Laser coagulation

Laser coagulation
Intervention
MeSH D017075

Laser coagulation or laser photocoagulation surgery is used to treat a number of eye diseases and has become widely used in recent decades. During the procedure, a laser is used to finely cauterize ocular blood vessels to attempt to bring about various therapeutic benefits.

The procedure is used mostly to close blood vessels in the eye, in certain kinds of diabetic retinopathy; it is no longer used in age related macular degeneration in favor of anti-VEGF drugs.

Medical uses

Diabetic retinopathy

The American Academy of Ophthalmology practice guidelines recommend laser coagulation for people who have both mild to moderate nonproliferative diabetic retinopathy (NPDR) and clinically significant macular edema outside the fovea; treatment with anti-VEGF drugs is better than laser coagulation for clinically significant macular edema in the fovea.[1] For people with severe NPDR and no macular edema, the AAO recommends laser photocoagulation for the whole retina; when there is macular edema, the laser coagulation focused on major lesions is recommended.[1] As of 2016, while there is preliminary evidence that anti-VEGF drugs may be useful for proliferative diabetic retinopathy, laser coagulation across the whole retina is still preferred in the AAO recommendations, as there is long-term follow up data for laser treatment but not for drug treatment.[1]

Diabetic macular edema

Anti-VEGF drugs are superior to laser coagulation for diabetic macular edema; laser coagulation is only used in rare cases.[2]

Macular degeneration

The American Academy of Ophthalmology practice guidelines do not recommend laser coagulation therapy for macular degeneration, but said that it may be useful in people with new blood vessels in the choroid outside of the fovea who don't respond to treatment with anti-VEGF drugs.[3][4]

Argon, krypton, dye and diode lasers have been used with varying levels of energy have been used to try to prevent age-related macular degeneration by eliminating drusen. A Cochrane review published in 2015 found that while laser treatment reduces drusen, there is no difference from placebo at 2 years with respect to preventing vision loss.[5]

A 2007 Cochrane review on found that laser photocoagulation of new blood vessels in the choroid outside of the fovea using blue-green argon, green argon, red krypton, or near-infrared diode is effective and economical method, but that the benefits are limited for vessels next to or below the fovea.[6]

Retinopathy caused by sickle cell disease

Laser coagulation has been used in people with retinopathy caused by sickle cell disease. A 2015 Cochrane review found two clinical trials conducted in the 1980s using three approaches - one single-center trial employed sectoral scatter laser photocoagulation using an argon laser; and in the second, two-center trial focused on feeder vessel coagulation, one center used an argon laser and the other used a xenon arc laser. Based on weak evidence, it appears that laser coagulation may be effective in preventing visual loss and vitreous haemorrhage in this condition but that it does not have an effect on regression of proliferative sickle retinopathy or preventing the development of new vessel growth.[7]

Radiation proctitis

When radiation therapy is administered to treat cancers like cervical cancer, prostate cancer, and colon cancer, radiation proctitis can occur, which involved chronic bleeding in the colon. Treatment with Nd:YAG lasers and with Nd:YAG laser passed through a Potassium titanyl phosphate crystal, and with an argon laser has been studied in small clinical trials.[8] Nd:YAG laser has been abandoned due to risks of damaging the colon wall, fibrosis, stricture formation, and recto-vaginal fistula, and severe damage in case of accidents, as well as the cost.[8] The other two modalities were largely replaced by argon plasma coagulation by 2011, which was safer and less expensive.[8]

Complications

In the eye, side effects and complications of laser photocoagulation are not infrequent and include include loss of vision, worsening visual acuity, reduced night vision, and hemorrhaging in the eye.[6] In about 8% of cases can cause scarring which in turn can lead to permanent central vision loss.[1]

History

Results of using laser coagulation to treat diabetic retinopathy were first published in 1954.[2][9] Conventional macular focal and grid laser photocoagulation were established as the treatment of choice for diabetic macular edema in the Early Treatment Diabetic Retinopathy Study (ETDRS), which published in 1985.[2][10]

See also

References

  1. 1 2 3 4 "Diabetic Retinopathy PPP - Updated 2016". American Academy of Ophthalmology Preferred Practice Pattern. 24 February 2016. Retrieved 22 October 2016.
  2. 1 2 3 Chen, X; Modjtahedi, BS; Young, LH (2015). "Management of Diabetic Macular Edema: Is It Time to Say Goodbye to Macular Laser?". International ophthalmology clinics. 55 (4): 113–22. PMID 26322431.
  3. ↑ "Age-Related Macular Degeneration PPP - Updated 2015". American Academy of Ophthalmology Preferred Practice Pattern. 29 January 2015. Retrieved 22 October 2016.
  4. ↑ Lindsley, K; Li, T; Ssemanda, E; Virgili, G; Dickersin, K (April 2016). "Interventions for Age-Related Macular Degeneration: Are Practice Guidelines Based on Systematic Reviews?". Ophthalmology. 123 (4): 884–97. PMID 26804762.
  5. ↑ Virgili, G; Michelessi, M; Parodi, MB; Bacherini, D; Evans, JR (23 October 2015). "Laser treatment of drusen to prevent progression to advanced age-related macular degeneration.". The Cochrane database of systematic reviews (10): CD006537. PMID 26493180.
  6. 1 2 Virgili, G; Bini, A (18 July 2007). "Laser photocoagulation for neovascular age-related macular degeneration.". The Cochrane database of systematic reviews (3): CD004763. PMID 17636773.
  7. ↑ Myint, KT; Sahoo, S; Thein, AW; Moe, S; Ni, H (9 October 2015). "Laser therapy for retinopathy in sickle cell disease.". The Cochrane database of systematic reviews (10): CD010790. PMID 26451693.
  8. 1 2 3 Rustagi, T; Mashimo, H (7 November 2011). "Endoscopic management of chronic radiation proctitis.". World journal of gastroenterology. 17 (41): 4554–62. PMC 3225092Freely accessible. PMID 22147960.
  9. ↑ Meyer-Schwickerath, G (1954). "[Light coagulation; a method for treatment and prevention of the retinal detachment].". Albrecht von Graefe's Archiv fur Ophthalmologie (in German). 156 (1): 2–34. PMID 14349833.
  10. ↑ "Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group.". Archives of ophthalmology (Chicago, Ill. : 1960). 103 (12): 1796–806. December 1985. PMID 2866759.
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