Photocoagulation of the retina or retinal laser photocoagulation is a minimally invasive procedure used to treat various diseases of the retina. Several conditions may cause the retina to swell due to abnormal leaky blood vessels growing over it. Laser photocoagulation uses laser light to create thermal energy of above 65°C, creating thermal burns in the retinal tissue. This can stop the bleeding blood vessels from leaking into the retina. Laser photocoagulation can also cause fibrosis and seal retinal tears. In cases of vision loss due to retinal disease, laser photocoagulation usually cannot restore vision that has already been lost, but it can prevent the disease from worsening, reduce the risk of further vision loss, and preserve remnant vision. The procedure is relatively safe with a very low risk of complications. Currently, laser retinal photocoagulation is the most common treatment option in many retinal and eye conditions. Retinal laser photocoagulation may be combined with other retinal procedures, such as cryopexy (freezing) or eye infections.
Why is photocoagulation of the retina done?
Indications for retinal photocoagulation include the following:
- Panretinal (all over the retina) photocoagulation (PRP) for neovascular diseases (diseases with new blood vessel) and proliferative diseases such as proliferative diabetic retinopathy, sickle cell retinopathy, and venous occlusion disease local or grid photocoagulation, in which a laser is targeted at a specific area. It is done for macular edema from diabetes or vein occlusion
- Retinopathy of prematurity
- Abnormalities of the blood vessels in the retina such as microaneurysms (weakening and ballooning of the small blood vessels), telangiectasia (dilation of the small blood vessels), and blood vessel leakage
- Removal of retinal adhesions formed around retinal tears and detached areas
- Targeted treatment of pigment abnormalities
- Treatment of eye tumors
- Treatment of certain types and causes of glaucoma (increased pressure in the eye)
How is photocoagulation of the retina performed?
During the procedure:
The procedure is performed under local anesthesia, using anesthetic eye drops. A mild sedative may be administered. The patient is seated in front of a slit lamp delivery system (a setup with a microscope and bright light used by an eye doctor to examine the eye and perform outpatient procedures). The pupils are dilated. The lens in the slit lamp is used to focus a beam of laser light onto the retina. The laser beams are targeted at the affected areas of the retina. The laser beams create thermal energy causing laser burns over the targeted areas of the retina. The patient may see bright flashes of light during the procedure. There is no significant pain or discomfort during the procedure. Patients may experience a mild pricking sensation or pressure over the eye during the procedure.
After the procedure:
The procedure is performed on an outpatient basis, and the patient can go home soon after the sedative wears off. Patients would need someone to drive them home after the procedure because the pupils would be dilated for a few hours after surgery. Patients may experience blurring of vision, pain, and discomfort for two to three days after the surgery. Pain can be managed with painkillers. There is a very low risk of infection after the procedure, so antibiotics are usually not prescribed. Most patients can resume daily activities immediately. Driving can be resumed after two to three days once vision becomes clear. Patients may be advised to avoid vigorous exercise and sports for one to weeks after surgery.
What are the complications of photocoagulation of the retina?
The procedure is quite safe, and complications are rare. Some possible complications are as follows:
- Bleeding
- Retinal detachment
- Decreased vision or loss of vision
- Accidental laser burns to other important structures in the eye
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