed one hour before and after the session.
The patient sits in front of the laser, the eye held open by a contact lens.
The session lasts about 1 minute and is painless, with the patient able to work and resume activities 1/2 hour after the session.
It is usual to propose a 2nd session 2 to 4 weeks after the first.
The final effect on the tension is appreciated after one month.
It will, therefore, be necessary to continue the previous medical treatment and to lighten it after one month according to a drop in blood pressure obtained.
Trabeculectomy with the Laser Argon or SLT is reimbursed by the Social Security (and Mutuelles) in the framework of this operation of glaucoma.
The role of laser in the treatment of glaucoma
It is usual to start with medical treatment, except in certain indications where the Laser can be proposed from the outset.
The Laser is indicated in case of bad compliance or bad tolerance to the treatment by eye drops.
It is also indicated to reduce the number of prescribed eye drops.
It also helps to avoid or delay the use of surgery or in the case of the disappointing result of the glaucoma surgery.
It should be noted that the use of the Laser SLT does not diminish the chances of success of the surgery nor the efficacy of a treatment by eye drops optionally prescribed thereafter.
The effectiveness of the Laser SLT in reducing long-term eye strain has been proven through some 100 international studies.
It is equivalent to Argon in the treatment of open-angle glaucoma.
It is equivalent to or even more effective than antiglaucoma eye drops used in monotherapy.
The studies confirm the absence of thermal effects and validate this non-invasive method with an excellent safety profile.
Restorations are possible without risk of altering the chances of future surgery.
The Laser SLT is, therefore, the new reference solution for the operation of glaucoma.
Laser Iridotomy and glaucoma surgery:
(Written by Abel F, Grenoble)
Mechanisms of action of laser iridotomy: Intraocular pressure is the result of a balance between the production of the aqueous humor by the ciliary body and its elimination by the trabecular or use scleral route. The aqueous humor is secreted by the ciliary bodies which are arranged circularly behind the iris. It then travels between the lens and the iris (pupil), then in the anterior chamber and is finally resorbed at the iridocorneal angle.
The flow rate of aqueous humor circulating in the anterior segment is approximately 2 to 3 μL / min under physiological conditions. The different anatomical spaces in which the aqueous humor runs, especially the pupil, are normally of sufficient size for the flow of this fluid to take place without significant resistance. As a result, there is no significant pressure gradient across the entire aqueous humor pathway in the eye.
Under certain anatomical or other conditions, an approximation of the anterior surface of the lens and the posterior aspect of the iris or a complete joining of these two structures leads to an increase in the resistance to the flow of aqueous humor at the level of The pupil being accompanied by the appearance of a pressure gradient between the posterior chamber (located upstream of the pupil, higher pressure) and the anterior chamber (located downstream of the pupil, lower pressure). This pressure gradient may be sufficient to push forward the root of the iris, which then becomes attached to the posterior surface of the cornea and to the trabecular, temporarily and then definitively closing the iridocorneal angle, Resulting from the aqueous humor outside the eye.
Laser peripheral iridotomy consists of perforating the root of the iris (periphery) by focusing on it one or more glaucoma surgery beams and creating an orifice of sufficient size to allow unimpeded flow of aqueous humor From the posterior chamber to the anterior chamber, thus preventing or lifting a permanent or permanent opposition of the iris against the trabecular. See Figure 1.
Fig 1 is laser
Figure 1. Mechanism of action of laser iridotomy in the case of pupillary blockage. According to Kolker AE. [2].
Primary pupillary blocking situations
- Curative treatment of an angle closure crisis: Laser iridotomy will allow a reopening of the iridocorneal angle and a decrease in intraocular pressure in the absence of extensive peripheral anterior synechiae. Implementation of iridotomy should be preceded by the introduction of hypotonic (systemic and local) and myopic treatment, so as to reduce corneal edema and to facilitate the focusing of the laser beam and to The iris in view of its perforation.
