Open-angle glaucoma can be operated on with an argon laser or more recently with a SLT (Selective) laser. It consists of making impacts in the angle between the iris and the cornea, more precisely on the trabecular meshwork. It has the effect of widening the meshwork of the trabecular meshwork, allowing it to be more permeable to aqueous humor and therefore reducing eye pressure.
The operation is performed without hospitalization, it is technically simple and can be done at the ophthalmologist's office. Anesthetic eye drops are instilled on the eye and a contact lens is placed on the eye in order to practice the laser.
The after-effects of Glaucoma laser treatment surgery are simple. At most, there is irritation of the eye that lasts a few hours. An anti-inflammatory treatment is then prescribed for about a week. This treatment is effective because it reduces eye pressure by almost 30%, which allows you to stop taking eye drops or reduce the number prescribed.
Mais son efficacité est transitoire. La tension oculaire peut remonter après quelques années dans près de 40 % des cas.
Le principal avantage du laser Sélectif par rapport à l’Argon est la possibilité du fait de son absence d’effets thermiques et son innocuité de retraiter le patient au laser après quelques années.
Un traitement médical peut être également réinstauré après quelques années.
Angle-closure glaucoma can be treated with laser. It consists of opening the iris to prevent it from blocking the trabecular meshwork when it relaxes. Angle-closure glaucoma surgery is performed without hospitalization with the same after-effects and procedures as in laser surgery for open-angle glaucoma but with another laser: YAG laser.
The SLT Laser
Mis au point en 1995 et approuvé par la FDA (Foods and drugs administration USA) en 2001, le SLT est un nouveau type de laser qui permet de traiter le glaucome en régénérant le trabéculum de l’angle irido-cornéen.
More than 3,000 centers are equipped with it worldwide, including 1,700 in the USA and around a hundred in France, including the Paris Ouest Vision Laser Center.
Le laser SLT qui a fait la preuve de son efficacité et de son innocuité est un nouveau traitement de référence dans le glaucome à angle ouvert.
A hundred international scientific publications have confirmed its effectiveness and its place in this glaucoma operation.
The data for our study come from these publications and from the summary presented by Professor Philippe Denis of the Hospices Civils de Lyon.
How it works
The trabeculum is one of the structures of the iridocorneal angle allowing the filtration of aqueous humor.
The SLT laser allows regeneration of the trabecular meshwork without creating tissue burns as is the case with the Argon laser.
Il procure une baisse tensionnelle identique à celle obtenue avec trabéculectomie Argon sans en avoir les effets thermiques indésirables, ni la fibrose.
La baisse tensionnelle est de près de 30% de la pression initiale ce qui, en terme d’efficacité, le place favorablement par rapport aux collyres utilisés en monothérapie.
C’est un traitement à faible énergie (près de 100 fois moindre qu’avec laser Argon) donc non invasif et sécurisant ce qui autorise les retraitements (ce qui le différencie encore des lasers thermiques à Argon).
Results: decreased eye pressure
Le Laser SLT permet une baisse de tension oculaire de 20 à 30% de la pression initiale, ce qui le place favorablement par rapport à une monothérapie médicale.
The higher the initial pressure, the more effective the laser will be.
The effect will be judged after 1 month.
It remains effective in the long term since according to studies the pressure drop would still be 20% after 5 years.
A therapeutic escape is nevertheless often observed but it will then be wise to do it again because it retains the same effectiveness in the event of reprocessing.
SLT retreatments are harmless because it is a non-invasive method.
Possible side effects
Sometimes, pain or rather transient ocular discomfort may be observed after treatment, sometimes moderate post-operative ocular inflammation prevented if necessary by anti-inflammatory eye drops.
Immediate and short-lived postoperative pressure spike is rare.
No long term side effects.
Contraindications
Congenital glaucoma,
juvenile,
post uveitic,
neovascular,
and closed or very narrow angle.
Conducting glaucoma surgery during an SLT laser session
The session takes place in a clinic or medical office.
The patient is awake, a few drops of anesthetic eye drops are instilled into the eye just before the session.
Depending on the case, preparatory eye drops are prescribed one hour before and after the session.
The patient sits in front of the laser with the eye held open by a contact lens.
La séance dure environ 1 minute et est indolore, le patient pouvant travailler et reprendre ses activités 1/2 heure après la séance.
It is usual to offer a 2nd session 2 to 4 weeks after the first.
The final effect on blood pressure is seen after one month.
It will therefore be necessary to continue the previous medical treatment and reduce it after a month depending on the reduction in blood pressure achieved.
Argon Laser Trabeculectomy or SLT is reimbursed by Social Security (and Mutual Insurance Companies) as part of this glaucoma operation.
Place of laser in the treatment of glaucoma
Il est habituel de commencer par un traitement médical, sauf dans certaines indications où le Laser peut être proposé d’emblée.
Le Laser est indiqué en cas de mauvaise observance ou de mauvaise tolérance au traitement par collyres.
It is also indicated to reduce the number of eye drops prescribed.
Il permet également d’éviter ou de retarder le recours à la chirurgie ou en cas de résultat décevant de la chirurgie.
Please note that the use of the SLT Laser does not reduce the chances of success of the surgery or the effectiveness of any eye drop treatment that may be prescribed subsequently.
Conclusions
L’efficacité du Laser SLT afin d’abaisser la tension oculaire à long terme a été prouvée au travers d’une centaine d’études internationales.
Elle est équivalente à l’Argon dans le traitement des glaucomes à angle ouvert.
It is equivalent or even more effective than antiglaucomatous eye drops used as monotherapy.
Studies confirm the absence of thermal effects and validate this non-invasive method with an excellent safety profile.
Retreatments are possible without risk of altering the chances of future surgery.
The SLT Laser is therefore the new reference solution for glaucoma surgery.