Laser trabeculoplasty consists in making a gentle burn of the trabecular tissue in the percolation angle with the use of a laser beam. As a result, the ways of outflow of aqueous humor from the eye widen and the intraocular pressure is lowered.
Laser trabeculoplastycan be performed with an argon or diode laser. The indication for the procedure is the difficulty in regulating the intraocular pressure despite the use of appropriate conservative treatment. Laser trabeculoplasty is also performed in patients who, for various reasons, cannot undergo anti-glaucoma surgery. In recent years, these procedures have been performed less and less frequently, because due to the developing modern techniques of surgical treatment, patients are referred to glaucoma surgery faster than in the past. Do not perform the procedure in very advanced glaucoma, when there is a small chance of stopping the progression of the disease with laser treatment.
The course of laser trabeculoplasty
The procedure is performed on an outpatient basis and does not require the patient to be admitted to the hospital. Before the procedure, the surface of the eye is anesthetized with anesthetic drops, and then a special ocular lens is put on the eye, thanks to which trabeculars can be visualized, within which laser therapy is performed. After the procedure, the patient receives treatment that lowers the intraocular pressure in the form of topical medications applied to the conjunctival sac and oral medications. The patient's intraocular pressure must always be controlled after the procedure, because it may increase temporarily. The ultimate goal of the procedure is to lower the intraocular pressure and modify conservative treatment with eye drops. However, it is rarely possible to stop the drops completely. Treatment with laser trabeculoplasty should rather be treated as an additional treatment to treatment with drops, because the main goal of the treatment is to obtain a pressure that is safe for the patient, and not to stop treatment.
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Possible complications after the procedure
The most important complications after this laser treatment include the formation of anterior adhesions and narrowing of the angle of infiltration.
Numerous clinical studies carried out on large groups of patients have shown that the effect of laser trabeculoplasty disappears over time and that the intraocular pressure increases again.
There is also a tendency towards ineffective filtration anti-glaucoma surgeries and a greater tendency for the filtering fistula to overgrow in eyes previously subjected to this laser treatment. Serious complications after trabeculoplasty surgery also include a large increase in intraocular pressure, which can be dangerous in eyes with advanced changes in the visual field. Usually, however, the increase in pressure is slight and temporary. Bleeding into the anterior chamber during the procedure is also possible, but this complication is usually temporary and not serious. Occasionally, transient anterior uveitis may also occur, and usually it is mild and not serious, and patients with advanced glaucomatous damage to the optic nerve and large visual field defects, monocular patients, patients with high blood pressure should be monitored closely afterwards. prior to laser surgery, patients with pseudo-exfoliation syndrome, and patients who underwent laser trabeculoplasty repeatedly.
About the authorBarbara Polaczek-Krupa, MD, PhD, specialist in eye diseases, Centrum Opulystowa Targowa 2, WarsawDr. Barbara Polaczek-Krupa, MD, initiator and founder of the T2 Center. She specializes in modern diagnostics and treatment of glaucoma - this was also the subject of her PhD thesis defended with honors in 2010.
Dr. med. Polaczek-Krupa has been gaining experience for 22 years, since she started working at the Ophthalmology Clinic of CMKP in Warsaw, with which she was associated in 1994-2014. During this period, she obtained two degrees of specialization in ophthalmology and the title of doctor of medical sciences.
In the years 2002-2016 she worked at the Institute of Glaucoma and Eye Diseases in Warsaw, where she gained knowledge and medical experience by consulting patients from all over Poland and abroad.
For years, as part of cooperation with the Medical Center of Postgraduate Education, he has been a lecturer at courses and trainings for doctors specializing in ophthalmology and primary he alth care.
He is the author or co-author of numerous publications in scientific journals. Member of the Polish Ophthalmology Society (PTO) and the European Glaucoma Society (EGS).
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