緑内障のレーザー治療

抄録

Laser therapy plays an important role in the ocular hypotensive therapy for various types of glaucomas.
Laser trabeculoplasty (LTP) and laser iridotomy (LI) are time-honored, well-established treatment. Experiences gained in the past decade clearly demonstrated that LIP is supplementary to medical therapy in the treatment of primary open-angle and capsular glaucoma. The ocular hypotensive effect is generally remarkable for one year or so. However, thereafter it decreases over time. Thus, the decline of therapeutic effect should be taken into consideration when the indication of LTP is considered. In contrast to LIP, LI is a real breakthrough in the glaucoma therapy. Surgical peripheral iridectomy, which has been practiced for more than 120 years, has been completely replaced by LI.
The new laser glaucoma therapy includes cyclophoto-coagulation (CPC) and ab interno or ab externo laser sclerostomy. The results of CPC using free-running or continuous wave Nd: YAG laser have been generally disappointing. Newly developed diode laser with wave length of 805nm appears to be more promising.
Ab externo laser sclerostomy with THC: YAG laser has first made quick, reproducible sclerostomy possible. Although the technique is relatively easy to master, the management of the incarcerated iris and the suppression of bleb scarring are particularly important for a functioning bleb formation.