LAMPIRAN

LASER MODULE FOR OPHTHALMOLOGY

(For Junior Medical Officer Joining Ophthalmology)

1. What is laser?
Abbreviation for Light Amplification By Stimulated Emission of Radiation

2. Common indications of laser:

a) Diabetes:
Panretinal photocoagulation (PRP) for Proliferative Diabetic Retinopathy (PDR),

Grid or focal laser for Diabetic Macula Edema

b) Retinal Vein Occlusion (RVO):

PRP for ischaemic RVO

Grid laser for Branch RVO

c) Angle Closure Glaucoma:

- Peripheral Iridotomy (PI)
- ALPI – Argon Laser Peripheral iridotomy

d) Retinal hole: Barricade

e) Other conditions: Proliferative retinopathy of any causes ( SLE/ Eale’s), Yag capsulotomy,
Anterior Yag vitreolysis.

3. Preparations before Laser

a) Explain indication of laser/ side effects of laser ( night blindness, reduction of contrast
sensitivity, macula oedema)
b) Introduction of Argon and Nd:YAG laser machine
c) Written consent for first timer, informed consent for subsequent laser session of the same
indication
d) Premark area of laser/identify the area for laser (including orientation of fundus during
laser)
e) Pupil dilatation – Only for Retina cases (PRP, Grid/focal)
f) Choose correct contact lens
g) Local anaesthetic – topical for laser using slit lamp, peribulbar/subtenon for laser CPC/ECP/
LIO
h) Coupling agent
i) Set correct laser setting
j) Comfortable position of patient and operator
4. Laser safety

a) Filter at laser machine is switched on before use

b) Standby mode is used for each interval ie movement of patient or change eye or before
change patient
c) contact lens with coating
d) Dark room – wall/curtain
e) Warning light is on outside laser room
f) Goggle with correct wavelength protection for bystander
g) Air conditioning room with good ventilation

5. Laser Parameters documentation

eg : 800 X 0.1 sec X 250 ųm (quadrispheric) x 200-300 mW

(a) (b) (c) (d)

a) number of shots
b) exposure time in second(sec) or millisecond (msec)
c) Spot size in micrometer (um) and the contact lens used
d) Power in milliwatt (mW)

6. Type of contact lens and magnification:

Lens type Field of view Laser spot Spot size

(degree) magnification mangnification

(spot size set at

200um)

Volk superquad 160 160-165 2.00 400

Ocular PDT 120-130 1.6 320

Volk Quadraspheric 130 1.92 400

Mainster Wide Field 125 1.47 294

Volk area centralis 80-90 1.01 200

Goldmann 3 mirror 36 (centre) 1.08 216

7. How to do laser PRP?

Contact lens Volk quadraspheric, Volk superquadrispheric, Mainster

Wide Field, Mainster PRP 165, Goldmann 3 mirror,

Setting Exposure time: 0.08- 0.1 sec

Spot Size: 200-300 um

Power: 150-350 mW (titrate)

Number of shots: Not > 1000 each session

Distribution Edge: 1 laser burn apart

Nasal proximity: no closer than 500 um (1/3 DD)

Temporal proximity: no closer than 3000 um (2DD) from

fovea

Superior/Inferior limit: no further than 1 burn within the

temporal arcade

Extent: Arcades 3000um from fovea to at least the equator

No of final Reach quiescent stage (but area mentioned in the

burns distribution must be covered with good quality burn
without any empty spaces), if laser not adequate, top up
laser is required

Wavelength Green/yellow

Intensity Grade 3 moderate burn, opaque, dirty white

Number of Unlimited until all areas (refer to distribution) are covered.

session

Things to Avoid complete PRP in 1 session.

avoid
Avoid blood vessels, new vessels, exudates, haemorrhage,
fovea, papillomacular bundle and area of fibrovascular
traction.
8. How to do DME laser?

Contact lens Volk Area Centralis, ocular PDT, Goldmann 3 mirror

Setting Exposure time: 0.05-0.1 sec

Spot Size: 50-100 um

Power: 50-100 mW (titrate)

Intensity Grade 1 light barely visible burn

Area of Grid 500-3000um superior, and inferiorly from centre of fovea;

500-3500 um temporally from macular centre, no burns placed

within 500 um of macular centre

Spare papillomacular bundle area

Burn separation for grid 2 visible burn widths apart

Wavelength Green to yellow

Direct treatment (focal) Directly treat all leaking microaneurysm (MA) in areas of
retinal thickening 500-3000 um form the centre of the macula

Grid laser Apply to area of edema not associated with Microaneurysm

(MA)
Figure 1: Laser Pan retinal Photocoagulation (PRP)

9. How to do laser Peripheral Iridotomy (PI)

Contact lens Abraham iridotomy lens

Preoperative Topical anaesthesia

treatment
Pilocarpine 2%

Technique Argon alone/Nd-yag alone/ Argon and Nd:YAG

Site Superior 1/3 of iris (above superior eyelid)

10-2 o’clock,

iris crypt or area of thin iris

Beam Focus within iris stroma than on the surface of iris

Setting Preparatory burns- Argon laser

Spot size: 200-500 um

Exposure time: 0.2-0.5 sec

Power: 200-600 mW (depends on iris pigmentation; lower power for

darker irides to avoid charring)

Penetrating burns – Argon laser (chipping technique)

Spot size: 50 um

Exposure time: 0.05-0.1 sec

 Power: 600-1000 mW

End point: presence of gush of aqueous and pigments.

Penetration laser burns –Nd: YAG laser

Energy: 3-8 J

Number of shots: usually 2-5 shots

Adequate iridotomy size 200-500 um

End point Gushing of fluid/pigment

Deepening of AC

Verify patency

Size of iridotomy 200-500 um

10. How to do barricade laser for retinal break/hole

Contact lens Volk quadraspheric, Volk superquadrispheric, Mainster Wide Field,

Mainster PRP 165, Goldmann 3 mirror,

Setting Exposure time: 0.1 sec

Spot Size: 400-500 um

3 near-confluent rows surrounding retina break/hole

11. How to do Yag capsulotomy

Contact lens Ocular Abraham capsulotomy lens

Setting Using Nd:YAG machine

Energy : 0.8-1.2mJ/pulse

Setting aiming beam at posterior indicator

Cross pattern method (undilated pupil)

or in bloc/circular pattern (sufficient dilated pupil with mydfrin)

12. How to do Anterior Yag vitreolysis

Contact lens Ocular Abraham Iridotomy lens

Setting Using Nd:YAG machine

Energy : 0.8-1.2mJ/pulse

Setting aiming beam at anterior or ‘0’ indicatior

Aiming the vitreous strand that tracked to the wound.