Transcript Lasers In Ophthalmology

ADVANCES
IN
LASER
&
EYE
SURYA
Dr. Ajay Dudani
Dr. Vinod Goyel
ZEN EYE CENTRE
Khar, Mumbai
SURYA EYETECH
Mulund, Mumbai
ISO 9001 : 2000 Certified
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What is LASER ?
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L
A
S
E
R
- Light
- Amplification
by
- Stimulated
- Emission
of
- Radiation
What is LASER ?
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Substances have the property to “lase” i.e.absorb
energy in one form & emit a new form of light
energy which is more useful.
Types of Lasers
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LASERS
Gas
Solid State
Metal
Vapour
EXCIMER
Argon
Ruby
Copper
Argon Fluoride
Krypton
Nd Yag
Gold
Helium
Neon
Carbon Dioxide
Dye
Diode
Tissue Interactions
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LASERS
Gas
Solid State
Argon
Ruby
(Photo coagulatn)
(Photo coagulatn)
Metal
Vapour
EXCIMER
Copper
Argon Fluoride
(Photo ablation)
Krypton
Nd Yag
Gold
(Photo coagulatn)
(Photo coagulatn)
(Photo disruption)
(Photo dynamic)
Helium
Neon
Carbon Dioxide
(Photo vaporisation)
Dye
Diode
(Photo coag.)
(Photo dynamic)
(Photo coag.)
Modes of Operation
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Mode depends on
• Laser material &
• Mode of excitation of material
Two modes• Continuous wave operation
• Conventional pulsed operation
- Q switched
- mode locked
Delivery Systems
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• Transpupillary
- Slit lamp
- Laser Indirect
Ophthalmoscopy
• Trans scleral
- Contact
- Non contact
• Endophotocoagulation
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Radiation Wavelengths
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•
•
•
•
•
•
193 nm
488 - 514 nm
694.3 nm
780 - 840 nm
1064 nm
10,600 nm
- Excimer (Cornea)
- Argon (Retina)
- Ruby
- Diode
- Nd Yag (Capsule)
- Carbon dioxide (Skin)
Uses
Diagnostic
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Therapeutic
Diagnostic Uses
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•
•
•
•
Laser Fluorescence Spectroscopy
Scanning Laser Ophthalmoscopy
Laser Interferometry
Fundus Fluorescein Angiography
Ffa PIC
Therapeutic Uses
Widely Used • Extra-ocular adnexae
• Anterior Segment
• Posterior Segment
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Therapeutic Uses
A.
Extraocular Adnexae
i. Removal of lid masses
ii. Orbitotomies
iii. Blepharoplasty, Aesthetics (smoothen
wrinkles)
iv. Capillary hemangioma, Portwine stain
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Therapeutic Uses
B. Anterior Segment
i. LASIK, PRK, PTK
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Therapeutic Uses
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What is LASIK ?

Suitable for 2 to 9 Dioptres of Ref. Error

OPD Procedure

5 minutes per eye
Therapeutic Uses
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LASIK
Suction Ring
Microkeratome
Flap Removed
Therapeutic Uses
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LASIK
LASIK
Flap Replaced
Post - Op.
Therapeutic Uses
B.
Anterior Segment
ii. Conjunctival / Corneal Growths,
Neovascularization
iii. Cyclophotocoagulation
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Therapeutic Uses
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B.
Anterior Segment
Therapeutic Uses
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What is Glaucoma ?
Therapeutic Uses
B.
Anterior Segment
iv. Reopen failed
filtering blebs
v. Iridoplasty,
Gonioplasty
vi. Iris cyst,
Pupilloplasty
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Therapeutic Uses
B.
Anterior Segment
vii. Posterior Capsular Opacification
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Therapeutic Uses
C.
Posterior Segment
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Therapeutic Uses
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What is Diabetic Retinopathy ?
Therapeutic Uses
What is Diabetic Retinopathy ?
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Therapeutic Uses
What is Diabetic Retinopathy ?
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Therapeutic Uses
What is Diabetic Retinopathy ?
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Therapeutic Uses
What is Diabetic Retinopathy ?
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Therapeutic Uses
What is Diabetic Retinopathy ?
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Therapeutic Uses
What is Diabetic Retinopathy ?
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
Severity of DR runs parallel to the duration of DM

50 % of Diabetics have DR after 10 years of DM

90 % of Diabetics have DR after 20 years of DM

A regular checkup every 6 - 12 months can detect
early changes & prevent blindness
Therapeutic Uses
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i.
Diabetic Retinopathy
Therapeutic Uses
i.
Focal
Diabetic Retinopathy
Grid
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Panretinal
Therapeutic Uses
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ii.
Retinal Haemorrhage
Therapeutic Uses
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iii.
Retinal Breaks or Tears
Therapeutic Uses
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C.
Posterior Segment
iv.
Subretinal neovascularisation
v.
Central serous retinopathy
Therapeutic Uses
C.
vi.
Posterior Segment
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Vitreolysis in cystoid macular edema
Therapeutic Uses
C.
vii.
Posterior Segment
Vitreous traction bands, to free
encapsulated foreign bodies
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Therapeutic Uses
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C.
Posterior Segment
viii. Drainage of subretinal fluid / haem.
Therapeutic Uses
C.
ix.
Posterior Segment
Intraocular tumors (RB)
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Therapeutic Uses
C.
ix.
Posterior Segment
Intraocular tumors (Choroidal
Melanoma)
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Therapeutic Uses
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C.
x.
Posterior Segment
Laser scleral buckling
Therapeutic Uses
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D.
i.
ii.
iii.
iv.
Miscellaneous Uses
Neovascular stimulation
Aseptic phototherapy for pre-op
preparation
Laser asepsis for diagnosed infectious
corneal ulcers
Endonasal DCR
What is the Latest ?
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• PDT
• TTT
(Photo Dynamic Therapy)
(Transpupillary Thermo Therapy)
What is ARMD ?
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Two types 
Dry ARMD

Wet ARMD
What is ARMD ?
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Wet ARMD 
Rare

More devastating

Drusen

SRNVM
What is ARMD ?
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Drusen
What is ARMD ?
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SRNVM
What is ARMD ?
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Vision in ARMD
What is PDT ?
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 Visudyne (Verteporfin)
 “Smart Bomb” for wet ARMD
 Selective Damage
of SRNVM
 Costly
What is PDT ?
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What is PDT ?
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What is PDT ?
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What is PDT ?
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What is PDT ?
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Zeiss Visulas
690s and
Visulink
PDT adapter
Coherent Opal
Photoactivator
and LaserLink
adapter
What is PDT ?
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What is PDT ?
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 Treatment is designed to reduce the
risk of vision loss
 Vision improves in few cases
 Re-treatment is often required at 3-month
intervals during the first 2 years
What is TTT ?
 For wet ARMD
 “Slow Cooking” of CNVM
 Cheap
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Lasers can….
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 Save a child’s eye as in Retinoblastoma
 Change a personality as in LASIK
 Cure a middle aged person with Glaucoma
 Restore Vn. in a person with After-Cataract
 Preserve & Retain Vn. in pts. with DR & ARMD
 The possibilities are endless…...
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THANK
YOU