Retinal Laser Photocoagulation

Laser photocoagulation; surgery to strengthen the retina. It is this structure that receives and transmits visual information to the human brain, so its damage leads to an irreversible loss of ability to see the outside world. To avoid this, with the occurrence of dystrophic lesions vulnerable to detachment, the retina is “soldered” to the eye wall using a laser.

Indications for Retinal Laser Photocoagulation

Laser reinforcement of the retina may be necessary for patients with the following pathological changes in the visual organ:

  • Peripheral retinal dystrophy. The risk of “detachment” development in this disease depends on the type of degeneration focus. Laser photocoagulation is especially indicated for grating dystrophy and degenerative retinal changes of the “cochlear footprint” type.
  • Retinoschisis. This is a state in which the retina becomes detached, with fluid accumulating between the layers of its cells.
  • Vascular pathologies. Laser cauterization of the retina may be prescribed in case of thromboembolic damage and obstruction of large arteries or veins, and also to stop the abnormal overgrowth of vessels in diabetic patients.

In order to diagnose retinal diseases, ophthalmoscopy of eye fundus details is always performed after instillation of special pupil dilating drops. This examination should be performed if there is a sudden and significant decrease in vision, double vision, blurred contours of objects, “flashes”, “sparks”, “lightning”, floating “gnats” as well as dizziness and migraine. Uncompensated diabetes mellitus, myopia of medium and especially high degree, in old age require regular annual examinations by an ophthalmologist for prevention.

How laser photocoagulation is performed

The procedure is used to differentiate focal changes on the retina, prevent the retinal detachment from happening there or from spreading to the macular area of the eye fundus which is responsible for the central visual acuity. Laser photocoagulation of the retina is performed on an outpatient basis, does not require hospitalization and a long recovery period. It is performed under local droplet anesthesia, so there is no medication load on the internal organs.

The duration of one procedure is about twenty minutes. After anesthetics and pupil dilation, the patient is seated behind a stereomicroscope and a high diopter specular lens is placed on the eye. Short-term local exposure to the argon laser rays increases the temperature in the retinal area many times, which triggers the process of tissue coagulation. Cauterization points may be compared to peculiar nails, which firmly fasten the tissues together and prevent their rupture or detachment.

The number of such coagulants depends on the type of disturbances and the type of surgical intervention – in case of small centers of dystrophy they are placed only around the pathological changes, but in the case of general thinning of the retina a prophylactic peripheral laser coagulation is performed which covers the entire perimeter of the eye fundus. An ophthalmologist can create up to three hundred cauterizations on one eye in one procedure.

What you can and cannot do after laser photocoagulation

Two to three hours after laser photocoagulation of the retina the patient can leave the treatment facility. Before the pupil returns to its previous diameter, decreased vision and intolerance to bright light are probable, therefore it is not recommended to drive a car, and sunglasses must be worn outside for this period.

To prevent complications, the patient is prescribed antibacterial and anti-inflammatory drops. Also within two weeks after the procedure, it is important for him to comply with the following recommendations:

  • Limit physical activity;
  • avoid prolonged bending of the torso, exposure to vibration, jolting;
  • Minimize the risk of falling;
  • reduce stress on the visual organ, including working at a computer monitor;
  • not drink alcoholic beverages and not smoke;
  • Do not visit the steam room, solarium.

If necessary, a period of rehabilitation after surgery is opened for a period of incapacity for work.

Contraindications

The operation may be complicated in case of decreased transparency of the eye media – cataract, corneal leukoma, extensive hemorrhage. In this case laser coagulation is performed after treatment and elimination of the consequences of the underlying disease.

Laser photocoagulation is not advisable in advanced retinal detachment or third-degree gliosis, when a considerable part of the light-sensitive cells has been replaced by connective tissue.

Complications

As in case of any surgical intervention there is a possibility of unfavorable consequences during laser photocoagulation of the retina. Among the complications of the procedure are:

  • conjunctivitis;
  • Dry eye syndrome;
  • Restriction of peripheral vision, appearance of floating threads, “flies”, and dots in front of the eyes.

Relapse of retinal detachment is also possible if the applied coagulants were insufficient. In such a situation, laser photocoagulation should be repeated.

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