Laser trabeculoplasty for glaucoma

Surgery Overview

Laser trabeculoplasty uses a very focused beam of light to treat the drainage angle of the eye. This surgery makes it easier for fluid to flow out of the front part of the eye, decreasing pressure in the eye.

There are two types of laser trabeculoplasty:

• Argon laser trabeculoplasty (ALT) uses a laser to open up the drainage angle of the eye.
• Selective laser trabeculoplasty (SLT) uses a lower level laser to open the drainage angle of the eye.

For laser trabeculoplasty:

• Eyedrops are put in the person's eye before or after the procedure to decrease the amount of fluid in the eyes and prevent elevation in eye pressure immediately after laser treatment.
• A special microscope (slit lamp) and lens (goniolens) are used to guide the laser beam to the canals (trabecular meshwork) where fluid drains from the eye.
• The doctor makes small burns in the trabecular meshwork.

Some people feel a heat sensation in the eye during the laser surgery.

What To Expect After Surgery

Laser trabeculoplasty can be done without the person being admitted to the hospital. The person needs to be checked by the doctor within 2 hours of the surgery. The person will also need to see the doctor for a follow-up exam as recommended.

Why It Is Done

Laser trabeculoplasty may be helpful in treating people with open-angle glaucoma that continues to get worse in spite of medication treatment. It may also be helpful in treating older adults with open-angle glaucoma who are not able to use medicines to treat the condition.

Laser trabeculoplasty for open-angle glaucoma is usually done before other surgical procedures are tried.

How Well It Works

Argon laser trabeculoplasty lowers the pressure in the eye about 75% of the time.¹ Research comparing ALT and the newer SLT has shown that SLT lowers pressure in the eye about the same or slightly better than ALT.² People usually need to continue taking medicine after laser surgery to keep down the pressure in their eyes.¹

Control over the pressure inside the eye may decrease as time passes. Argon laser trabeculoplasty is often not effective when repeated. But experts believe that SLT may be repeated because it uses a lower level of laser and causes less scarring than ALT. SLT may be used if ALT fails to lower eye pressure. The results of repeated laser surgeries are less predictable than the first surgery.

Decreased vision is usually a temporary problem unless there is a significant rise in the pressure inside the eye. Very high pressures inside the eye can lead to permanent vision loss.

Risks

If excessive scar tissue forms after laser trabeculoplasty for open-angle glaucoma, other surgery may be needed.

Complications of laser trabeculoplasty are rare. The most common complication of laser surgery for glaucoma is an increase in the pressure in the eyes. The pressure may be normal immediately after laser surgery and rise sharply within 1 to 4 hours after laser surgery. This complication can be prevented by using apraclonidine or brimonidine before or after laser surgery, especially in people with high intraocular pressure before laser surgery.

Other complications of laser surgery may include:

• A brief period of inflammation of the colored part of the eye (iris).
• Cloudiness of the clear covering (cornea) over the iris. This usually does not last long.
• Blockage of the drainage angle when the cornea and the iris stick together.
• Pain.
• Decreased vision.

What To Think About

Laser trabeculoplasty is less effective in people who have inflammatory glaucoma, a type of glaucoma caused by an existing inflammation, and in young people who have developmental defects.

The drop in pressure in the eye after laser surgery may not be enough to prevent loss of eyesight in people with very high pressure who have already lost some of their vision.

If damage to the optic nerve continues after laser trabeculoplasty, other surgery may be needed.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Author:	Jeannette Curtis	Last Updated: May 23, 2008
Medical Review:	Kathleen Romito, MD - Family Medicine Carol L. Karp, MD - Ophthalmology
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