Year : 1983 | Volume
: 31 | Issue : 7 | Page : 961--963
Laser photogoaculation and prophylactic treatment for retinal detachment of the lesion
Kanti Mody, Asha Saxena
Senior Ophthalmic Surgeon, Jaslok Hospital and Research Centre, Mumbai, India
Senior Ophthalmic Surgeon, Jaslok Hospital and Research Centre, Mumbai
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Mody K, Saxena A. Laser photogoaculation and prophylactic treatment for retinal detachment of the lesion.Indian J Ophthalmol 1983;31:961-963
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Mody K, Saxena A. Laser photogoaculation and prophylactic treatment for retinal detachment of the lesion. Indian J Ophthalmol [serial online] 1983 [cited 2022 Jan 21 ];31:961-963
Available from: https://www.ijo.in/text.asp?1983/31/7/961/29717
The prophylactic Management of Retinal Detachment consists of (1) Recognition and assessment of the lesions, tears and degenerations; (2) Evaluation of the risk factors and (3) The treatment of those lesions which would otherwise lead to Retinal Detachment.
Clinical Study at Eye Department of Jaslok Hospital and Research Centre, Bombay, was conducted on the Value of Laser Photocoagulation as a method of Prophylactic Treatment for retinal Detachment.
METHODS AND MATERIAL
(a) Case Selections: Eligibility for the Treatment of Eye.
1. Tears/Holes with Symptoms (20 Eyes)
Tears/Holes with Vitreous Traction and
Posterior Vitreous Detachment.
2. Tears/Holes in Aphakic Eyes (6 Eyes)
3. Tears/Holes in Myopic Eyes (10 Eyes)
4. Tears/Holes in Fellow Eyes (15 Eyes)
5. Retinal Dialysis without Retinal
Detachment (1 Eye)
6. Lattice Degeneration (12 Eyes)
a) Same eye or fellow eye with retinal
detachment (8 Eyes)
b) Presence of aphakia, myopia and
giant tear (8 Eyes)
c) Prior to the cataract surgery (3 Eyes)
7. Snail Track Degeneration (2 Eyes)
8. Fellow Eye of Giant Tear (2 Eyes)
9. Combination of more than one of the above condition.
Total Eyes: 40
(b) Pre-treatment Evaluation and Assessment.
1. Complete History and Ophthalmic Clinical Examination of both Eyes with fully dilated pupils.
2. Most important-3 mirror contact lens Biomicroscopy and Indirect Ophthalmoscopy with $cleral Indentation.
(c) Following factors were considered for Evaluation and Assessment:
1. Size, shape and location of the tear and the degeneration.
2. Presence or absence of the surrounding pigment.
3. Refractive Error (Myopia, Aphakia etc.)
4. Condition of the Vitreous (Posterior Vitreous Detachment, traction etc.)
5. Previous Retinal Surgery in the involved eye.
6. Anticipated Cataract Surgery.
7. Fellow Eye.
8. Family History.
(d) Treatment - Equipments and Technique
Argon Laser attached to Haag-Streit Slit Lamp.
-Local Surface Anaesthesia.
-Contact Lens-3 mirror Goldman's
Contact Lens. -Pupil-full dilatation.
Power : 500 to 600 mw. (mills watts)
Size : 300 to 500 micron spot size.
Duration: 0.07 to 0.12 seconds.
Burn : Grade III-but not chalky
Patterns :-Two to three rows of burns around the tear or degeneration.
-Not to treat the actual area of tear or degeneration.
-Burns touching each other, or a small gap between the two burns.
-Complete encirclement of the lesions with laser burns.
-Horse-shoe Tear: Completely cover the lesion including special care to cover anterior aspects.
Lattice & Snail Track Degeneration: To treat
these lesions by covering with burns all around, but it is important not to treat the sctual lesion. Keep a small distance away from the edge of the degeneration (in view of the vitreous attachment and traction).
(e) Post Laser Treatment:
1. 0101-Antibiotic Steroid drops or ointment four times a day for 10-14 days. -To keep the pupil dilated with mydriatic. -Analgesics if required.
2. Patch or dark glasses (if patient commplains of photophobia).
3. Gentle activities may be allowed. Bed rest is not required.
4. Patient should instructed to report promptly on the symptoms e.g. more floaters, more flashes, "Clouds and Curtains", sudden loss of vision or field of vision.
(f) Follow-up Examination
The treated eyes were examined at the following intervas: 1 week, 3 weeks, 6 weeks, 3 months, 6 months and then if required.
Follow-up period for the eyes treated ranged from 6 months to 18 months.
Aim of the Prophylaxis was achieved in all
-there was no retinal detachment in any of the teated eye. This method was as effective as other methods.
This method was as effective as other methods.
Complications: Nil. Benefits ofArgon Laser
1. It is a convenient, safe, comfortable, OPD procedure requiring only local anaesthesia.
2. Post treatment period is short and patient experience minimum discomfort.
3. Accurate and easy localisation of the lesion for the laser photocoagulation.
4. Conjunctiver chemosis, conjunctival laceration, retinal and choroidal haemorrhage as well as choroidal detachmentThese side effects were not observed.
5. Macular pucker a more serious complication is unlikely to occur with laser photocoagulation compared to that with other procedures.
(None of the treated eyes developed this complication).
Following factors are not favourable for Laser Photocoagulation as Method of Prophylactic Treatment.
1. Hazy Media-Cornea, Lens (peripheral opacities) Vitreous haemorrhage and opacities.
2. Poor Pupil dilatation.
3. Tear/Holes with subretinal fluid even if it be shallow.
This study has shown that laser photocoagulation as a method of prophylactic treatment for retinal detachment is quite effective, safe, convenient, comfortable, out patient (office) procedure requiring local surface anaesthesia. Its technique provides accurate and relatively easy localisation ofthe lesion and its photocoagulation. Side effects and complications were not observed, though low incidence of a few complications are reported in the literature.