Laser photocoagulation - Prima Health

Laser photocoagulation - Prima Health

In the realm of ophthalmology, L’Espérance was the pioneer in utilizing the Argon laser for the treatment of diabetic retinopathy. This significant advancement paved the way for Zweng, Little, and Peabody, who, by connecting the Argon laser system to the slit lamp, made whole-retina photocoagulation more accessible and easier to perform, thereby enhancing treatment options for patients.

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1. Definition

Laser retinal photocoagulation refers to the application of a laser that matches the absorption spectrum of the retinal pigment epithelium, effectively coagulating cellular layers. This process is instrumental in forming adhesions between the choroidal layer and the retina.

Types of lasers used for retinal photocoagulation

• Argon laser (blue, green)
• Green Argon laser (the most frequently utilized laser for comprehensive retinal photocoagulation)
• KTP laser or Nd:YAG laser
• Color laser
• Krypton laser
• Semiconductor Diode laser

2. Indications for laser retinal photocoagulation

• Management and prevention of retinal detachment, including conditions such as retinal tears or holes; retinal degeneration; and risks in high myopia patients with mixed degeneration.
• Treatment of retinal ischemia.
• Addressing proliferative diabetic retinopathy.
• Managing retinal neovascularization, whether it is age-related macular degeneration or post-chorioretinitis, particularly when new vessels form on or near the optic disc.
• Identifying new vessels of medium to large sizes that exceed one-fourth of the optic nerve.
• Addressing hemorrhages in the vitreous where microvascular malformations occur among ring exudates in the posterior polar retina.
• Targeting macular edema, whether diffuse, cystic, or localized.
• Contraindications exist for systemic and ocular conditions that impede surgical options.

3. Procedural steps

• Dilation of pupils using drops.
• Application of a local anesthetic on the surface of the eyeball; employing Mainster Wide Field contact lenses coupled with 0.2% Lacrinorm gel on the treated eye.
• Establishing appropriate treatment parameters.

4. Post-laser photocoagulation care

• Post-operative eye bandaging may be required for a period of 6-24 hours if ocular anesthesia is administered.
• Patients may use mild pain relievers for any discomfort; significant pain may necessitate evaluation for acute glaucoma due to potential choroidal hemorrhage.
• Aftercare includes avoiding strenuous activities, bending, or excessive coughing, as these can exacerbate risks of vessel rupture in conditions with choroidal neovascularization.
• Patients should undergo a follow-up examination within 2-3 weeks to assess the healing and scar formation of lesions, with additional treatments if necessary.

Laser peripheral iridotomy

1. Indications

• Shallow anterior chamber with a narrow angle.
• A history of acute angle closure surgery in one eye, with the opposite eye unaffected.
• Previous episodes of acute angle closure where the angle remains less than half open.

2. Mechanism of action

The procedure involves creating a small hole in the edge of the iris, facilitating fluid flow from behind to the front of the iris to alleviate pupil blockage.

3. Steps for peripheral iris laser procedure

1. Prepare the patient by instilling 2% Pilocarpine pupils medication one hour before the laser treatment.
2. Administer a local anesthetic prior to placing the Abraham contact lenses (66D).
3. Set treatment parameters for the procedure.

4. Post-procedural care

• Monitoring intraocular pressure should occur 1-2 hours post-treatment.
• Topical corticosteroids may be administered four times daily for seven days.
• Patients may require analgesics and glaucoma-lowering medication such as acetazolamide (two 250mg tablets) for two days.

Our Ophthalmology Care Team

If you require an eye assessment, consider visiting the Prima Medical Center Saigon:

• Address: 27 Ky Dong St, District 3, HCMC
• Website: https://primahealth.vn/en/
• Business Hours: Monday to Saturday, 07:30 - 17:00
• HOTLINE: -209-039

Retinal Laser Treatment

Many people mistakenly believe that laser eye surgery is solely for correcting refractive errors; however, it has proven critical in addressing a variety of eye conditions, particularly retinal diseases.

Pan-Retinal Photocoagulation
If blood supply to the retina is compromised, ischemic areas may provoke abnormal vessel growth, leading to complications like vitreous hemorrhage or elevated intraocular pressure. Pan-retinal photocoagulation, focusing on the peripheral retina, can help rectify this metabolic imbalance, directing nutrients to the macula to safeguard central vision. This treatment is commonly administered to those suffering from proliferative diabetic retinopathy and ischemic retinal vein occlusion.

Barrier Laser
Any retinal breaks can allow fluid to seep through, significantly increasing the risk of retinal detachment. Laser treatments can forge a barrier around areas of retinal degeneration or breaks, thus minimizing detachment risks.

Focal Laser
In cases where diseased blood vessels leak and result in fluid accumulation, focal laser treatment can be utilized to halt or mitigate leakage when the affected vessels lie outside the fovea. This is a prevalent procedure for patients experiencing macular edema due to diabetic retinopathy or vascular tumors.

Grid Laser
When macular swelling is present, applying gentle laser in a grid pattern may stimulate the retinal pigment epithelium to facilitate fluid loss, thereby reducing swelling. This treatment method is frequently used for patients with diabetic macular edema.

Advancements in Retinal Laser Treatment
Innovations such as the pattern scanning laser system support the delivery of laser energy in predetermined patterns, which significantly shortens treatment durations. Micropulse laser technology administers brief energy pulses interspersed with rest periods, allowing treated tissues to cool and minimizing thermal damage. Lasers utilizing yellow light deliver increased penetration power while minimizing scattering; hence, they achieve the same therapeutic effects with reduced energy. The continuous evolution in medical technology is instrumental in making retinal laser treatments safer, more precise, effective, and comfortable for patients.

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