A Beginner's Experience
Ahmed Badawy
Ophthalmologist
Bolak El Dakroor Hospital
Ophthalmic Laser Unit

Practical

When to do?

Roles to follow

Important Notice

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

PRP	Mild Scatter	Full Scatter	Extensive
Numbers of Shots	1000	2000	3000
Diameter	400-500 um	400-500 um	400-500 um
Duration	200 msec	200 msec	200 msec
Power	Moderate Whitening	Moderate Whitening	Moderate Whitening
When to use	According to	Severity of Condition	& Visual Acuity

Supplemental "Retreatment" Fill in treatment

PRP

Same schedule

When to use If

1} Neovascularization  does not show evidence of regress during 2/4w follow-up. 2} If any sign for indication does not improve during 2/4w follow-up 3} Previous treatment was scanty 4} Progression of retinopathy evidenced by appearance of:                                          a) Neovascularization                                          b) Refresh of vitreous Haemorrhage                                          c) New rubiosis                                          d) New pre retinal haemorrhage

Back
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

When to do?

Very Severe Non Proliferative DR	High Risk DR	Pre/Post  Vitrectomy	Rubiosis  iridis
" Any Two of the following" " Four/Two/One Role" Intra-Retinal Haemorrhages in 4 quadrants Venous Beading  in 2 quadrants IRMA                                         in 1 quadrants	Neovascularization of the Disc  "NVD" NeoVascularization Else where "NVE" Pre-Retinalhaemorrhages Vitreous Haemorrhage	Prophylactic	BVO CRVO

 Back
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Roles to follow
 

Visual Acuity	Macular Oedema	Clinically Significant Macular Oedema
<6/60 <6/12>6/60	Not Clinically Significant	CSMO

Important Practical Points "Early experience PRP
"Goldman three mirror lens"

Very critical points to do before thinking to use laser in treating an eye disease

• Master slit lamp device well
• Master the lens you are going to use
• Master the laser machine you are using

PRP:

• First Delineate Temporal Foveal area for protection by 2 to 3 rows barrier 2 DD form the fovea between the temporal arcades "To avoid shooting the fovea"
• Every now and then as starter shift to the central lens to ensure you are away from the fovea confirming using the proper mirror
• Start by using the rectangular mirror as it gives you more better view, wider field, more ability to tilt & more easier to overcome light reflections from the aiming beam and slit lamp beam.
• If no vitreous haemorrhage is present Start with the lower retina "to avoid future vitreous haemorrhage that might obscure the lower retina
• If vitreous haemorrhage is present start any where you can see retina clearly
• Rotate the same mirror you are using to reach a new retinal area either Clock or anti Clock wise according to your decision making all the time part of the retina with laser marks in the field as a land mark to follow as well as a guide not to shot the posterior pole
• Try not to tilt the mirror you are using too much as you might shot the posterior pole even when using the mirror mainly if the patient is not looking straight forward
• You can approximate to the optic disc out side nasal arcades but not more than 1 DD.
• NVD "Flat & < 2 DD" are not directly treated but underlying retina is photo coagulated with slightly overlapping confluent with moderate whitening effect and with smaller spot size.
• NVE "Flat; at least 1 DD from the disc/ 2 DD temporal to the fovea/ Out side the arcades" are treated like NVD but not try to directly focally ablate it.
• Never try to directly close any neovascularization by directly focusing it but underlying retina.
• Avoid :





Major Blood Vessels  Areas of pre retinal haemorrhage  Areas of elevated Neovascularization  Directly treating traditional elevated fibrovascular proliferation  More than 1000 shots/setting if previous parameters are used "our schedule 250 um"

• Post Laser management:





Mild analgesic  Avoid : lifting heavy weights; bending straining  Sleep with elevated head if Vitreous haemorrhage is present  Next appointment for laser setting or follow up   Return immediately if severe pain occurs "for fear of post laser choroidal effusion  with secondary angle closure  Topical steroids & Cyclopegics  Systemic vasculotonics"Doxium/Ruta C 60/Ronicol" circulatory enhancement "Trental400/Vasotal/Trivestal"  Perfect control of Blood Sugar  For more perfect follow up a colour photo at the initial visit and after 4 weeks follow up for documentation

• Supplemental "Retreatment/Fill-in treatment"





Exactly follow same role for PRP  Start to fill spaces of untreated areas  Extend more anterior by tilting the mirror and instructing the patient to look for the opposite direction  Extend more anterior by using the square mirror with patient look to opposite direction  Extend more posterior till arcades by tilting the mirror with patient looks to the mirror you are using  Extend more posterior till arcades by using the central lens with patient looks to different directions  You can apply 1 or 2 rows parallel to temporal arcades using smaller spot size and mild whitening effect  The temporal edge of the initial land marking rows should be retreated  If extensive PRP retreat previously treated areas but with minimum power to bleach "Mild Whitening"  Use Cryoapplication

•  Back

This page is designed by Ahmed Badawy©Copy Right Protected