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  • Q&A with Australian Health Practitioners

    What can I expect from laser trabeculoplasty?

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    Have already had removal of pterygium,corneal graft and cataract removal on this eye. Using tymoptal gel but pressure going up again so have stopped taking flarex as well.IOP 24. Has anyone had this procedure?
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    Glaucoma Australia is the peak glaucoma awareness/education/support association in Australia.It is a national, not-for-profit registered charity dedicated to providing educational services to raise awareness about … View Profile

    Selective Laser Trabeculoplasty (SLT) is a laser procedure that relieves increased eye pressure by changing the fluid outflow through the trabecular meshwork.
    When the fluid that normally flows out of the eye cannot drain through the trabecular meshwork, pressure inside the eye may rise. This rise in pressure could damage the optic nerve and lead to vision loss (glaucoma). The reason for the blockage in the meshwork is unclear, but may be likened to leaves blocking a downpipe or gully trap.

    The laser works by releasing local body chemicals that alter the ‘leakiness’ of the meshwork, allowing more fluid out of the eye and thereby decreasing the pressure. The particular benefit of SLT is that it may be repeated many times as there is no appreciable tissue damage.
     
    Laser trabeculoplasty does not work in all patients, but likely benefit can often be predicted beforehand and appropriate patients selected. Patients with heavy pigmentation in the meshwork do best. The duration of effect of the laser is variable, with an average benefit of around 5 years. It may be necessary to supplement the laser with ongoing glaucoma medication, and it is generally unusual for pre-existing treatment to be able to be ceased, except in an exceptionally good response.
     
    A laser trabeculoplasty is usually performed as an outpatient procedure. You will be given eyedrops to prepare the eye (one of which may cause a mild forehead ache). A contact lens is placed on your eye (after local anaesthetic drops) to precisely focus the laser. A laser trabeculoplasty takes only a few minutes. You may see a bright red light that is an aiming beam; the laser beam itself is invisible. You may feel a mild tingling sensation with each laser burn – there are 50-60 fine burns in a treatment, which is given over a half or sometimes a full circumference of the inside of the eye.
     
    You will be asked to return after 30 minutes so that your pressure can be re-checked. Assuming it is normal, you will then be allowed home. There are usually no activity restrictions following the laser treatment, although you should have someone drive you home after the procedure. You will need to continue your usual glaucoma medication. The pressure is checked within a fortnight or so after the procedure, and then again at 5-6 weeks. It is not until this last visit that the success of the treatment is judged.
     
    Complications
    Loss of vision after laser trabeculoplasty is rare. The main risks of the laser procedure are:

    • The pressure may rise after the treatment, sometimes requiring additional treatment.
    • Significant inflammation is rare, but can occur.
    • A second procedure or another type of surgery may be required.
     
    Selective laser trabeculoplasty is a safe and effective procedure with few risks. While glaucoma treatments cannot restore vision already lost from glaucoma, early detection and treatment of glaucoma offers the best chance of preserving your vision.

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    Clin A/Prof Andrew White

    Ophthalmologist (Eye Specialist)

    Andrew is Clinical Senior Lecturer at the University of Sydney and glaucoma specialist at Westmead Hospital. His area of expertise is the medical and surgical … View Profile

    SLT is a very benign proceedure to reduce intraocular pressure. It has a very low compliation rate.

    An eye is anaeshtetised with eye drops and a lens placed on it. Laser is fired into the drainage areas of the eye (the angles) which may feel like a pinprick sensation. Typically about 60-70 shots per eye are done at a time and a second treatment may be needed. The procedure itself may take less than 5 minutes and activity afterwards is as normal. Usually no addtional eye drops are required. The vision may be slightly blurred for a day or so but often isn't. It is not unusual to have a gritty sensation in the eye for 2-3 days which will resolve. It may take up to 12 weeks to see the full effect of the treatment though 4-6 is more typical.

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