Glaucoma Laser Surgery

Selective Laser Trabeculoplasty

Selective Laser Trabeculoplasty or SLT is a non-invasive surgical therapy for glaucoma that is proven to be effective and is approved by the FDA.  It is safe and long term studies, greater than 10 years, show that patients who had SLT showed no negative impact.  The laser is a tiny, low-energy beam of light that passes harmlessly through the outer covering of the eye and targets the pigment cells of drainage system of the eye.  The body's natural healing system responds to the light energy by healing the drainage cells, restoring it's natural pressure relieving functions.  SLT lowers eye pressure.  The laser is gentle and selectively targets pigmented cells while preserving the surrounding tissue. This makes it possible to have multiple SLT treatments in the same eye. SLT is safe as a primary, adjunctive, or repeat therapy to reduce intraocular pressure.

In the schematic figure above, a cool green laser beam is being used to treat the drainage system inside of the eye. This treatment improves the function of the drainage system leading to lower eye pressure. 

Benefits

Potential Risks

Procedure Day
During laser surgery, you will see a bright light, like a camera flash, and you may feel a tingling sensation. You will be asked to stay for approximately one hour after the procedure so that the eye pressure can be measured.  

 

After your procedure
The eye pressure may not respond to the laser surgery for several weeks.  Although the laser may not permanently control the eye pressure, it can delay the need for additional medications or microsurgery.

 

Laser Iridotomy

Laser iridotomy is a non-invasive surgical therapy used to prevent or treat narrow angle glaucoma.  In patients with narrow angles or narrow angle glaucoma, the space between the iris and the cornea is not as wide and open as it should be.  When the angle is narrow, the iris “bunches up” over the drainage canals and blocks the outflow of fluid inside of the eye, causing a glaucoma attack.  Glaucoma attacks are painful and can cause permanent loss of vision. 


The Problem

In the left side of the figure above, the blue arrows demonstrate the normal flow of aqueous fluid in the eye towards the drainage system (the trabecular meshwork). In the right side of the figure above, there is a more narrow angle between the cornea and the iris.       

This leads to a decreased amount of flow of aqueous fluid into the trabecular meshwork. 

The Solution

On the left side of the figure above (C), the laser is a tiny but powerful beam of light that can make a small burn or opening in tissue. The laser is used to remove a small portion of the bunched up iris which immediately unblocks part of the drainage canals and allows fluid to drain into the drainage system. On the right side of the image above (D) the blue arrow indicates the new route of drainage for the aqueous fluid in the eye into the drainage system (trabecular meshwork).

 

The day of your procedure
On the day of the laser therapy, you will be asked to come in prior to the planned surgery appointment to receive eyedrops to make the pupil smaller, and to control inflammation in the eye scheduled to have the laser.  These eye drops sometimes cause a temporary brow ache or headache. 

During laser surgery, you will see a bright light, like a camera flash, and you will  feel a pinch or tingling sensation.  Afterwards, the eye may be slightly irritated, and you are advised to avoid strenuous activity for a few days.  

 

Risks associated with Laser Iridotomy
As with any type of surgery, there is always the possibility of adverse effects. With laser iridotomy, the more common risks include:

  1. Transient increase in eye pressure that is usually responsive to medicated eye drops 
  2. Inflammation or iritis that is usually responsive to anti-inflammatory eye drops
  3. Blurred vision lasting several hours
  4. Bleeding at the site of laser impact that is usually treated with slight pressure to the eye
  5. In order to minimize the risk of bleeding, we ask that you stop any blood thinners before surgery. Stop aspirin 10 days prior. Stop coumadin or similar medication 5-7 days prior.
  6. Corneal burns that are usually painless and usually resolve without sequelae
  7. Scarring and closure of the iridotomy that may necessitate a repeat laser treatment
  8. Opacity in the lens. This is usually insignificant.
  9. Possible long-term elevation of intraocular pressure (very rare)
  10. Corneal abrasion or irritation