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Laser's in OPEN ANGLE GLAUCOMA :
Most patients with open angle glaucoma can be controlled by antiglaucoma medications. Alternatively, argon laser trabeculoplasty (ALT) / selective laser trabeculoplasty (SLT ) can provide a clinically significant reduction of IOP in some people. The advantages of trabeculoplasty over medical treatment include lack of systemic adverse effects, minimal patient compliance, and decreased incidence of ocular problems that could possibly compromise subsequent surgical therapy .
However, it seldom reduces the number of required glaucoma medications. Also the effect of this procedure is temporary.For these reasons and also because its efficacy has not yet been demonstrated in Indian eyes laser trabeculoplasty is not a viable option in Indian eyes.
Lasers in ANGLE CLOSURE GLAUCOMA
A laser iridotomy with the Nd Yag laser is required for those who have been diagnosed with narrow-angle glaucoma or where it is has been determined that the laser iridotomy is the appropriate treatment . A laser iridotomy involves placing a small hole in the brown part of the eye (iris) to create a passage for the fluid to drain from the back to the front of the eye. Without this new channel the eye pressure may build up rapidly causing damage to the delicate optic nerve which can cause a permanent loss of vision. A laser iridotomy can halt or prevent an attack of acute angle closure.
The iridotomy site is a small hole, usually positioned under the upper eyelid. It will not be noticed by you or anyone looking at you. The purpose of the iridotomy is to open the fluid passages, thereby helping to control the eye pressure and thus preserve vision. Following the procedure, one may still require medication or other treatment options may need to be considered to keep the eye pressure in the desired range. The need for this additional treatment is dependant, in addition to an individual response on the extent of damage to the outflow channels / optic nerve prior to the iridotomy.
Diode laser in treatment of glaucoma : Typically the diode laser is used as a destructive procedure when all possible modalities for control of glaucoma are unacceptable or have failed to lower the IOP. It is a non surgical procedure which may need to be repeated .
Excerpts from the lecture "Recent Advances In The Management Of Glaucoma With Lasers " by Dr. Devindra Sood at the meeting organized by the Amritsar Academy of Ophthalmology , Punjab, August 2008 |
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