- Treatment of glaucoma by closing the angle: Glaucoma by closing the angle are linked to an absolute or relative pupillary blockage resulting in a pressure gradient between the anterior chamber and the posterior chamber, pushing the root of the angle, Iris and partially or completely closing the iridocorneal angle. This closure of the angle can raise the intraocular pressure in a chronic or acute manner, and complement one another with optical neuropathy. This is called glaucoma by the closure of the angle. An iridotomy must be systematically performed in order to lift the pupillary block and to prevent or lift the closure of the angle.
- Preventive treatment in a subject with perforation site. The main lenses are the Abraham glass (+ 66 diopter convex-plane lens), Wise glass (+ 103 diopters) and the monolithic CGI glass (Fankhauser). See Figure 3.
Fig 3 Laser IP
Figure 3. A glass of Abraham.
- The site of the iridotomy: The 12-hour meridian is to be avoided since the formation of a gas bubble during argon laser coagulation will prevent the continuation of iridotomy. In order to avoid the phenomena of monocular diplopia or dazzling, the meridians situated opposite the meniscus of tears due to the eyelids must be avoided. The meridians of 11h or 1h are thus generally chosen. Some operators sometimes chose the meridians of 3h or 9h.
- glaucoma surgery and parameters: The Argon laser can first be used (100 ms, 150 μm, 300 to 600 mJ, 5 to 10 spots on the area to be perforated) so as to retract the iris The cornea), thin the iris and reduce the risk of bleeding. Immediately afterward, the Nd: YAG laser (2 to 4 mJ / impact, in a crypt) can be used up to perforation (sign of the flow).
- Criteria for success: A flood of aqueous humor and pigments, and the deepening of the anterior chamber in the periphery, testify to the perforating character of iridotomy. A retro illumination transillumination is a bad criterion because a thin layer
COMPLICATIONS for glaucoma surgery:
The complications of iridotomy are relatively infrequent:
- Eye Hypertonia
- Bleeding, hyphaema: A digital compression of the eye can be performed for a few minutes in order to stop the bleeding. The realization of some impacts of argon laser on the bleeding vessel can also help stop the bleeding.
Defocusing the beam with the risk of epithelial, stromal or endothelial corneal burns; Crystalline marking
- Persistent Inflammation
- I ride-crystalline synechiae
- Anterior peripheral synechiae
- Corectopia
- Monocular Diplopia, photophobia
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Laser surgeries are gaining popularity in the treatment of various eye problems and diseases.
During the laser surgery, the eye is numbed so that the patient does not feel pain, or almost. Then the ophthalmologist places a special lens on the eye. It points the laser beam in the eye and the patient sees a great brightness, like the flash of a camera.
Risks associated with glaucoma surgery:
Laser surgery remains surgical and therefore involves risks. For example, intraocular pressure (IOP) in some patients may increase shortly after surgery. In patients undergoing YAG (laser cyclo photocoagulation) laser surgery, IOP may become too weak to preserve the normal shape and metabolism of the eye. To prevent this problem, anti-glaucoma medication is recommended before and after surgery.
The following types of interventions are the most popular in the treatment of glaucoma.
Laser Peripheral Iridectomy (IPL)
For the treatment of narrow-angle glaucoma
Narrow-angle glaucoma is a condition that affects people whose iridocorneal angle is very narrow. A closure of this angle results in decreased excretion of the aqueous humor and thus the increase in IOP. During a laser peripheral iridectomy, a small hole is made in the iris to allow the aqueous liquid to circulate better.
Argon laser trabeculoplasty
For the treatment of primitive open-angle glaucoma surgery
The laser beam opens the channels for channeling the ocular liquid, which facilitates the operation of the eye evacuation system. Most patients will have to continue taking medication after this type of intervention.
Generally, half of the channels of the ocular liquid are treated. If necessary, the other half will be dealt with in a subsequent intervention. In this way, overcorrection of the eye is prevented while reducing the risk of increased pressure after surgery.
