Laser Retinopexy Techniques and Applications

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Questions and Answers

What is the typical spot size used for laser retinopexy with a three-mirror contact lens?

100–150 μm

200–300 μm (correct)

150–250 μm

250–350 μm

In cases of retinal holes with a fluid cuff, what is typically the surgeon's immediate action if the patient is symptomatic?

Delay intervention to monitor changes

Perform a laser retinopexy (correct)

Observe the hole without intervention

Initiate vitrectomy immediately

What is the maximum power setting suggested to begin laser retinopexy?

100 mW

300 mW

200 mW (correct)

150 mW

Why is it important for ophthalmologists to laser in a specific pattern during retinopexy?

To achieve proper sealing of the retinal tear Signup and view all the answers

What role does the condensing lens play in the delivery of laser treatment using headmounted BIO?

It helps in estimating and adjusting the spot size Signup and view all the answers

What is the primary purpose of applying laser treatment around a retinal tear?

To create a barricade to prevent fluid spread Signup and view all the answers

What is a potential consequence of laser treatment applied directly to the fovea?

Disruption of the ellipsoid zone Signup and view all the answers

In which area of the retina are tears most likely to occur?

Mid periphery Signup and view all the answers

Why is vision loss considered rare when procedures are performed in the far periphery of the retina?

These procedures do not affect the posterior pole Signup and view all the answers

What might complicate laser treatment in individuals with albinism?

Absence of retinal pigment epithelium for scarring Signup and view all the answers

What does anatomical success in retinal surgery not guarantee?

Return to baseline vision Signup and view all the answers

What is a typical reason for opting for surgical intervention over laser treatment?

Tears too large to be treated effectively with laser Signup and view all the answers

What role does anesthesia play during retinal surgery?

It ensures no memory of the procedure after surgery Signup and view all the answers

What is the primary purpose of eye drops used during surgery according to the provided content?

To dilate the eye Signup and view all the answers

What effect does anesthesia have on patients undergoing eye surgery?

It puts patients into deep sleep without memory of the procedure Signup and view all the answers

What does traction on the macula during surgery potentially cause?

Macular distortion Signup and view all the answers

In laser procedures, which factors can surgeons adjust within a given range?

Duration of laser pulse, power, and spot size Signup and view all the answers

What condition can potentially arise due to vascular compromise during a procedure?

Ant segmentation ischemia Signup and view all the answers

What is a key difference between a vitrectomy and a scleral buckle in managing retinal issues?

Vitrectomy alleviates traction, but a scleral buckle does not Signup and view all the answers

What may happen to intraocular pressure (IOP) following the surgical procedure described?

It typically rises but resolves quickly Signup and view all the answers

Which surgical tool is designed to release traction and assist in pulling up the internal limiting membrane (ILM)?

Membrane peeling tweezers Signup and view all the answers

Study Notes

Laser Retinopexy Overview

Laser retinopexy is a procedure often performed under topical anaesthesia, although regional or general anaesthesia may be necessary.
Typical settings include a duration of 0.1 seconds, a spot size of 200–300 μm with a three-mirror contact lens or 100–200 μm with a wide-field lens, and an initial power of 200 mW.
Power adjustments are made to achieve moderate blanching of the retina.

Application Technique

Two to three rows of confluent burns are applied around the lesion to create a sealing effect.
Head-mounted BIO delivery requires adjustment of the condensing lens (usually 20 D) for proper spot size estimation.
Caution is essential to identify anatomical landmarks frequently to prevent macular damage.

Retinal Conditions and Management

Retinal holes can be associated with fluid cuffs, indicating movement of fluid under the retina; surgical intervention is required if symptomatic.
The primary goal is to create a “gate” around the tear or hole to prevent fluid spread and further retinal damage.
Fresh laser application results in immediate markings, which develop into darker scars after a few weeks.

Challenges in Treatment

Retinal dialysis or other conditions at the ora can benefit from laser application as a barricade to protect the posterior pole, which is crucial for vision.
Vision loss is rare due to procedures being performed in the far periphery of the retina.
There are inherent risks with laser treatment, including retinal tissue destruction, especially if applied to sensitive areas like the fovea.

Special Considerations

Patients with albinism or a blonde fundus may lack the required retinal pigment epithelium (RPE) leading to complications in scarring during laser treatment.
Retinal tears are most likely to occur in the mid-periphery due to stronger attachments at the ora, optic nerve, and macula.

Surgical Indications

Surgical intervention is typically recommended for large tears that cannot be repaired with laser, or in cases of retinal detachment.
Anatomical success does not necessarily correlate with visual success post-procedure.

Patient Experience During Surgery

Patients may receive sleep medicine for deep sedation, often resulting in amnesia of the procedure.
Alternatives include local anaesthesia with eye drops and injections for comfort, with possible pupil dilation.

Clinical Training and Equipment

Upcoming laser labs will provide hands-on experience with laser technology, allowing students to adjust pulse duration, power, and spot size within standard parameters.
Ant segment ischemia, although uncommon, may occur due to vascular compromise from surgical pressure, temporarily raising intraocular pressure.

Tractional Retinal Detachment (RD) Management

Tractional RD may involve fibrous tissue that distorts the macula, making surgery (PPV) necessary to relieve traction, which differs from scleral buckle techniques.
Tools are utilized to release traction and reposition the inner limiting membrane (ILM) for better retinal stability.

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Description

This quiz explores the key techniques and applications of laser retinopexy in retinal care. It covers procedural details, settings, and the management of retinal conditions that may require surgical intervention. Test your knowledge on how to effectively use laser therapy for retinal issues.