terminology and guidelines for glaucoma ii - Kwaliteitskoepel
terminology and guidelines for glaucoma ii - Kwaliteitskoepel
terminology and guidelines for glaucoma ii - Kwaliteitskoepel
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3.5 - LASER SURGERY<br />
3.5.1 - LASER IRIDOTOMY 76<br />
Indication<br />
Clinically relevant pupillary block.<br />
Preoperative preparation<br />
- Pilocarpine 2% or 4% single instillation (unfolds the iris, reduces iris thickness, fascilitates per<strong>for</strong>ation)<br />
- Prevention of IOP spikes<br />
Oral or intravenous acetazolamide<br />
Topical apraclonidine 1%<br />
One hour prior to the procedure <strong>and</strong> immediately afterwards, diminishes the frequency <strong>and</strong> magnitude of the<br />
acute postoperative IOP spikes <strong>and</strong> decreases bleeding due to the vasoconstrictor effect.<br />
Remember to check <strong>for</strong> known drug intolerance or other systemic contraindications.<br />
- Topical anaesthesia<br />
- Topical glycercerine, intravenous mannitol or oral hyperosmotic agents to be considered if the cornea is oedema<br />
tous<br />
Procedure<br />
A laser iridotomy contact lens is needed to keep the lids open, stabilize the eye, focus the laser beam <strong>and</strong> act as a<br />
heat sink, while providing additional magnification.<br />
Lenses<br />
- Abraham (+66 dioptres)<br />
- Wise (+103 dioptres)<br />
- CGI © LASAG CH<br />
Iridotomy site<br />
- superior quadrants of the iris covered by the upper lid (to prevent monocular diplopia)<br />
- avoid the 3 o`clock <strong>and</strong> 9 o`clock positions to lessen discom<strong>for</strong>t <strong>and</strong> reduce the risk of hitting the iris vessels<br />
- avoid visible vessels<br />
- as far peripherally as possible within the arcus senilis<br />
- choose a thin looking area or an iris crypt<br />
- electively superonasal to reduce the likelihood of a macular injury when using the Argon laser<br />
Laser parameters<br />
Nd:YAG Laser Iridotomy<br />
Power: 1-6 mJ<br />
Spot size: 50-70µm (constant <strong>for</strong> each laser model)<br />
Pulses per burst: 1-3<br />
Focus the beam within the iris stroma rather than on the surface of the iris<br />
Lens capsule damage is possible above 2 mJ energy. Use the least amount of energy that is effective. With most<br />
lasers it is unlikely that more than 5 mJ per pulse will be needed.<br />
Ch. 3 - 28 EGS