Trabeculoplasty laser surgery treats open-angle glaucoma, a condition where high pressure inside the eye damages the optic nerve. This non-invasive, outpatient procedure uses a focused laser to target the trabecular meshwork, the tissue responsible for fluid outflow in the eye’s drainage angle. By stimulating or modifying this meshwork, the surgery enhances the flow of aqueous humor, reducing intraocular pressure (IOP) and preventing irreversible vision loss.
Understanding the Different Types of Laser Trabeculoplasty
The two primary methods are Argon Laser Trabeculoplasty (ALT) and Selective Laser Trabeculoplasty (SLT). ALT uses a thermal laser to create microscopic burn spots on the trabecular meshwork, causing a scarring effect that pulls adjacent tissue open to improve drainage. This thermal action causes structural damage, limiting treatment to only half of the drainage angle in one session. Repeat procedures on the same spot are generally unadvisable due to the risk of extensive scarring.
SLT utilizes a lower-energy laser that targets only the pigmented cells within the meshwork without causing thermal damage or scarring. This non-destructive approach uses short-pulsed light to stimulate a biological response in the cells, encouraging them to clean and rebuild the drainage pores. Because the trabecular meshwork architecture is preserved, SLT can be applied to the full 360 degrees of the drainage angle and safely repeated if the pressure-lowering effect wears off. The safety profile and potential for retreatment make SLT the preferred option for many patients.
Preparing for and Undergoing the Procedure
Preparation is minimal. Patients may be instructed to temporarily stop certain glaucoma medications or be given a pre-treatment eye drop, such as an alpha-adrenergic agonist, 30 to 60 minutes prior to the laser. This helps prevent a temporary spike in eye pressure. On the day of the procedure, the eye is numbed with anesthetic drops for comfort, and sometimes a drop to constrict the pupil is also administered.
The procedure is performed in an outpatient setting using equipment similar to a slit lamp microscope. The ophthalmologist places a special contact lens directly onto the eye to keep the eyelids open and allow precise focusing of the laser beam. The laser application usually takes less than ten minutes per eye. Patients may see bright flashes of light and hear a soft clicking sound, but the procedure is generally painless.
Immediate Recovery and Post-Operative Care
After the contact lens is removed, vision may be blurry for a few hours due to the numbing drops and light exposure. Intraocular pressure is typically checked about one hour after the procedure to ensure it has not temporarily risen, which is a possible short-term side effect. Patients must arrange for someone to drive them home, as driving is not permitted immediately following treatment.
Post-operative care involves using anti-inflammatory eye drops for a few days to manage minor discomfort, redness, or inflammation. Patients should avoid rubbing their eyes and refrain from strenuous activity or heavy lifting for a short period. It is also recommended to avoid swimming or exposing the eyes to irritants for about a week to reduce infection risk. Follow-up appointments monitor eye pressure, as the full pressure-lowering effect may take one to three months to become apparent.
Effectiveness and Potential Adverse Reactions
Laser trabeculoplasty is highly effective for lowering IOP, with success rates around 75% in suitable patients. The pressure reduction can last for several years, though the effect gradually decreases over time, sometimes requiring repeat treatment or additional medication. For many patients, SLT can reduce or eliminate the need for daily glaucoma eye drops, representing a significant improvement in quality of life.
While generally safe, potential adverse reactions are usually mild and temporary. The most common immediate complication is a transient increase in IOP within the first hour, which is monitored and managed with eye drops. Other short-term effects include mild inflammation, light sensitivity, and temporary blurred vision, which typically resolve within one to three days. Serious complications, such as prolonged inflammation or retinal swelling, are infrequent.