Laser Retinopexy & Scleral Buckle Procedures PDF

Laser retinopexy. Using slit lamp delivery under topical anaesthesia (occasionally regional or even general anaesthesia is required), typical settings are a duration of 0.1 second, a spot size of 200–300 μm with a three- mirror contact lens or 100–200 μm with a wide-field lens, andst...

Laser retinopexy. Using slit lamp delivery under topical anaesthesia (occasionally regional or even general anaesthesia is required), typical settings are a duration of 0.1 second, a spot size of 200–300 μm with a three- mirror contact lens or 100–200 μm with a wide-field lens, andstarting power of 200 mW; the power should be adjusted asappropriate to obtain moderate blanching. With headmounted BIO delivery, the spot size is estimated and adjusted by adjusting the condensing lens (usually 20 D) position. The lesion is surrounded with two to three rows of confluent burns (Fig. 16.25). With both forms of laser, care should be taken to identify appropriate landmarks frequently to avoid inadvertent macular damage - Ophthalmologists are taught to laser in this patter for proper sealing of the tear - In tears that are far peripheral, we may not get ability to see to the anterior aspect of the tear, so the surgeon could indent then fn - Here we see a retinal hole with a fluid cuff in the superior quadrant, there is an operculum; Although there is an operculum, the cuff around here shows that fluid has already begun to move under the retina; particularly if the patient is symptomatic, you will need to repair this - The area has been lasered The area where there is a hole is still present, but it will not get any bigger because it is “gated off” - Is this a retinal hole or a retinal tears? - It is a hole, but why would we laser it if it is a hole? - There is fluid around it - The basic idea is to create a gate around the tear/hole so that the fluid can’t spread and it cannot get any bigger - This is a picture of fresh laser - After a few weeks the areas that are lasered with scar, causing a much darker laser scar to form If you have a retinal dialysis or another entity at the ora, you can apply the laser as a barricade so it does not move posterior - You want to protect the posterior pole, since so much of your usable vision is in that area -vision loss is super rare bc these procedures are being done in the far periphery - Laser is burning areas of the retina, so there will always be retinal tissue that is not viable after that; the trade off between a smal - This is a laser burn directly to the fovea - Do you think this would cause a change in vision – yes; the reason being that the ellipsoid zone is disrupted so your photoreceptors are not properly able to transduce information - This is a very bad outcomes; I have not see this in real life, very uncommon - Laser is burning areas of the retina, so there will always be retinal tissue that is not viable after that; the trade off between a smal - This is a laser burn directly to the fovea - Do you think this would cause a change in vision – yes; the reason being that the ellipsoid zone is disrupted so your photoreceptors are not properly able to transduce information - This is a very bad outcomes; I have not see this in real life, very uncommon -if someone has a blonde fundus or has albinism they don’t have RPE to form that scarring so it is more challenging if they have a retinal tear to do laser and may need to use a different intervention - -where is the retina most likely to have a retinal tear à mid periphery -we know that the retina is strongly attached at the ora, optic nerve, and macula and mid periphery is attached but not as strong in that area - Typically we do surgery when the tear is too large can’t repair on its own with laser or if you have a retinal detachment - This the pathophysiology of a retinal detachment -anatomical success does not equal visual success  You may receive sleep medicine (anesthesia) to put you to sleep. If this is the case, you will sleep deeply through the surgery and will not remember it afterwards. In other cases, you may be awake during the surgery. You will receive a medicine to help you relax. In this case, your eye care provider may use eye drops and injections to make sure you do not feel anything. Your eye care provider may give you eye drops to dilate your eye.  You may receive sleep medicine (anesthesia) to put you to sleep. If this is the case, you will sleep deeply through the surgery and will not remember it afterwards. In other cases, you may be awake during the surgery. You will receive a medicine to help you relax. In this case, your eye care provider may use eye drops and injections to make sure you do not feel anything. Your eye care provider may give you eye drops to dilate your eye.  You may receive sleep medicine (anesthesia) to put you to sleep. If this is the case, you will sleep deeply through the surgery and will not remember it afterwards. In other cases, you may be awake during the surgery. You will receive a medicine to help you relax. In this case, your eye care provider may use eye drops and injections to make sure you do not feel anything. Your eye care provider may give you eye drops to dilate your eye.  You will learn more about this in your advanced procedures lab and class; about retinal lasers and how they are applied - When you have your laser lab, you will be trying some of these laser machines - But there are a few things you can change; how long each puslse of laser is applied, how much power you are using, and the size of the spot - There are some standards for various procedures, but you can change within a range  Ant seg ischemia can happen due to vascular compromise from the pressure of the band – not common but it can happen The patients often have high IOP after the procedure, but this resolved relatively quickly -this is pushing from inside out so pushing the retina towards the choroid/sclera -also can involve laser to create scars - Tractional RD on the right - Area of traction/fibrocit tissues on the left - Tractional RD on the right - Area of traction/fibrocit tissues on the left - Traction on the macula can cause distortion of the macula and can do a PPV on this pt bc it relieves traction in this whereas scleral buckle doesn’t - Area of traction/fibrocit tissues on the left - This took is used to release traction and pull up the ILM - This took is used to release traction and pull up the ILM