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   Table of Contents      
GUEST EDITORIAL
Year : 1988  |  Volume : 36  |  Issue : 2  |  Page : 63

The impact of lasers on glaucoma management


R P. Centre for Ophthalmic Sciences, AI.I.M.S. Ansari Nagar, New Delhi-110029, India

Correspondence Address:
N N Sood
R P. Centre for Ophthalmic Sciences, AI.I.M.S. Ansari Nagar, New Delhi-110029
India
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Source of Support: None, Conflict of Interest: None


PMID: 3235162

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How to cite this article:
Sood N N, Sihota R. The impact of lasers on glaucoma management. Indian J Ophthalmol 1988;36:63

How to cite this URL:
Sood N N, Sihota R. The impact of lasers on glaucoma management. Indian J Ophthalmol [serial online] 1988 [cited 2020 Apr 7];36:63. Available from: http://www.ijo.in/text.asp?1988/36/2/63/26148

The advent of lasers has opened exciting and alternative possibilities- in the management of glaucoma. [1],[2],[3] The lack of availability of adequate number of machines in the country as also the pre occupation with treatment of posterior segment disorders perhaps delayed its use for glaucoma Another factor that soon came to light was the inadequate response of Argon lasers for iridotomy in cases of angle closure glaucoma. [4],[5] It is a well known fact that angle closure glaucoma is as frequent as open angle glaucoma, tends to occur in younger individuals and is related to the shallower AC. depth in Indians. [6] With the availability of Yag lasers in the country the non invasive approach for A.C.G. has been revolutionised. Argon laser iridotomy is more difficult and more often associated with closures due to proliferation of pigment epithelium in dark brown iridis of Indian eyes. Nd Yag laser causes disruption of tissue and the opening in the pigment epithelial layer is larger than the stromal, assuring a long term patency is almost all eyes. Nd. Yag (mode locked) iridotomies require a power of 3-5 mJ in Indian eyes and 85% of patients need only one sitting and 15% need two sittings. [5] Microhyphaemas are a common feature, especially with Q switched Nd Yag lasers and need pretreatment with-Argon laser. Care is needed in carrying out the iridotomies in extremely shallow AC's in the peripheral area, as temporary dysfunction of the corneal endothelium may occur. This non- invasive approach is attractive both to the ophthal­mologists and the patients, being an out patient proce­dure, the risk of complications being less as compared to surgical iridotomy. [5],[7] Laser iridotomy is effective and safe. Until such time that more institutions are equipped with lasers both surgical and laser iridectomies would continue. However, in certain situations it would be preferable to refer cases to centres for laser iridotomy­ viz one eyed cases needing iridectomy, other eye having developed malignant glaucoma and cases of nanoph­thairnos.

Argon laser trabeculoplasty on the other hand may only postpone the surgery or decrease the medications for those on maximal medical therapy in cases of OAG. [8],[9] ALT is currently also being evaluated as a primary therapy for cases of OAG. It needs to be appreciated that these patients with OAG who are not suitable for medical treatment should not be subjected to ALT as drug therapy may need to be continued after ALT.

Another laser procedure that is reasonably established is Laser iridoplasty (gonioplasty) for cases of plateau iris, nanophthalmos and case of OAG with narrow entry to enable A LL f. to be carried out.

Iris and Goniophotocoagulation with/ without prior retinal photocoagulation is helpful in cases of neovas­cular glaucoma. Photocoagulation of ciliary process by Argon laser may be especially useful in cases of aphakic malignant glaucoma

Lasers now form a basic element of current glaucoma care and the liberalization of import of laser equipment by the Government of India is a welcome step. A reorientation of gonioscopy and a more efficient utiliza­tion of laser machines already available in the country is called for. Carbon-dioxide lasers and tunable dye lasers are adding new dimensions to management strategies. Will these replace the surgeon s knife ? Such possibili­ties are on the horizon.

Key words

ACG - Angle Closure Glaucoma OAG - Open Angle Glaucoma

ALT - Argon Laser Trabeculoplasty AC - Anterior Chamber

 
  References Top

1.
Abraham R K, Miller G L Outpatient argon laser iridotomy for angle closure glaucoma : A 2 year study. Trans. Am Acad. Ophthalmol Otolaryngot 79 : 529, 1975.  Back to cited text no. 1
    
2.
Frankhauser F, Roussel P, Staffen T, Jan der Zypen E, Chrenkor A Clinical studies on the efficiency of high power laser radiation upon some structures of the anterior segment of the eye. Int Ophthalmol. 3 : 129-139, 1981.  Back to cited text no. 2
    
3.
Wise J B. Long term control of adult open angel glaucoma by argon laser treatment Ophthalmology, 88 : 197-202, 1981.  Back to cited text no. 3
    
4.
Rao K R M and Rao P N S. Prophylactic peripheral iridotomy with Argon laser and Abraham contact lens. Ind. J. Ophthal 32 : 437-38, 1984.  Back to cited text no. 4
    
5.
Kalra V K, Sood N N, Kumar Harsh, Madan Mohan Nd YAG iridotomy in Indian eyes. Presented at the All India Ophthalmic Conference, Jan. 1988.  Back to cited text no. 5
    
6.
Sood N N, Jain R C, Agarwal H G Ocular Biometry in Primary Angle Closure Glaucoma Indian J. Medical Res under publication.  Back to cited text no. 6
    
7.
Gupta S, Sood N N, Dayal Y. Angle Closure Glaucoma-IL Complica­tions of peripheral Iridectomy. East Arch Ophthalmol. Vol 3 : 223­227, 1975.  Back to cited text no. 7
    
8.
Sridhar Rao B. Argon Laser trabeculoplasty in open angle glaucoma Ind J Ophthalmot 31 :755-58, 1983.  Back to cited text no. 8
    
9.
Takenaka Y, Yamamoto T, Shirato S. Factors affecting success and IOP rise after argon laser trabeculoplasty. Jap. J. Ophthalmol. 31 : 475-482, 1987.  Back to cited text no. 9
    




 

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