Glaucoma Laser Surgery

SLT uses gentle laser energy to improve drainage through the trabecular meshwork, the tissue that filters fluid out of your eye. This procedure selectively targets specific cells while leaving surrounding tissue unharmed. Typical pressure reduction is about 20 to 30 percent, with effects beginning over days to weeks.

Because SLT is so precise, we can often repeat it years later if eye pressure starts to rise again. Most patients experience a pressure drop within a few weeks, and the effects typically last several years. Not everyone responds, and repeat treatments may have a smaller or shorter-lived effect. We use extra caution in eyes with heavy trabecular pigment or a history of uveitis due to higher inflammation or pressure spike risk.

ALT has largely been replaced by SLT in routine practice. ALT was one of the first laser treatments for glaucoma and uses argon laser energy to open drainage channels. While effective, this procedure creates more heat than SLT and may cause more tissue changes.

• Often used when SLT is not available or appropriate
• Can lower eye pressure by improving fluid outflow
• May be considered in specific cases based on your individual anatomy
• Usually performed in one or two sessions
• Less commonly used today and generally not repeatable in the same area due to scarring

LPI creates a tiny opening in the outer edge of your iris to allow fluid to flow more freely between the front and back chambers of your eye. We recommend this procedure primarily for primary angle-closure suspect (PACS), primary angle closure (PAC), or primary angle-closure glaucoma (PACG), depending on your diagnosis, or when you are at risk of angle-closure attacks. The opening is intended to be permanent, but it can narrow or close and occasionally needs enlargement or repeat treatment. Placing it under the upper eyelid helps reduce glare.

LPI may also be used to help break an acute angle-closure attack once the pressure is lowered with medications. This preventive treatment takes only a few minutes and can protect you from sudden, painful pressure spikes.

• Common temporary effects include light sensitivity, brow ache, and seeing glare or ghost images, which often improve over time
• We typically use pilocarpine before the procedure to constrict the pupil
• We may give an eye pressure drop before and after to reduce the chance of a short-term pressure spike

CPC lowers pressure by reducing aqueous fluid production from the ciliary body, the tissue that makes the fluid inside your eye. Options include continuous wave transscleral CPC, micropulse transscleral CPC, and endoscopic CPC.

Micropulse CPC can be considered earlier in selected cases as an adjunct to drops or SLT. Endoscopic CPC is often combined with cataract surgery. Continuous wave CPC is usually reserved for eyes needing larger pressure reductions or with limited visual potential.

Important risks we discuss before any CPC procedure include the following.

• Prolonged inflammation or pain
• Overly low pressure (hypotony) with possible vision loss, very rarely phthisis
• Choroidal effusion or detachment
• Cystoid macular edema in susceptible patients
• Need for additional treatments if pressure does not fall enough

We select the most appropriate laser treatment based on your type of glaucoma, current eye pressure, and overall eye health. Your drainage angle anatomy, lens status, and previous treatments all influence this decision.

• Open-angle glaucoma or ocular hypertension often respond well to SLT
• Angle-closure spectrum may need LPI and sometimes early lens extraction rather than LPI alone
• Plateau iris may require adjunctive laser iridoplasty
• Advanced or refractory disease may need CPC, trabeculectomy, or tube shunt
• Lens status, prior surgeries, inflammation history, and your ability to use aftercare drops help guide our recommendation

Your eye may feel scratchy or slightly irritated for a few hours after the procedure. Some patients notice mild sensitivity to light or a feeling of pressure in the treated eye.

• Blurred vision that gradually clears over several hours
• Mild redness that should fade within a day or two
• A dull ache that usually responds to over-the-counter pain relief
• Watering or tearing as your eye adjusts

We typically prescribe a short course of anti-inflammatory drops for several days. If you have had steroid-related pressure increases in the past, tell us so we can adjust the plan.

Continue using your regular glaucoma medications unless we specifically tell you to stop or adjust them. We will monitor your eye pressure over the next few weeks and may reduce your medications if the laser effectively lowers your pressure.

Most people return to normal activities the day after laser surgery. Avoid rubbing your eye and protect it from irritants like dust or wind for the first day or two.

You can shower and wash your face normally, but try to keep soap and water out of your treated eye for at least 24 hours. Skip swimming pools, hot tubs, and heavy exercise for a few days to minimize the risk of inflammation or infection. Do not wear a contact lens in the treated eye until the next day and after we confirm it is safe.

We check your eye pressure 30 to 60 minutes after the procedure, then schedule a follow-up within 1 to 6 weeks to see how well the laser worked. Additional visits may be needed over the next few months to track your progress.

Regular monitoring helps us determine whether your pressure has dropped enough or if we need to adjust your treatment plan. These appointments are crucial for protecting your vision long-term.

The pressure-lowering effect varies. Many patients see a reduction for 1 to 5 years after SLT.

If pressure rises again, repeating SLT may help, although the response can be smaller or shorter. We may add or adjust other treatments as needed.