Laser Techniques in Ophthalmology: A Guide to YAG and Photothermal Laser Treatments in Clinic

Description

This is a practical guide to using lasers in the Eye clinic and includes all commonly performed Lasers for a range of ocular conditions. It uses multiple illustrations of real-life fundus photographs, FFA images, OCT images and digitally modified retinal images to simplify learning the fundamentals of laser physics and physiology, laser safety and an overview of the variety of ophthalmic lasers in current use. It standardizes Laser procedures and serves as a reference guide for Ophthalmic trainees learning the technique that can be transferred to their clinical practice. The book simplifies understanding of Ophthalmic Lasers and answers common questions of how and why things are done. Key Features • Emphasizes on Nd-YAG Laser, Lasers in Glaucoma and Photothermal Lasers for Retinal Pathology, with clarity on techniques and pearls on dealing with common laser related issues that come with experience. • Provides content in a Q&A format which is ideal as a lesson from trainer to trainee and answers all the doubts and laser related questions a trainee may have and aids their learning and progression to performing Lasers safely and independently. • Uses digitally modified images with bullet points and reference text boxes, making the content user friendly and easy to understand. Cover Half Title Title Page Copyright Page Dedication Table of Contents Acknowledgements Trainee Feedback About the Author Glossary Introduction 0.1 Lasers in Ophthalmology (Diagnostic and Therapeutic) Therapeutic Role of Lasers in Ophthalmology Section 1 Basic Principles of Laser 1.1 Laser Physics 1.1.1 Properties of Laser Light 1.1.2 Understanding Laser Physics 1.1.3 How Does an Atom in the Ground State Move to an Excited State? 1.1.4 Stimulated Emission 1.1.5 Parts of a Laser 1.2 Parameters of Laser Light – Determines Its Tissue Biological Effects 1.2.1 Laser Wavelength 1.2.2 Tuneable Lasers 1.2.3 Power 1.2.4 Mode 1.3 Laser Delivery Systems 1.3.1 Slit Lamp Laser Delivery 1.3.2 Binocular Indirect Ophthalmoscopy (BIO); Laser Indirect Ophthalmoscopy (LIO) 1.4 Laser Tissue Interaction 1.4.1 Principles of Laser Tissue Interactions 1.4.2 Laser Mechanisms in the Retina 1.4.3 Starling’s Law and Macular Oedema 1.4.4 How Does Focal Laser Treatment Reduce Macular Oedema? 1.5 Laser Hazard and Laser Safety Protocols 1.5.1 Laser Classification and Safety (ANSI Standards) 1.5.2 Laser Safety Protocols Know Your Laser Safety Officer in the Hospital. 1.5.3 Laser Safety Eyewear 1.6 Laser Lenses 1.6.1 Advantages of Contact Lenses in Lasers 1.6.2 Safety Principles of Contact Lenses 1.6.3 Laser Cone Angle 1.6.3.1 Optical Characteristics of Ocular Media 1.6.4 Lens Classification 1.6.5 Common Features of Laser Contact Lenses 1.6.6 Lens Used With YAG Laser 1.6.7 Contact Lenses Used in Conjunction With Photothermal Lasers 1.6.7.1 Common Contact Lenses Used in the Laser Clinic 1.6.7.2 Volk Lenses for Laser 1.6.7.3 Indirect Ophthalmoscopy Suggested Reading Section 2 YAG Laser 2.1 The Nd-YAG Laser 2.1.1 Getting Started 2.2 YAG Laser Posterior Capsulotomy 2.2.1 Pathophysiology of Posterior Capsular Opacification 2.2.2 Posterior Capsular Opacification in Paediatric Patients 2.2.3 Types of Capsular Opacification 2.2.4 How Does YAG Laser Work? 2.2.5 YAG Capsulotomy 2.2.6 YAG Capsulotomy Techniques – Two Main Techniques 2.2.7 Treatment Procedure 2.2.8 Size of the Posterior Capsulotomy 2.2.9 YAG Capsulotomy With Eccentric Pupil 2.2.10 Complications of YAG Capsulotomy 2.2.12 Newer Concepts in Posterior Capsulotomy 2.2.14 IOL Opacification/Calcification 2.3 Capsular Block Distension Syndrome 2.3.1 Pathophysiology of CBDS 2.3.1.1 CBDS Presentation 2.4 Anterior Capsulotomy 2.5 Inflammatory Pupillary Membrane and Synechiolysis in Pseudophakes 2.5.1 Clearance of Inflammatory IOL Deposits 2.5.2 Clearance of Retained SLM in the Visual Axis 2.6 YAG Laser Vitreolysis 2.6.1 Treatment 2.6.2 YAG Vitreolysis for Vitreous Wick 2.7 YAG Laser Hyaloidotomy 2.7.1 Procedure 2.7.1.1 Pre-Treatment Drops 2.7.1.2 Treatment Section 3 Lasers in Glaucoma 3.1 Introduction 3.1.1 Outflow Enhancing Procedures 3.1.2 Inflow Reducing Procedures (Aqueous Production) 3.2 YAG Laser Peripheral Iridotomy (LPI) 3.2.1 Indications for YAG LPI 3.2.2 How Does YAG LPI Work? 3.2.3 Laser Peripheral Iridotomy – Procedure 