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In modern medicine, there are several effective ways to treat glaucoma: the first is with drugs, the second is with laser, and the third is with the help of surgery. Ophthalmologists were the first to use laser radiation to treat patients, so laser trabeculoplasty is in great demand and popularity.
Features of laser trabeculoplasty
For the effective treatment of glaucoma, which occurs due to increased intraocular pressure, 2 types of lasers are used: pulsed with a short thermal effect and with constant radiation, providing a thermal effect on the tissues.
The very first operations using a laser began to be performed by surgeons at the end of the 19th century. At that time, a ruby laser with short pulses was used. For 1 procedure, 15 to 25 applications were applied to the trabecula. With laser radiation with high power, a lasting effect was observed, intraocular pressure returned to normal in almost 80% of patients within 1 year after the manipulation. The disadvantage of the procedure is the appearance of scars in the area of intervention.
Laser trabeculoplasty using pulses was developed in the Russian Federation. Its essence lies in the fact that impulses act on the trabecula sequentially. The specialist sets the necessary parameters: wavelength, energy, number of cauterizations, exposure and diameter.
The so-called “gold standard” in ophthalmology is the treatment of glaucoma with an argon laser. In one session, about a hundred applications are applied around the entire circumference of the organ of vision. This method improves the outflow of aqueous humor of the organ. The operation is considered effective, but it has its drawbacks and complications: after manipulation, pressure inside the eyes may rise in a few hours, the cost of manipulation is high, it is advisable to carry out the procedure for people with severe pigmentation of the Schlemm’s canal.
Laser treatment of glaucoma is a unique technique in which the laser plays the role of a needle or a knife, with which an operation is performed on the organ of vision without opening and cutting it. Laser trabeculoplasty has established itself as the most painless and effective procedure.
Regardless of the type of laser, the therapy of the disease is aimed at normalizing the outflow of fluid from the eye, resulting in a decrease in intraocular pressure. Manipulation can be performed as an independent method of treating the disease, or in combination with microsurgical interventions.
Advantages of laser trabeculoplasty
The main advantages of the operation include: quick recovery after manipulation, the minimum number of complications and adverse reactions, non-invasiveness of the technique, accessibility of the procedure, outpatient treatment (sterility), anesthesia is not required (local anesthesia with drops is sufficient), the outflow of fluid from the eyes is restored naturally way.
Depending on the wavelength, the eye receives a local burn, which leads to scarring and atrophy, or a microexplosion, accompanied by tissue rupture. In this regard, iridotomy is considered more gentle.
Manipulation is aimed at preventing the occurrence of complications after glaucoma, it also avoids surgical intervention, and allows the patient to return to a full life.
Indications and contraindications for the procedure
Laser trabeculoplasty is indicated for:
- people diagnosed with open-angle or narrow-angle glaucoma;
- with unsatisfactory results of surgical methods of therapy;
- with partial or pronounced pigmentation of trabeculae;
- patients with aphakic, pseudoexfoliative or postveal eye disease;
- with intolerance or ineffectiveness of drug treatment, including the ineffectiveness of antihypertensive drops.
There were no contraindications to the operation. If the patient feels unwell before the manipulation, the attending physician should be informed about this and appropriate measures should be taken.
Stages of the operation
The procedure takes place under local anesthesia in a hospital. The patient needs to take a comfortable position in front of a special lamp. A specialist installs a three-mirror goniolens with a reflective surface on the organ of vision. The second eye focuses its attention on some object in its field of vision.
If a linear technique is carried out, then burns are applied in one row to the Schlemm canal zone. Approximately 50 point burns are applied to the eye in one session. The duration of one manipulation takes from 20 to 30 minutes. The patient does not experience discomfort or pain, he can only watch the flashes of the red or green laser.
Postoperative recovery
After the manipulation, the patient is examined by an ophthalmologist, measures the pressure inside the eyes and prescribes drops that reduce the inflammatory process. The doctor prescribes medications to stabilize intraocular pressure. The patient after the operation may feel blurred vision, increased sensitivity to light (it may persist for several days after the procedure). Pain and discomfort should not be observed.
Laser microsurgery is very effective, and if it is performed by an experienced specialist, then its re-appointment is not needed. Sometimes, 2-3 years after the operation, glaucoma may recur, in which case it is advisable to perform a conventional surgical intervention.
Many ophthalmologists recommend treating eye diseases first with a laser, and only then, if trabeculoplasty has not brought the desired effect, resort to surgical methods. After surgery, there are many complications, infections and there is a risk of bleeding.
Complications after laser trabeculoplasty
Complications may occur after microsurgery: there is a risk of infection, for example, keratitis and conjunctivitis; allergic reactions such as burning, itching, swelling, redness of the mucosa; a sharp increase and decrease in intraocular pressure (may worry the patient for a week after laser therapy); inefficiency of manipulation (occurs in 10-12% of patients and requires surgical intervention).
Disadvantages of the procedure
Today, laser trabeculoplasty has no analogues in the world. Therapy of the disease has allowed many people to maintain their vision and avoid major surgical operations. Although the technique has a number of advantages, there are also disadvantages: in chronic glaucoma, manipulation will be ineffective or have a short-term positive result; there is a risk of developing an inflammatory process; intraocular pressure in the first few hours after the operation either decreases or increases; there is a risk of damage to the cornea, blood vessels and lens. Another disadvantage of laser treatment is the frequent formation of scars.
Laser therapy is effective in the early stages of the disease. In terminal or long-term illness, laser treatment has a low hypotensive result. For this category of people, many doctors offer microsurgical methods for the treatment of glaucoma.