Laser basal iridectomy as an effective treatment for glaucoma

Laser treatment of glaucoma was first used in the 70s of last century. Today, -2% of the population over 60 years old suffers from this incurable disease. The quantitative ratio of the number of sightless due to glaucoma to the total number of blind is 1,% (5 million. people. ), and their number is constantly growing. Since operations with a laser are now widely available, this method is the most in demand in modern ophthalmic practice.

Method definition

Laser iridectomy - excision of part of the iris of the eye:

• Full- when the ciliary and pupil parts are excised;
• Incomplete (basal)- there is excision of the pupillary part or the root of the iris.

The essence of the operation is the formation of a small hole in the marginal zone of the iris. Thanks to a new pathway, the intraocular fluid can freely circulate between the eyeball chambers, and the pressure within the eye normalizes.

The risk of damage to the optic nerve is a cause of glaucoma.

Usually antiglaucomatous iridectomy is done in the upper part of the eye, so that after the operation the eyelid covered the postoperative columb (defect of the iris) and protected from light access operated plot.

Application area

Laser iridectomy is used to treat primary and secondary closed-angle glaucoma - a pathology that occurs only in 10% of patients with glaucoma.In the remaining 90%, patients have an open-angle form of the disease - with an open iris-corneal angle.

Laser iridectomy is performed in mixed forms of glaucoma, and also for preventive purposes on the second eye after surgery on the first. Sometimes a one-step intervention does not give the proper effect, or eventually disappears, so a re-operation is prescribed.

Laser iridectomy can be performed in patients with open-angle disease as a preparatory procedures for trabeculoplasty - applying a lot of microscopic burns to the trabecular net. This helps improve drainage of the fluid and normalize intraocular pressure.

Kinds

Treatment of open-angle and angle-closure glaucoma by laser can be performed using the following methods:

• Trabeculoplasty using an argon laser(ALT). This operation brings only temporary relief and is aimed at stimulating the increase of the grid windows. This is a traditional operation using a thermal argon laser;
• Trabeculoplasty selective(SLT), using a cold laser. A more modern method, which reduces the trauma during the operation. This allows you to use this method 3-4 times, whereas traditional trabeculoplasty can be done only once;
• Iridectomy peripheralIt is performed using a YAG laser, which makes it possible to make a small through hole in the iris of the eye. In this case, there is an equalization of pressure inside the eye, which largely prevents risk of attack with a closed-angle form of the disease, prevents the appearance of adhesions of the iris with trabecular network;
• Iridoplasty, peripheral- application of laser coagulants to the periphery of the iris of the lungs, as a result of which the anterior chamber angle widens due to wrinkling and retraction of the iris stroma;
• Puppylloplastyis performed in the case of impossibility of laser iridectomy, application of coagulants by means of a laser to a certain sector of the iris. At the same time, the pupil is pulled up and the anterior chamber angle is released.

Laser treatment has shown high efficiency (more than 90%) when using open-angle glaucoma in the early stages, if the treatment is delayed, the positive result is reduced to 83%. And in the late stages of the disease is only 52%.

Treatment

The operation of correcting the vision through the laser can be prescribed to patients with the following indications:

• Primary or secondary angle-closure glaucoma;
• Mixed form of the disease;
• Repeated operation with insufficient effect during primary exposure;
• Prophylactic iridectomy on the second eye in order to prevent the development of glaucoma.The probability of spreading the disease to the second eye is 15-20%;
• As a preliminary procedure before trabeculoplasty.

Preparation of the patient

Before the operation, the patient undergoes a full medical examination and comes to the doctor's office one day before the procedure. During the preliminary examination, tactics and type of surgical intervention are determined, and also medicines for preoperative preparation are selected.

Laser iridectomy is one of the most gentle methods used in the treatment of glaucoma.The procedure does not take much time (10-15 min. ) and can be performed on an outpatient basis.

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Preparing a patient for surgery may include:

• In the hour before the procedure - 3-time use of dropwise NSAIDs (non-steroidal anti-inflammatory drugs);
• For, hours before the procedure - the introduction of drip myiotics (narrowing the pupil) drugs;
• Immediately before carrying out - local anesthesia drops. It can be Inokain, Alkain, etc. ;
• In severe pain syndrome, retrobulbar anesthesia can be used - conductive anesthesia, when an anesthetic solution is injected into the ciliary region.

Contraindication to surgery is the opacity and swelling of the cornea. The procedure is not carried out even if the patient has a small eye chamber.

Before the operation for 4 hours, stop eating. It is also forbidden to dress woolen things, so if necessary, take with you a change of clothes.

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Procedure

During the operation the following medical procedures are performed:

• On the cornea of ​​the operated eye, goniolysis is established, which allows the laser beam to be focused on a strictly defined area;
• With the help of a laser, a specialist makes one or several punctures in the thin portions of the iris or in its natural grooves (lacunae).

Rehabilitation period

After laser iridectomy, careful monitoring of intraocular pressure is required to assess the results of surgical intervention. To reduce the risk of complications, the following drug therapy is carried out:

• Use NSAIDs in the form of drops or orally for 5-7 days.According to the indications, joint use of medicines is possible;
• Carbonic anhydrase inhibitors are used orally (3-day reception with a break of 3 days for 9 days) or in the form of instillations during the week;
• Hypotensive therapy with constant monitoring of IOP.

results

Laser iridectomy has several advantages over surgical methods of treatment:

• The possibility of using local anesthesia, which helps reduce the burden on the body;
• Short terms of preoperative preparation, procedure and rehabilitation period.This allows for outpatient treatment;
• Use of the procedure as a preventive measure.

The effectiveness of laser iridectomy with a competent procedure, according to statistics, is 96%.

Advice to patients

During the rehabilitation period, it is necessary to follow certain medical recommendations so as not to cause harm to the operated eye due to inexperience.

In the recovery period it is forbidden:

• Rinse, scratch, rub your eyes;
• Do self-medication;
• Sleep on your stomach or on the side of a sick eye.You can only sleep on your side so that the operated eye is on top;
• Include in the diet solid hot, pickled, salty foods;
• To go to a bath or a sauna;
• Exposed to physical stress.

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Ophthalmologist's charts

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conclusions

Laser iridectomy is one of the most progressive and effective methods of vision correction. However, like most medical methods, it is used more successfully in the early stages of the disease. One of its main advantages is the possibility of using as a preventive and repeat procedure, as well as a high percentage of positive results in treatment.

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