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Chapter-15 Nd:YAG Laser Iridotomy, Selective Laser Trabeculoplasty and Cyclophotocoagulation

BOOK TITLE: Clinical Ophthalmology: Medical and Surgical Approach

Author
1. Kaushik Sushmita
2. Pandav Surinder S
ISBN
9789350250044
DOI
10.5005/jp/books/11246_15
Edition
2/e
Publishing Year
2011
Pages
9
Author Affiliations
1. Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India, Postgraduate Institute of Medical Education and Research Chandigarh, India, Postgraduate Institute of Medical Education and Research, Chandigarh, India, Post Graduate Institute of Medical Education and Research, Chandigarh, India, Advanced Eye Center, PGI, Chandigarh, Postgraduate Institute of Ophthalmology, Chandigarh, India, Advanced Eye Care Centre, PGIMER, Chandigarh, India
2. Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India, Postgraduate Institute of Medical Education and Research Chandigarh, India
Chapter keywords

Abstract

Neodymium:yttrium-aluminium-garnet (Nd:YAG) iridotomy has essentially replaced surgical iridectomy in the vast majority of cases. Laser iridotomy is the established procedure of choice for angle-closure glaucoma associated with papillary block, whether primary or secondary or acute, intermittent or chronic. The trabecular meshwork has been targeted by laser application since the early 1970’s. The conventional argon laser trabeculoplasty (ALT) was first described by Worthen and Wickham in 1973, and modified by Wise and Winter in 1979. Krypton lasers, continuous wave neodymium lasers and diode lasers can be effectively used to perform trabeculoplasty. Selective laser trabeculoplasty is a new alternative to ALT for the treatment of open-angle glaucoma, and achieves about the same level of pressure lowering compared with ALT. Cyclodestructive procedures for intractable glaucoma that are unlikely to benefit from surgery, have evolved in the last 70 years from penetrating cyclodiathermy, cyclocryotherapy, ultrasound for ciliary body ablation and laser cyclophotocoagulation. Cyclocryotherapy was initially shown to reduce intraocular pressure (IOP) in 1950, and was shown to be a reasonably safe and effective treatment that was less destructive and more predictable than cyclodiathermy. But problems did exist with cyclocryotherapy, e.g. severe postoperative pain, IOP rise, hemorrhage, marked inflammatory reaction, hypotony and severe visual loss.

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