Laser surgery for glaucoma
General Surgery (East Africa)
The glaucomas constitute a group of chronic progressive diseases of the optic nerve which, if not treated, can lead to visual field loss and blindness. Open-angle glaucoma is a leading cause of irreversible blindness throughout the world, with the exception of China, where angle closure is a common cause of glaucoma. Elevated intraocular pressure is clearly the most identifiable causative risk factor for glaucomatous optic atrophy, and decreasing pressure has been shown to halt or slow progression of the disease. The lowering of elevated intraocular pressure can be performed by use of hypotensive eye drops, incisional surgery, or various types of laser treatments.
Laser procedures commonly used for various forms of glaucoma include argon laser trabeculoplasty, selective laser trabeculoplasty, peripheral laser iridotomy, and laser iridoplasty. Argon laser trabeculoplasty and selective laser trabeculoplasty treatments are directed at the trabecular meshwork in open-angle glaucoma with aim of improving aqueous outflow. Peripheral laser iridotomy and iridoplasty aim to modulate the configuration of the peripheral iris in various forms of angleclosure glaucoma. A distinct advantage of lasers over medical and surgical options is the absence of most of the ocular and systemic adverse effects associated with medication and far fewer serious complications when compared with more invasive intraocular glaucoma procedures (eg, trabeculectomy, aqueous drainage devices).
This article will describe the indications, mechanisms, technique, and possible complications for these procedures. Evidence will be presented to define the role of these lasers in the overall management of glaucoma.
Cyclophotocoagulation is a laser treatment that suppresses aqueous production by causing damage to the ciliary body. It can be applied ab externo (transscleral) or ab interno (eg, endoscopic). This type of laser treatment will not be dealt with in this article.
Techniques in Ophthalmology
Damji, K. F.
(2008). Laser surgery for glaucoma. Techniques in Ophthalmology, 6(3), 76-82.
Available at: http://ecommons.aku.edu/eastafrica_fhs_mc_gen_surg/13
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