LUMENIS smart532 - A.5.2. Patient Warnings; A.5.3. Guidelines for Use

Clinical Guide Smart532
™
A-14 UM-1151440EN, Rev. C, May 2016
Warning
● Following photocoagulation, patients should be cautioned
against any activity that could increase the venous pressure in
head, neck, or eyes, such as straining, lifting, or holding their
breath. Patients should be advised to sleep with the head of
their bed elevated 15 to 20°.
● Patients should be cautioned against stifling a sneeze, as this
may raise ocular blood pressure to a high level. Vigorous nose
blowing should also be discouraged. Rubbing the eyes
following photocoagulation may disrupt blood vessels inside
the eyes. Sneezing and coughing should be controlled with
cough syrup or other medications.
● Patients should be cautioned, however, against the use of
medications such as nose drops, sprays, inhalators, or other
medications that contain ephedrine or epinephrine, because
these drugs tend to elevate systemic pressure.
● Immediately following treatment, patients should avoid
altitudes over 2,400 m / 8,000 ft. (commercial aircraft cabins
are pressurized below this altitude).
● For retinal laser treatments, the pupil should be dilated.
● Topical anesthetic is normally adequate, but occasionally
a retrobulbar block is needed.
● A contact lens specifically designed for use with laser energy is placed
on the eye (note: a standard diagnostic contact lens will result in a
power loss due to reflection from the surface of the lens. The reflected
energy may pose a hazard both to the patient and the physician). Such
a contact lens allows the physician to visualize and treat peripheral
areas of the retina which otherwise cannot be reached.
● The power setting depends on a multitude of conditions, such as spot
size, pulse duration, pigmentation and turbidity of the vitreous. The
standard procedure is to find the approximate power by titration using
a continuous waveform, done at a peripheral retinal location: titration
is started with a low power that produces no visible reaction. The
power is then gradually increased until a blanching (faint whitening)
of the retinal spot occurs. Power setting for retinal procedures is
usually 250-750 mW, though lower (down to 50 mW) or higher (up to
1,000 mW) are sometimes used. Once power settings P
vis are identified
through titration using a continuous waveform, if the user desires to
operate in SmartPulse Mode then the power typically used is P
vis
multiplied by a factor of 1.2 to 2.0 (see Table A-2 for references)
● Tissue reaction depends also on pulse duration: longer pulse durations
result in more thermal energy and more temperature increases. For
A.5.2. Patient Warnings
A.5.3. Guidelines for
Use