There are two types of laser trabeculoplasty:
- Argon laser trabeculoplasty (ALT) uses a laser to open up the drainage angle of the eye
- Selective laser trabeculoplasty (SLT) uses a lower energy laser to open the drainage angle of the eye
For laser trabeculoplasty:
- Eye drops are put into the patient’s eye before or after the procedure to decrease the amount of fluid in the eyes and prevent elevation in eye pressure immediately after laser treatment
- A special microscope (slit lamp) and lens (goniolens) are used to guide the laser beam to the canals (trabecular meshwork) where fluid drains from the eye
- The doctor makes small burns in the trabecular meshwork
Some people feel a heat sensation in the eye during the laser surgery.
What to Expect After Surgery
Laser trabeculoplasty can be done in the doctor office. The person needs to be checked by the doctor one month after the laser.
Why it is Done
This procedure is carried out to reduce the eye pressure. For some patients this is the first treatment they have done before eye drops are given. For others it is in addition to drops that they use already. Studies showed that using laser as first line treatment to decrease eye pressure is more successful than using after starting the drops or as a second line of treatment.
How Well it Works
Laser trabeculoplasty lowers the pressure in the eye about 50% of the time. People usually need to continue taking medicine after laser surgery to keep the pressure in their eyes down.
Control over the pressure inside the eye may decrease as time passes. Laser may be repeated twice. The results of repeated laser surgeries are less predictable than the first surgery.
Decreased vision is usually a temporary problem unless there is a significant rise in pressure inside the eye. Very high pressures inside the eye can lead to permanent vision loss.
Risks
If excessive scar tissue forms after laser trabeculoplasty for open-angle glaucoma, other procedures may be needed.
Complications of laser trabeculoplasty are rare. The most common complication of laser surgery for glaucoma is an increase in the pressure in the eyes. The complication can be prevented by using apraclonidine or brimonidine before or after the laser procedure, especially in people with high intraocular pressure before the laser procedure.
Other complications of a laser procedure may include:
A brief period of inflammation of the colored part of the eye (iris).
Cloudiness of the clear covering (cornea) over the iris. This usually does not last long.
Blockage of the drainage angle when the cornea and the iris stick together.
Pain.
Decreased vision.
What to Think About
Laser trabeculoplasty is less effective in people who have inflammatory glaucoma, a type of glaucoma caused by an existing inflammation, and in young people who have developmental defects. Laser trabeculoplasty is not done for patients who have closed-angle glaucoma.
The drop in pressure in the eye after a laser procedure may not be enough to prevent loss of eyesight in people with very high pressure who have already lost some of their vision.
If damage to the optic nerve continues after laser trabeculoplasty, other procedures may be needed.