Abstract: Laser procedures have revolutionized the management of glaucoma, offering minimally invasive alternatives to traditional surgical interventions. This article provides a comprehensive review of laser procedures in glaucoma management, covering their indications, mechanisms of action, efficacy, safety profiles, and recent innovations. By exploring the latest advancements in laser technology, ophthalmologists can optimize patient care and achieve favorable outcomes in glaucoma management.

Introduction: Laser procedures have emerged as valuable tools in the armamentarium of glaucoma management, offering precise, targeted interventions to reduce intraocular pressure (IOP) and preserve visual function. From trabeculoplasty to iridotomy, laser procedures provide effective options for patients with various forms of glaucoma, ranging from primary open-angle glaucoma to angle-closure glaucoma.

Indications: Laser procedures are indicated in cases of medically uncontrolled glaucoma, intolerance to medication, or as adjunctive therapy to lower IOP and prevent disease progression. Common indications include primary open-angle glaucoma (POAG), pseudoexfoliative glaucoma, pigmentary glaucoma, and angle-closure glaucoma. Additionally, laser procedures may be utilized in the management of ocular hypertension and as prophylactic measures in high-risk eyes.

Mechanisms of Action: Laser procedures exert their effects through various mechanisms, including increasing aqueous outflow through the trabecular meshwork (e.g., selective laser trabeculoplasty), creating a new drainage pathway (e.g., laser peripheral iridotomy), or reducing aqueous production by the ciliary body (e.g., cyclodestruction). By precisely targeting specific ocular structures, laser therapy achieves IOP reduction while minimizing collateral damage to surrounding tissues.

Efficacy and Safety: Laser procedures demonstrate favorable efficacy and safety profiles in reducing IOP and preserving visual function in patients with glaucoma. Selective laser trabeculoplasty (SLT) has been shown to effectively lower IOP by enhancing trabecular outflow, with minimal risk of adverse effects such as intraocular inflammation or scarring. Similarly, laser peripheral iridotomy (LPI) offers rapid and sustained IOP reduction in angle-closure glaucoma, with low rates of complications such as hyphema or corneal endothelial damage.

Recent Innovations: Recent innovations in laser technology aim to improve treatment outcomes, enhance patient comfort, and expand the applicability of laser procedures in glaucoma management. Advancements such as micropulse laser trabeculoplasty (MLT), which delivers laser energy in a pulsed manner to minimize thermal damage, offer potential benefits in reducing postoperative inflammation and optimizing long-term IOP control. Additionally, novel laser platforms incorporating advanced imaging modalities enable precise targeting of diseased ocular structures, enhancing treatment efficacy and safety.

Conclusion: Laser procedures play a pivotal role in the management of glaucoma, offering effective and minimally invasive options for lowering IOP and preserving visual function. By staying informed about the latest advancements in laser technology and understanding their applications in glaucoma management, ophthalmologists can optimize patient outcomes and improve quality of life for individuals affected by this sight-threatening condition.

For further reading and reference:

• American Academy of Ophthalmology – Laser Procedures for Glaucoma: https://www.aao.org/eye-health/diseases/glaucoma-laser-procedures
• Glaucoma Research Foundation – Laser Treatment for Glaucoma: https://www.glaucoma.org/treatment/laser-treatment-for-glaucoma.php
• National Eye Institute – Glaucoma: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma