LUMENIS SELECTA - Inadvertent Patient Movement; Bleeding

Iridotomy—1064 nm Nd:YAG  113
Selecta
PBL200051, Rev J
• energy levels greater than 10 mJ are used
• there is apposition of the peripheral iris to the lens as might occur
with extensive posterior synechiae
To reduce the risk of lens damage when an iridotomy is performed, the
following actions are recommended:
• ensure good patient fixation
• use an appropriate contact lens
• select an iris treatment site as far in the periphery as is practical (as
with all iridotomies, the site should be located under the upper lid
whenever possible)
• focus the aiming beam on the surface of the treatment site
• use the minimum number of pulses per burst
• use the lowest possible amount of energy per pulse
• avoid treatment through a site that is already totally or partially
patent
Inadvertent patient movement
Inadvertent or uncontrolled eye movement by the patient may result in
hitting tissues adjacent to the target. If a patient cannot fixate with the
untreated eye to assure stabilization of the treated eye, retrobulbar anesthesia
injection is recommended.
Bleeding
Mild, localized bleeding occurs in 20% to 50% of eyes undergoing Nd:YAG
laser iridotomy. Mild hyphema is rare (less than 2%) and severe hyphema is
very uncommon (less than one in 200). Unlike an argon laser, an Nd:YAG
laser creates minimal heat at the treatment site and, therefore, does not
cauterize vessels. Eyes with engorged iris blood vessels (active uveitic,
neovascular, or angle closure glaucoma) are at an increased risk of bleeding.
Patients who are otherwise at risk of bleeding (as with hemophilia or those
receiving anticoagulant therapy) are also at an increased risk of bleeding and
hyphema.
In otherwise normal patients with pupillary block glaucoma, bleeding usually
stops spontaneously and can be controlled by digital pressure upon the
contact lens. All eyes should be observed with a biomicroscope for bleeding. If
bleeding occurs, additional Nd:YAG laser treatment may aggravate it. Further,
if bleeding does not stop spontaneously or after applying digital pressure,
argon laser photocoagulation of the bleeding site may be necessary.