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Endoscopic Laser Treatment
For persons with severe glaucoma damage that has not been successfully managed by standard glaucoma surgery, or for types difficult to treat such as neovascular glaucoma, there is a surgical technique available which may prove to be effective — endoscopic laser surgery.
Endoscopic laser surgery is a type of cyclodestructive surgery — surgery that actually destroys part of the ciliary body, the part of the eye that produces intraocular fluid. This helps to lower the eye pressure. Diode and Nd:YAG Laser Cyclophoto-coagulation are other types of surgery that work this way.
Working from the Inside
The tool used for this surgery, a laser endoscope, is as thin as a large paper clip, and consists of small optical fibers that are used as lenses and cameras.The surgeon controls the progress of surgery by viewing a video monitor, rather than imaging through an operating microscope.The laser is applied directly to the eye tissue that needs to be removed.
Endoscopic laser treatment has possible advantages over other similar types of surgery. With other types of cyclodestructive surgery, doctors apply the laser from the outside.In endoscopic laser surgery, doctors can directly target the tissue they need to remove from the inside.
Inflammation and temporary postoperative pain are common side effects of cyclodestructive surgeries. The intensity of these effects has been reported to be less with endoscopic laser treatment.As with other cyclodestructive surgeries, because part of the ciliary body is being destroyed, there is a risk of the eye pressure dropping too low to maintain the eye’s normal metabolism and shape.
Endoscopic laser surgery is available outside of clinical trials. The long term effects of this surgery are still being evaluated.
Contributor: Joseph Caprioli, MD. Dr. Caprioli is Frances and Ray Stark Professor of Ophthalmology and Chief, Glaucoma Division at Jules Stein Eye Institute, University of California Los Angeles.
This article appeared in the Spring 1999 issue of Gleams. Subscribe