Laser Lab Notes

Instructions

Selecta Duet HD

• class III B lasers (FDA)

• critical users take precaution to eyes and skin from direct or reflected laser beams

• must use laser safety eyewear, also built in eye safety filter

Tutorial Steps

1. turn laser on with key

2. bottom wheel has filters, upper wheel is slit height

3. side wheels control slit width (5mm), big top wheel adjust specific angle

4. select YAG or SLT

5. magnification (similar to regular SL) - set to lowest setting to adjust eyepiece but highest setting to focus on target

6. aiming beam intensity (has 4 ticks around a cirlce)

7. retro illumination knob

8. set binocular eye piece diopter setting to 0

YAG

1. main function is power (back side silver knobs)

2. offset no more than +250 (most common +100)

3. ensure position of slit lamp is correct and not in front of laser

4. press status button, ready to fire

5. burst mode: iridotomy, triple burst is more efficient on energy

6. in focus: when 2 red dots come together

7. sum of energies in middle (1.8 mJ per burst), shot count to the right

SLT and YAG

• no burst, just single shot

LPI

• Multiple shots per burst

Quiz material

SLT

Indications for use

• Ocular HTN

• POAG

• Low tension Glaucoma

• Other: PDG, PXG

Contraindications

• Narrow angles

• chronic angle closure glaucoma

• neovascular glaucoma

• glaucoma secondary to inflammation

• traumatic glaucoma (angle recession)

Drops used: proparacaine, pilocaprine (small pupil), alpha agonist (brimonidine), artificial tears

Avoid mistake: mark eye with blue X, and have pt declare which eye will be treated

Consent:

• what are we doing?

• what eye are we treating?

• what to expect with success or failure?

• repeat procedure may be needed

• discuss persistent inflammation & change in refraction

Lens used

• Latina lens

• single mirror

Procedure

• 360 degrees

• 100 non-overlapping spots (0.4-1.2mJ)

• tilt lens in direction of targeted angle to enhance visualization when needed

• rinse eye (remove Genteal tears)

• IOP check 60 mins after treatment - > 5 mmHg from patients baseline

• Champagne bubbles: too much energy used, try to lower energy

Post-procedure

• Artificial tears, steroid or NSAID QID for 4 days

• Recheck IOP 4-6 weeks later

• expect 25% IOP lowering in 65% of patients

Complications

• AC inflammation*** (most common): appears within 1hour, resolved by 24 hours

• Ocular discomfort: more common with ALT

• IOP spikes (>5mmHg) (less common): <2 hours from treatment, easily controlled with medications

Guidelines and Parameters