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Laser treatment for glaucoma 

PAGE 32 DR SAFFIEDINE

WHY LASER TREATMENT?

Glaucoma can cause, chronologically, a progressive deterioration of the peripheral visual field followed by a decrease in central vision that may lead to complete and irreversible loss of vision.

Glaucoma is a major cause of blindness in the Western world. Among its many causes, the most common and most important is a too high pressure in the eye.

Only your ophthalmologist is qualified to assess the harmfulness of the level of your eye pressure by taking into account all the data collected by an appropriate and thorough examination of your eyes. Personal and familial background, fluctuations of the eye pressure, the quality of the retinal fiber layer, the status of the optic nerve, the visual field, the thickness of the cornea, the aqueous in- and outflow facilities in the anterior chamber etc. are ones among many more ocular parameters to take in account before assessing the level of the glaucomatous disease or the risk of developing it.

Laser treatment can be an appropriate means of lowering the pressure in the eye and controle of glaucoma.

The goal of this treatment is to create a reaction scar at the level of the cells of the trabecular meshwork, which is a place of resistance to the outflow of the liquid produced by the eye. The expansion of the trabecular mesh leads to a greater ease of evacuation of the liquid and therefore a decrease in the pressure inside the eye.

THE LASER TREATMENT

The laser beam uses a ray of light capable of carrying a large amount of energy that is delivered in a specific location of the eye. It can create a scar that, by retracting, opens the spaces of the trabecular meshwork.

The session is performed on an outpatient basis. Anesthesia of the eye is obtained by the instillation of anesthetic drops. The patient sits in front of the laser engine. Laser impacts are applied through a lens placed on the eye. The whole procedure does not exceed 20 minutes per session. It is painless.

The treatment is performed in 1 or 2 sessions spaced by several days to several weeks.

USUAL COURSE

In the vast majority of the cases, the treatment is well tolerated. The patient leaves immediately after treatment the Eye Clinic. Usual activities can be directly performed.

The local care is reduced to the instillation of drops in the way that will be indicated by the ophthalmologist.

A post laser control is necessary at a date that is stated by the ophthalmologist.

A decrease in pressure is achieved in most cases.

COMPLICATIONS OF THE TREATMENT

The non serious complications are:

* Glare, due to the laser session itself, will be felt throughout the examination.

* Arterial hypotension may occur in susceptible individuals. It disappear quickly by lying down.

* Irritation of the cornea (superficial keratitis): It is a rare hazard, occurring in less than 1% of the cases. Promptly treated, it cures generally in 24 to 72 hours.

* A paradoxical transient increase, during several hours to several days, of the intraocular pressure. It is a frequent hazard that is always treated preventively with hypotensive eye drops.

* Conjunctival bleeding due to the contact lens: rare, benign, disappears in few days.

These incidents are of no concern. If the patient is prone to arterial hypotension, it is necessary to get the ophthalmologist informed.

A misplaced impact, reaching the middle of the centre of the retina is a severe complication of this treatment. This incident can permanently reduce detail vision. It is so rare that it is impossible to calculate its risk. It occurs in restless, undisciplined patients who do not control their eye movements and their bodies. To avoid this, the patient is asked to keep the most calm and compliance during the laser treatment.

LIMITATIONS OF THIS LASER TREATMENT

This laser treatment is a complementary therapeutic tool, available to the ophthalmologist, to lower the eye pressure and prevent, as much as possible, the continuous progression of glaucomatous damages.

Like all living tissues, the trabecular meshwork may react variably, immediately or along the months or years, to the impacts of laser. Thus, this treatment cannot pretend preventing permanently subsequent increases of the intraocular pressure.

This laser treatment is often associated with a medical treatment to pursue the aim of lowering eye pressure. In some cases, glaucoma may somehow continue to progress, especially if other factors, particularly circulatory disturbances, are involved.

THE PATIENT SHOULD CONTACT AN OPHTHALMOLOGIST IMMEDIATELY IN CASE OF

* Pain, severe sensitivity to light, redness, tearing, secretions, swelling of the eyes or eyelids

* Sharp decrease of the vision.

By courtesy of Dr. SAFFIEDINE, ophthalmologist in Playa De Las Americas.