Most Likely Side Effects of a Glaucoma Laser Surgery

Glaucoma modes of treatment include medications, laser, or intraocular surgery. In all three modes of treatment, the goal is to reduce the intraocular pressure (IOP) that is too high for the eye and that can result in optic nerve damage, subsequently leading to peripheral or central visual field loss. Glaucoma laser surgery was developed as an adjunct and supplement to topical and oral medications. It has been developed by Wise and Witter in the 1970s and is known as Argon Laser Trabeculoplasty (ALT). Several side effects appear after ALT notably elevated IOP and inflammation as well as peripheral synechiae as the result of coagulation of the trabecular meshwork tissue. In 1999, Latina and Park developed a laser treatment called Selective laser trabeculoplasty (sometimes cold-laser) that can reduce IOP in patients with open-angle glaucoma. Unlike ALT, SLT has the advantage of reducing collateral damage to surrounding tissues, making repeat treatments possible, and minimizing the incidence of iritis and elevated IOP compared to ALT.

SLT is reportedly a relatively safe procedure compared to ALT. Studies in 2014 revealed a number of reported side effects, including elevated IOP, iritis, choroidal effusion, hyphema, macular edema, foveal burns, corneal edema, diffuse lamellar keratitis, and refractive shifts (hyperopic and myopic). Over the years and with the advancement of technology SLT became very safe with a favorable side effect profile, even when compared with medications. SLTs are repeatable however their success is reduced when repeated. For this particular reason, many practitioners prefer to treat the tissue partially on many occasions in order to obtain positive results in each intervention.

Micropulse laser trabeculoplasty (MLT) is the third procedure that clinical results were reported by Ingvoldstad and collaborators at the Association for Research in Vision and Ophthalmology meeting in 2005. MLT is designed to reduce the amount of energy delivered to ocular tissues by pulsing the energy in small increments. It, therefore, has similar potential benefits as SLT in terms of lower inflammation, tissue scarring, and repeatability. The IOP lowering results of all three laser procedures ALT, SLT, and MLT are comparable with MLT providing the least discomfort both during and after treatment.