To date, argon laser trabeculoplasty has been able to lower ocular pressure in 75% of cases.
Selective laser trabeculoplasty
For the treatment of primary open-angle glaucoma surgery
In laser trabeculoplasty, various frequencies are used which allow the laser to operate at very low intensity. This type of procedure treats the cells selectively so as not to damage untreated portions of the trabecular tissue. Thanks to this unique concept, it is believed that laser trabeculoplasty, unlike other types of laser procedures, can be performed several times in the same eye.
Neodymium: YAG laser cyclo photocoagulation
An alternative to microsurgery filtering that is used later in the treatment algorithm. This surgery destroys a portion of the ciliary body, the section of the eye that produces the intraocular fluid. It may be necessary to repeat this procedure a few times in order to control glaucoma permanently.
Pain during laser surgery to treat glaucoma surgery:
Laser peripheral iridectomy and argon laser trabeculectomy are accompanied by a slight pinching. During YAG laser cyclo photocoagulation, local anesthesia is used to numb the eye. Once the eye is numb, the patient should not feel pain.
Long-Term Advantages Of Laser Surgery
Laser surgery helps lower intraocular pressure (IOP). The duration of this decrease in IOP depends on the type of surgery advocated, type of glaucoma, age, breed and many other factors. If necessary, laser surgery can be repeated several times in the same eye to better control IOP.
Medications to be taken after glaucoma surgery:
In most cases, it is still necessary to take medication to control intraocular pressure. Nevertheless, surgery can reduce the number of medications required.
Convalescence
In general, patients can go about their daily routines in the aftermath of surgery.
Surgery is usually done by an ophthalmologist. Before the operation, the eye is put to sleep by means of a medicine. After surgery, the vision could be cloudy and the eye irritated. The patient should ensure that someone takes him home after the procedure.
Increased risk of cataracts
After laser surgery, there is a minimal risk of developing cataracts. On the other hand, the benefits of surgery are far greater than the risks, in most cases.
Contrary to what is meant, cataracts are not eliminated with lasers, except in experimental medicine. When a cataract has been removed with traditional incisions, it often leaves an outer membrane similar to a lens. This membrane could, little by little, thicken and disturb the sight, just like a cataract. Thanks to the laser surgery, this membrane can be opened and clear the view without any operation. This kind of surgery is called "capsulotomy".
On this, patients should not hesitate to voice their concerns about laser surgery to their ophthalmologist.
glaucoma surgery: Symptoms And Treatments
Glaucoma is an eye disease that mostly affects people over 45 years of age. This serious disease can progress to blindness. Due to early diagnosis, however, it is possible to stop the development of the disease and stabilize the vision.
October 30, 2009, Audrey Web Average Reading Time: 1'18
Presentation
Glaucoma is a disease caused by high ocular tension that reaches the optic nerve and prevents visual information from reaching the brain.
This common eye disease affects more than 2% of the population beyond 45 years.
Note: the ocular tension corresponds to the pressure of the fluids inside the eye and has no connection with the blood pressure
A silent disease
Without systematic screening, glaucoma can remain undetected for a long time.
Indeed, this disease is not painful and does not translate initially by a visual discomfort.
If the disease is not treated, it evolves and eventually becomes embarrassing for certain activities such as reading and driving. It causes an irremediable reduction of the field of vision. The first symptom is a blurred peripheral view.
A complete loss of sight is even possible. Glaucoma is the second leading cause of blindness in the world after cataracts
This is why it is important to consult an ophthalmologist every two or three years from the age of 35 years in order to detect a possible glaucoma surgery.
glaucoma surgery Treatment:
When diagnosed early, glaucoma can be treated to stop the progression of the disease and stabilize the vision.
On the other hand, there is no treatment to recover the lost visual acuity, hence the advantage of early diagnosis and treatment.
Possible treatments include eye drops, oral medications, laser treatment and surgery. Most often, medication should be taken for life.
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