LASER USE IN OPHTHALMOLOGY by cuiliqing

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									   LASER SURGERY
 OPHTHALMOLOGY IN
       ZAMBIA
EUSTACE A. PENNIECOOK, MD.
   LUSAKA EYE HOSPITAL
  an Adventist Health International Institution
General Info…


 Laser's are a primary tool in the
 complex treatment of ocular diseases.
 – The laser may be used on many parts of
  the eye
 – and has been helpful in treating many
  different types of eye diseases


                                  Lusaka Eye Hospital
                                     An SDA institution
Reasons…

 – precisely
   treated with
   no risk of
   infection
 – painless way
 – on an
   outpatient
   basis
                  Lusaka Eye Hospital
                     An SDA institution
Types of treatment

 Posterior Capsule Opacity
 Retina
 – Diabetic Retinopathy
 Glaucoma
 – Angle Closure Glaucoma
 – Open Angle Glaucoma


                             Lusaka Eye Hospital
                                An SDA institution
Post. Cap. Opacity

 Most frequent
 postop complication
 – Membrane that
   grows (epithelial
   cells), proliferate
   and migrate.




                         Lusaka Eye Hospital
                            An SDA institution
Anatomy…




           Lusaka Eye Hospital
              An SDA institution
Lusaka Eye Hospital
   An SDA institution
General Info…

 Incidence
 – Foldable lenses 13.5%
 – PMMA lenses 30.2%
 – Acrylic 2.0%
     Youth is a risk factor
      – Thorofare, NJ, Slack, 2000 p.157-215




                                               Lusaka Eye Hospital
                                                  An SDA institution
What to do…

 Treatment
 – Neodium Yag Lase (Nd:yag)
     Solid state radiation of 1.064 nm
     Aim at XII go to VI
 – Other uses
     Iridectomy synnechialis, vitreolisis.




                                             Lusaka Eye Hospital
                                                An SDA institution
Lusaka Eye Hospital
   An SDA institution
Artistic drawing…




                    Lusaka Eye Hospital
                       An SDA institution
Currently in Zambia

 Two Nd: Yag laser
 LEH
 – 4xweek (200x
   year)
 Military Hospital




                      Lusaka Eye Hospital
                         An SDA institution
Lusaka Eye Hospital
   An SDA institution
Diabetic Retinopathy

 Diabetes Mellitus
 – 5-7% in 20 years or older.
 – 1 irreversible blindness
 – Diabetic Retinopathy study
     50% -- Proliferative Diabetic Retinopathy
           Ophthalmology 1991;98:739-840
           American Academy of Ophthalmology XII,
           2004;p88,89


                                           Lusaka Eye Hospital
                                              An SDA institution
General Info…

 Pan Retinal Photocoagulation
 – Reduces probability of Vision loss 50%
 – Risk of Vitreous hemorrhage persist
 – Moderate vision loss is possible
     Nictalopia, visual field reduction
 – Patients most return for followup
     Additional laser is needed
      – LEH % 3 sessions

                                          Lusaka Eye Hospital
                                             An SDA institution
Lusaka Eye Hospital
   An SDA institution
How this works

 – Coagulates tissue
     Energy absorbed by target and converted to
     thermal energy
      – Temp rises + 65C
      – Tissue proteins = coagulate necrosis.
     Laser beam 400-780nm




                                                Lusaka Eye Hospital
                                                   An SDA institution
Pathogenesis…

 Why…
 – Less oxygen
   neovascularizatio
   n (NVD)
 – +NVD = traction
   to Retina
 – =Detachment of
   retina

                       Lusaka Eye Hospital
                          An SDA institution
Lusaka Eye Hospital
   An SDA institution
Lusaka Eye Hospital
   An SDA institution
Currently in Zambia

              Two Argon laser
              LEH
              – 2xweek (100x
                year)
              Military Hospital




                           Lusaka Eye Hospital
                              An SDA institution
Lusaka Eye Hospital
   An SDA institution
Glaucoma…

Angle closure glaucoma,
 – a sudden, painful attack of
   elevated IOP,
 – How it works
    creates a tiny opening in the iris
     – allow the fluids to drain and
     – reduce pressure

                                       Lusaka Eye Hospital
                                          An SDA institution
Lusaka Eye Hospital
   An SDA institution
Lusaka Eye Hospital
   An SDA institution
Way Forward.. LASER
 Create Awareness      Photo radiation of
 – Public              tumors
 – Medical Staff       – Squamous Cell Ca
 Evaluate need of      Refinement, photo
 more                  ablative LASER
 – District Hospital   – Post segment
 Train Personnel         surgeries
 – Ophthalmologist
 – OCO

                                   Lusaka Eye Hospital
                                      An SDA institution
Conclusion

  Lasers are concentrated beams of
 light which can very precisely cut,
 seal, heat, and even vaporize tissue.
 Much like a knife, they can cause harm
 when used indiscriminately, but in the
 best hands, lasers have many
 revolutionary medical uses.

                                Lusaka Eye Hospital
                                   An SDA institution

								
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