3.2.4 Complications of LPI 3.2.5 Sequential Argon/PASCAL Iridoplasty With Nd:YAG PI 3.2.6 Outcomes of LPI 3.3 Pigment Dispersion Syndrome (PDS) 3.4 Plateau Iris 3.4.1 Mechanism of Glaucoma 3.4.1.1 Treatment and Outcome 3.5 Iridoplasty 3.6 Selective Laser Trabeculoplasty (SLT) 3.6.1 SLT Vs ALT 3.6.2 Mechanism of Action 3.6.2.1 Recommendations for SLT Use 3.6.3 SLT Laser Technique 3.6.4 Recent Advances Section 4 Photothermal Lasers 4.1 Introduction – Treatment Concepts and Current and New Laser Technology 4.1.1 Current Concepts in Laser Photocoagulation 4.1.2 New Laser Treatments/Technology 4.1.2.1 Reduce Retinal Damage 4.1.2.2 Principles of Modern Retinal Laser Therapy (MRT) 4.1.2.3 Concept of Subthreshold Laser Treatment 4.1.2.4 Subthreshold Diode Micro-Pulse (SDM) Laser 4.1.2.5 New Laser Delivery Systems 4.1.2.6 Navilas Laser System 4.1.2.7 Multi-Spot Pattern Laser Systems 4.1.2.8 Use of Selective and Targeted Retinal Therapy 4.2 Getting Started With Laser Retinal Photocoagulation 4.2.1 PASCAL Laser Machine 4.2.1.1 Laser Treatment Parameters 4.3 Pan Retinal Photocoagulation 4.3.1 Methods of PRP Delivery 4.3.2 Normal Ocular Anatomy 4.3.2.1 Indication for Pan Retinal Photocoagulation 4.3.3 How Does PRP Work? 4.3.4 Getting Started With Pan Retinal Photocoagulation 4.3.5 Schematic Approach to PRP 4.3.6 Understanding Laser Parameters for PRP 4.3.7 Exceptions to Treatment Plan 4.3.8 Aggressive Laser Treatment in Ischaemic Retinal Vasculopathy 4.3.9 Pan Retinal Photocoagulation – Procedure 4.3.10 Starting PRP Treatment – Lesson Based On Treatment-Naïve Eye 4.3.11 Risks of PRP 4.4 Sectoral PRP 4.4.1 When Is Sectoral Laser Treatment Appropriate in BRVO? 4.4.2 Sectoral PRP in BRVO Or HRVO 4.5 Focal Laser Treatment 4.5.1 Indications for Focal Laser Treatment 4.5.2 Is It Essential to Target Microaneurysms? 4.5.3 Pre-Laser Investigations 4.5.3.1 Why Is It Important to Document Other Macular Changes? 4.5.3.2 OCT Documents the Type of Macular Oedema 4.5.3.3 Fundus Fluorescein Angiography 4.5.3.4 Focal Laser Treatment in Diabetic Maculopathy 4.5.3.5 Starting Focal Laser Treatment 4.5.3.6 Grid Laser Treatment 4.5.3.7 Extended Grid Laser Treatment 4.5.4 Grid Laser Treatment – Including the Papillo-Macular Bundle 4.5.4.1 Ischaemic Maculopathy 4.5.4.2 Focal/Grid Laser Treatment Using End Point Management (EPM) 4.5.4.3 Outcomes of FLT 4.5.4.4 Treatment of Persistent Diabetic Maculopathy 4.5.4.5 Complications of Laser Treatment 4.6 Focal Laser Treatment for Non-Diabetic Maculopathies 4.6.1 Retinal Vein Occlusion 4.6.1.1 CRVO and HRVO 4.6.1.2 Branch Retinal Vein Occlusion 4.6.2 Retinal Artery Macroaneurysm (RAM) 4.6.3 Central Serous Chorioretinopathy (CSCR) 4.6.4 Idiopathic Juxtafoveal Telangiectasia (IJFT) 4.6.5 Laser Treatment for Age Related Macular Degeneration 4.7 Laser Retinopexy 4.7.1 Peripheral Retinal Degenerations 4.7.2 Diagnosis of Retinal Holes and Tears 4.7.3 Role of Posterior Vitreous Detachment 4.7.4 Formation of Retinal Holes and Tears 4.7.5 Operculated Retinal Holes 4.7.6 Horseshoe Tear 4.7.7 Treatment of Retinal Holes and Tears 4.7.8 Laser Retinopexy – Procedure 4.7.9 Special Situations Section 5 Approach to Retinal Vascular Disease 5.1 Multimodal Treatment of Retinal Vascular Disease 5.1.1 Anti-VEGF Agents Used Alone Or in Combination 5.1.2 What’s ‘Visually Significant’ DME? 5.1.3 Real-World Implications of Visual Assessment 5.1.4 Steroids + Laser 5.1.4.1 Therapy Switching 5.1.4.2 Lost to Follow-Up Patients (LTFU) 5.1.4.3 Surgery 5.1.4.4 Cataract Surgery 5.2 Approach to Diabetic Eye Disease 5.2.1 Pathogenesis of Diabetic Retinopathy 5.2.2 ETDRS Classification and Clinical Signs of DR 5.2.3 Management of Diabetic Retinopathy 5.2.4 Treatment Strategies 5.3 Approach to Retinal Vein Occlusion 5.3.1 Risk Factors for RVO 5.3.2 Pathogenesis of RVO 5.3.3 Location of RVO 5.3.3.1 Type of Retinal Venous Occlusion 5.3.3.2 How Do You Assess Extent of Ischaemia? 5.3.3.3 Clinical Features of Ischaemic Retinal Vein Occlusion 5.3.3.4 Ischaemia Associated With BRVO 5.3.3.5 RVO Presentation 5.3.3.6 Assessment of RVO 5.3.3.7 Management of RVO 5.3.3.8 Treatment of Macular Oedema 5.3.3.9 Laser Therapy in RVO 5.3.3.10 Laser Treatment for Macular Oedema 5.3.3.11 When Is Laser Used in RVO-Related Macular Oedema? 5.3.4 Laser Treatment for Neovascularization 5.3.4.1 Laser Photocoagulation 5.3.4.2 Outcomes in RVO Acknowledgement of Images Borrowed Index