Argon laser trabeculoplasty
• Continue all glaucoma medications before and after treatment.
• Instil G. proxymethacaine 0.5%, G. pilocarpine 2–4%, G. apraclonidine 0.5%.
• Select a Goldmann model goniolens
Target the circular aiming beam at the junction of pigmented and nonpigmented meshwork
• Use continuous wave laser at 50 microns, 0.1sec.
• Increase power in 100 mW increments (maximum 1200 mW), until the meshwork blanches with a tiny bubble. Pigmented meshwork requires less energy.
• Equally space 50 burns over the superior 180o (inferior 180o for re-treatment).
• Document the area treated.
9. Prescribe prednisolone 0.5% for 1 week.
• Let patient waiting after the procedure and check IOP at 1.5 hours, treat acute pressure spikes.
Argon laser trabeculoplasty power point presentations:
1. LASER TRABECULOPLASTY
2. Trabeculoplasty ??? • Laser trabeculoplasty uses a very focused beam of light to treat the drainage angle of the eye. This surgery makes it easier for fluid to flow out of the front part of the eye, in order to lower the IOP in the eye.
3. HISTORY In 1961, Zweng and Flocks introduced the concept of applying light energy to the anterior chamber angle for the treatment of glaucoma. In 1979, Wise and Witter described the first successful protocol of what has become known as laser trabeculoplasty.
4. 1979 Argon Laser [488 nm blue-green, 514 nm green] 1984 Krypton Laser [red 647.1 nm, yellow 568.2 nm] 1988 Nd:YAG Laser [1064 nm] 1990 Diode Laser [810 nm] 1996 Solid State “ALT” [532 nm] 2001 Frequency Doubled Nd:YAG laser: SLT [532 nm] 2006 Diode Micro Pulse Laser: MLT [810 nm] 2008 Titanium: Sapphire Laser [790 nm]
5. INDICATIONS when IOP remains above “target” IOP despite maximally tolerated medical therapy when patients are noncompliant pseudoexfoliation glaucoma when surgery needs to be deferred due to a patient’s systemic status
6. CONTRAINDICATIONS Narrow angles Presence of peripheral anterior synechiae Uveitis Advanced glaucoma Developmental glaucoma
7. TYPES Argon Laser Trabeculoplasty (ALT) Selective Laser Trabeculoplasty (SLT)
8. ARGON LASER TRABECULOPLASTY
9. Definition • It is a laser treatment for glaucoma • It is done on an Argon Laser equipped slit lamp, using a Goldman gonioscope lens mirror. • Specially, Argon Laser is used to improve drainage through the eye’s trabecular meshwork. • It helps to reduce IOP caused by open angle glaucoma.
10. PREOPERATIVE PREPARATION • Patients are instructed to continue all glaucoma medications on their regular schedule. • Patients are routinely pretreated with apraclonidine to prevent a significant IOP spike that could adversely affect visual function. • The eye should not be exposed to diagnostic procedures before the treatment because this can affect corneal clarity.
11. POSTOPERATIVE MANAGEMENT • The patient is instructed to continue all glaucoma medications as usual and begin a topical steroid drop four times a day for 4 to 5 days. • If the patient has had a significant IOP elevation or has severe glaucomatous damage, the IOP is measured the next day. • Most patients are reexamined 2 to 5 days later and then at about 4 weeks. • If at 4 weeks the pretreatment goal has not been achieved, the second half of the angle can be treated.
12. COMPLICATIONS Transient IOP elevation Iritis Peripheral anterior synechiae Membrane covering the entire trabecular meshwork
Argon laser trabeculoplasty Videos
Argon Laser Trabeculoplasty
Argon laser trabeculoplasty