Laser Surgery

Many types of open-angle glaucoma are amenable to treatment with laser trabe-culoplasty. In contrast, only some types of closed-angle glaucoma, particularly (but not exclusively) those with a component of pupillary block, are amenable to treatment with laser iridotomy. Laser trabeculoplasty is usually performed over 360° of the anterior chamber angle during one or two sessions using appropriate treatment parameters. Except in situations where it has not performed correctly or in the presence of pseudoexfoliative glaucoma, retreatment is seldom effective. Although re-treatment with selective laser trabeculoplasty has been touted as more effective than argon laser trabeculoplasty, studies to prove this have not yet been reported. Re-treatment with either laser can be attempted, however, before proceeding to trabe-culectomy if the clinician and the patient are willing to incur certain risks: possible deterioration of the condition during the additional delay, a reduced level of expectation for success, and temporary or sustained elevation of IOP.

Certain types of patients tend to respond poorly to laser surgery; therefore, laser surgery should not be offered routinely to patients with childhood glaucoma, inflammatory glaucoma, angle-recession glaucoma, iridocorneal endothelial syndrome, corticosteroid-induced glaucoma, and chronic angle-closure glaucoma. Laser surgery is difficult, if not impossible, to perform in certain other patients, such as those who cannot cooperate or hold a steady position at the laser, whose cornea is edematous, or whose angle cannot be adequately visualized.

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