Selecta
PBL200051, Rev J
112 Professional Use Instructions
Poor candidates for Nd:YAG laser iridotomy
Patients with any of the following conditions may not be suitable candidates
for Nd:YAG laser iridotomy because of the risks of bleeding, or inability to
create an iridotomy or iridotomy closure:
• slight or moderate haze of the cornea or aqueous humor
• chronic uveitis
• pupillary block associated with neovascular glaucoma or with any
condition causing engorged iris blood vessels
• tendency to bleed (as with hemophilia or patients receiving
anticoagulant therapy)
• inability to cooperate in the procedure
• nystagmus
• blepharospasm
Intraocular pressure rise
Significant rises in the IOP occur following both argon laser and Nd:YAG
laser iridotomy in a substantial proportion of treated eyes. The risks of IOP
elevation do not appear to differ between Nd:YAG laser and argon laser
treatment. Patients should therefore be carefully monitored during the post-
operative period. Clinical data suggest that if a pressure rise will develop, it is
almost always detectable within the first two to three post-operative hours. No
risk factors are yet known to be positively associated with this IOP rise after
iridotomy. However, eyes with acute pupillary block glaucoma tend not to
have this problem.
The decision to use additional medical treatment in the event of a rise of IOP
should be based on the status of the individual patient. Most elevations resolve
without intervention within 24 hours of Nd:YAG laser surgery. The treating
physician should take into consideration the pre-existing condition of the
optic nerve and other ocular structures when deciding whether to treat the
eyes with IOP-lowering medication.
Damage to the lens
Clinically visible evidence of crystalline lens damage has been reported
following Nd:YAG laser iridotomies in humans, and has been noted in animal
studies and in human histologic studies. The risk of lens damage during
Nd:YAG laser iridotomy will increase if:
• laser focusing is inaccurate
• laser energy is applied through an already patent iridotomy
• laser energy is applied through the pupil directly to the lens
To Next Page
Loading...
