LASER MODULE

FOR
OPHTHALMOLOGY
1. What is LASER?

Abbreaviation 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 (DME)

b. Retinal Vein Occlusion (RVO) :

• PRP for Ischemic RVO
• Sectoral laser for Branch RVO (BRVO)

c. Angle Closure Glaucoma :

• Peripheral Iridotomy RVO
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 in 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 anaesthestic - 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 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 μm (quadrispheric) x 200-300 mW
(a) (b) (c) (d)

a. Number of shots
b. Exposure time in second (sec) or milisecond (msec)
c. Spot size in micrometer (μm ) and contact lens used
d. Power in miliwatt (mW)
6. Type of contact lens and magnification :

Lens Type Field of view Laser spot Spot size

(degree) magnification magnification (spot
size set at 200 μm)
Volk Superquad 160 160 - 165 2.00 400
Ocular PDT 120 - 130 1.60 320
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 superquadraspheric, Mainster Wide
Field, Mainster PRP 165, Goldmann 3 mirror
Setting Exposure time : 0.08 - 0.1 sec
Spot size : 200 - 300 μm
Power : 150 - 350 mW
Number of shots : Not > 1000 each session
Distribution Edge : 1 laser burn apart
Nasal proximity : no closer than 500 μm (1/3 DD)
Temporal proximity : no closer than 3000 μm (2DD) from fovea
Superior / Inferior limit : no further than 1 burn within the
temporal arcade
Extent : arcades 3000 μm from fovea to at least the equator
No of final burns Reach quiescent stage (but area mentioned in the 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 session Unlimited until all areas (refer to distribution) are covered
Things to avoid Avoid complete PRP in 1 session
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 μm
Power : 50 - 100 mW (titrate)
Intensity Grade 1 light barely visible burn
Area of Grid 500 - 3000 μm superior, and inferiorly from the centre of
fovea; 500 - 3500 μm temporally from the macular
centre;
No burns placed within 500 μm of macular centre
Spare papillomacular bundle area
Burn separation for 2 visible burn widths apart
Grid
Wavelength Green to Yellow
Direct treatment Directly treat all leaking microaneurysm (MA) in areas of
(focal) retinal thickening 500 - 3000 μm from the centre of the
macula
Grid laser Apply to area of oedema not associated with
microaneurysm (MA)
 9. How to do laser Peripheral Iridotomy (PI)?
Contact lens Abraham Iridotomy Lens
Perioperative treatment Topical anasthesia
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
Setting Preparotory laser burns - Argon laser
Spot size : 200 - 500 μm
Exposure time : 0.2 - 0.5 sec
Power : 200 - 600 mW (depends on iris pigmentation; lower
power; lower power for darker iris to avoid charring)

Penetrating laser burns - Argon laser (Chipping technique)

Spot size : 50 μm
Exposure time : 0. 05 – 0.1 sec
Power : 600 - 1000 mW
End point : Presence of gush of aqueous and pigments
Endpoint Gushing of fluid / pigment
Deepening of AC
Verify patency
Size of iridotomy 200 - 500 μm
 10. How to do barricade laser for retinal break / hole?

Contact lens Volk quadraspheric, Volk superquadraspheric, Mainster

Wide Field, Mainster PRP 165, Goldmann 3 mirror
Setting Exposure time : 0.1 sec
Spot size : 400 - 500 μm
3 near-confluent rows surrounding retina break / hole
 11. How to do Yag Capsulotomy?

Contact lens Ocular Abraham Capsulotomy lens

Setting Laser machine : Nd : YAG machine
Energy : 0.8 - 1.2 mJ/pulses
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 Vitreolyis?

Contact lens Ocular Abraham Iridotomy lens

Setting Laser machine : Nd : YAG machine
Energy : 0.8 - 1.2 mJ/pulses
Setting aiming beam at anterior or ‘0’ indicator
Aiming vitreous strand that tracked to the wound
THANK YOU