Glaucoma Laser Surgery: Laser Trabeculoplasty

Your doctor has recommended that you undergo laser surgery for your glaucoma. The procedure is called laser trabeculoplasty. There are two types of this treatment: argon laser trabeculoplasty and selective laser trabeculoplasty. Depending on the type of glaucoma you have and the exact situation, your doctor will select the type of treatment that is appropriate for you. These procedures lower the pressure in your eye by affecting its internal drainage system. They do not "drill holes" in the drainage system; they act by stimulating it to function more normally.

Before the laser treatment

You may eat and drink as you like before the treatment. You should continue all of your glaucoma medications and all other medications you are taking for the rest of your body. If you are taking a blood thinner called Coumadin, please let your doctor know in advance. He or she may choose to stop this a few days before the procedure. An appointment will be made for you to come to the doctor’s office as usual. When you arrive, your vision and pressure will be checked, and a drop of either Alphagan or Iopidine will be placed in the eye that is to have the laser. Your doctor also may choose to give you a pill, usually Diamox, before the treatment to help lower the eye pressure. You then will be taken to the laser room.

During the treatment

In the laser room, you will be seated at the laser instrument, and a drop of anesthetic will be placed in the eye. A special lens, which directs the laser energy to the eye’s drainage angle, then will be placed on the eye along with some gel to allow the lens to fit properly. The laser light will not harm the remainder of the eye. Approximately 50 to 100 laser spots will be placed along one-half or all of the eye’s drain. During the treatment, you may feel some tingling or slight stinging, and you will see some bright flashes of light. The treatment takes about 10 to 15 minutes to complete.

After the laser treatment

When the laser is completed, the special lens will be removed, the eye will be rinsed, and an additional drop of Alphagan or Iopidine will be given. You then will be asked to sit in the reception area for approximately 45 minutes to an hour. At that time, to make sure that your pressure has not risen as a result of the treatment (an immediate pressure lowering effect is not expected), your pressure will be checked. If it is satisfactory, you may go home.

If it is increased, you may be asked to stay in the office for additional medical glaucoma treatment and additional pressure measurements until the level is acceptable. Generally, any pressure increase that occurs after the laser treatment is transient and effectively treated with temporary medications. Rarely, however, the pressure elevation can persist and, if dangerously high, may necessitate urgent incisional glaucoma surgery. Other, less serious complications include inflammation of the eye (again, usually transient and treated with temporary medications) or a scratch or irritation on the surface of the eye from the laser lens.

Immediately after the laser treatment, the vision can be quite blurry, and there can be some mild irritation, but this usually quickly clears. You will not be required to wear a patch, and you may continue your usual activities. You will be asked to continue all of the glaucoma medications that you were using before the laser treatment. There are also some additional drops to decrease any inflammation that you will be asked to use temporarily.

The laser treatment may take several weeks to take full effect. Postoperative visits will be scheduled for approximately one to two weeks and then one to two months after the treatment. At one of those visits, your doctor may wish to perform the same laser treatment on the other half of the drainage area in the same eye or may treat your other eye. Even if the laser works well to lower your eye pressure, please be aware that you will likely need to continue most if not all of the medications you were taking before the treatment.

Our goal is to provide you with the best possible surgical care. We hope that this information is helpful. If you should have additional questions or concerns regarding your surgery, please feel free to speak with your doctor or a member of the staff.

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