What is Laser Photocoagulation?

Laser photocoagulation is a method used in various clinical contexts, particularly concerning retinal pathologies.

Laser photocoagulation uses light capable of carrying a considerable amount of energy. Different types of lasers are used in ophthalmology (argon, krypton, diode, Nd-Yag).

The laser can be used for various purposes: coagulation of a vessel, destruction of diseased tissue, creation of scars to strengthen the retina in delicate areas, fixation of healthy retina around pathological areas, etc.

Laser Photocoagulation: Treatable Diseases

Diabetic Retinopathy

Diabetic retinopathy is the most frequent ocular complication of diabetes mellitus. The aim of laser photocoagulation is to destroy lesions that can lead to severe ocular hemorrhages. It should be noted that the treatment does not improve visual acuity but prevents worsening by stabilizing the eye's conditions. The success rate is approximately 80%. Early intervention is crucial.

Macular Edema

This is a pathological condition characterized by inappropriate fluid accumulation in the retina. It is one of the complications of certain retinal diseases such as vascular occlusions, diabetic retinopathy, etc.

Age-Related Macular Degeneration

Also called age-related maculopathy, this is a serious progressive eye disease that causes irreversible impairment of central visual function. Laser photocoagulation allows photocoagulation of the abnormal retinal vessels that have been detected. The laser beam reaches the subretinal areas and destroys the neovascularization. It should be noted that with this type of treatment, there is no improvement in vision; only the leakage of fluid from the abnormal retinal vessels is stopped.

Retinoblastoma

This is a malignant tumor affecting the retina. It is a neoplasm that can occur at any age but usually develops during the first five years of life, so much so that, although considered a rare tumor, it is the most common form of malignant tumor in children. In the case of retinoblastoma diagnosed at an early stage, the blood vessels supplying the tumor mass are destroyed by laser to deprive the tumor of nourishment and cause it to die. Laser photocoagulation is used in the case of very small tumors.

Retinopathy of Prematurity

This is a vascular disease of the retina that occurs in premature infants. Generally, the problem is bilateral. Laser photocoagulation, by destroying diseased tissue, aims to prevent the growth of new retinal vessels that can damage visual acuity.

Degenerative Lesions of the Retinal Periphery

Certain areas of the retina may exhibit structural fragility. In general, this is a problem more frequently found in subjects with high myopia. In these individuals, the lengthening of the eyeball leads to thinning of the retina in the peripheral areas. Peripheral retinal degeneration is a risk factor for retinal detachment. If these degenerations are found, laser photocoagulation should be used as a preventive tool by strengthening and sealing the most at-risk areas.

Choroidal Neovascularization

This is a condition secondary to pathological myopia and is the main cause of visual impairment in subjects under 50 years of age. Laser photocoagulation "burns" the lesion that attacks the macula.

Retinal Vascular Occlusions

Laser photocoagulation is not a suitable tool for the treatment of retinal vascular occlusions, but for its complications (macular edema and neovascularization).

Surgical Technique of Laser Photocoagulation

Laser photocoagulation is a procedure that involves instilling eye drops to dilate the pupil and an anesthetic eye drop, after which a number of laser impacts will be performed with or without the interposition of a lens placed in contact with the eye.

On average, a laser photocoagulation session lasts 15 to 20 minutes. During the procedure, dazzling sensations of unpredictable duration may be felt.

Postoperative Laser Photocoagulation

In the postoperative period of laser photocoagulation, the patient may experience slight discomfort, such as blurred vision, headaches, and dizziness. These problems are usually short-lived.

If there are no particular complications, in most cases it is possible to resume normal daily activities the next day, avoiding the most strenuous ones. You will probably need to use antibiotic eye drops for a few days.

In some cases, however, complete rest may be necessary, and it is always advisable not to exert excessive effort. Proper hydration is important. The laser, in fact, works by heating the retina, and by passing through the eyeball, it also heats the fluid inside. Since the vitreous humor is mostly composed of water, it undergoes a certain decrease. Dehydration of the vitreous humor causes it to contract and increases the risk of vitreoretinal traction that can cause a break in the peripheral retina.

Possible Complications

Laser photocoagulation is not free from complications, even serious ones, but rather rare. Among the most critical complications, alterations in the peripheral visual field and a more or less lasting decrease in visual acuity (this generally concerns diabetic patients) can be mentioned. Less serious problems that may be encountered after photocoagulation are keratitis, angular dilation of the pupil, and acute glaucoma attacks. These last two events should be considered exceptional. Cases of corneo-conjunctival infections of bacterial or viral nature can also be found.