Laser trabeculoplasty uses a focused laser beam to treat the drainage angle of the eye and lower intraocular pressure (IOP) by making it easier for fluid to drain from the front of the eye. The first successful protocol for laser trabeculoplasty was described in 1979 using an argon laser. Laser trabeculoplasty is now performed using various laser types and is indicated when IOP remains high despite medication or when surgery needs to be deferred. Argon laser trabeculoplasty specifically treats the trabecular meshwork to improve drainage and uses an argon laser through a gonioscope during the procedure.

1. LASER TRABECULOPLASTY

2. Trabeculoplasty ???
• Laser trabeculoplasty uses a very focused
beam of light to treat the drainage angle of
the eye. This surgery makes it easier for fluid
to flow out of the front part of the eye, in
order to lower the IOP in the eye.

3. HISTORY
In 1961, Zweng and Flocks introduced the
concept of applying light energy to the
anterior chamber angle for the treatment of
glaucoma.
 In 1979, Wise and Witter described the first
successful protocol of what has become
known as laser trabeculoplasty.

4. 1979 Argon Laser [488 nm blue-green, 514 nm
green]
 1984 Krypton Laser [red 647.1 nm, yellow 568.2
nm]
 1988 Nd:YAG Laser [1064 nm]
1990 Diode Laser [810 nm]
1996 Solid State “ALT” [532 nm]
2001 Frequency Doubled Nd:YAG laser: SLT [532
nm]
2006 Diode Micro Pulse Laser: MLT [810 nm]
 2008 Titanium: Sapphire Laser [790 nm]

6. INDICATIONS
when IOP remains above "target" IOP despite
maximally tolerated medical therapy
when patients are noncompliant
 pseudoexfoliation glaucoma
 when surgery needs to be deferred due to a
patient's systemic status

7. CONTRAINDICATIONS
Narrow angles
 Presence of peripheral anterior synechiae
 Uveitis
 Advanced glaucoma
 Developmental glaucoma

9. TYPES
 Argon Laser Trabeculoplasty (ALT)
Selective Laser Trabeculoplasty
(SLT)

10. ARGON LASER TRABECULOPLASTY

11. Definition
• It is a laser treatment for glaucoma
• It is done on an Argon Laser equipped slit
lamp, using a Goldman gonioscope lens
mirror.
• Specially, Argon Laser is used to improve
drainage through the eye’s trabecular
meshwork.
• It helps to reduce IOP caused by open angle
glaucoma.

12. PREOPERATIVE PREPARATION
• Patients are instructed to continue all glaucoma
medications on their regular schedule.
• Patients are routinely pretreated with
apraclonidine to prevent a significant IOP spike
that could adversely affect visual function.
• The eye should not be exposed to diagnostic
procedures before the treatment because this
can affect corneal clarity.

13. POSTOPERATIVE MANAGEMENT
• The patient is instructed to continue all glaucoma
medications as usual and begin a topical steroid
drop four times a day for 4 to 5 days.
• If the patient has had a significant IOP elevation or
has severe glaucomatous damage, the IOP is
measured the next day.
• Most patients are reexamined 2 to 5 days later and
then at about 4 weeks.
• If at 4 weeks the pretreatment goal has not been
achieved, the second half of the angle can be
treated.

14. COMPLICATIONS
Transient IOP elevation
Iritis
 Peripheral anterior synechiae
Membrane covering the entire trabecular
meshwork