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Argon Laser Trabeculoplasty

Argon laser trabeculoplasty (ALT) is a procedure which has been proven to be efficacious for different types of glaucoma. The procedure has been used for many years and continues to be a powerful tool in the armamentarium of ophthalmologists for glaucoma treatment. ALT is often recommended when medical therapy alone is insufficient in controlling pressure and the progression of glaucoma. However, it has recently been advocated by some as primary therapy in the treatment of glaucoma, especially for those patients who have contraindications to glaucoma medications or, for any reason, are unable to use eye drops.

In the ALT procedure, the eye surgeon directs a laser beam into the trabecular meshwork, which is the primary aqueous (fluid) drainage region of the eye. The trabecular meshwork is located in the angle of the eye, approximately where the cornea meets the iris. In most cases, 180 degrees of the trabecular meshwork is treated with laser spots, which typically requires about 40 to 80 laser applications. The effect of the procedure is increased drainage of aqueous fluid out of the eye, thereby lowering the intraocular pressure.

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The ALT Procedure
The ALT procedure can be completed in the office or as an out-patient procedure. The procedure is completed with the patient seated at the laser, with topical (eye drop) anesthesia, and a lens applied to the surface of the eye to allow delivery of laser applications into the trabecular meshwork.

This procedure is typically painless or results in only minor discomfort. After the procedure, the patient is typically treated with anti-inflammatory eye drops for a few days, perhaps in association with their usual glaucoma medications. Vision is minimally, if at all, affected, even on the day of the procedure. There is generally no discomfort after the procedure. Most patients are scheduled for a return visit within a few weeks to re-evaluate.

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Does an ALT Procedure Reverse Glaucoma? Is it Always Effective?
In general, glaucoma is not reversed, or cured, by any procedure or medication. However, an ALT often works like a powerful medication, in terms of pressure reduction, without the potential side effects of medicines. Therefore, it may be used alone or in combination with medicines to treat glaucoma. The procedure isn’t always effective, although it will be effective in pressure reduction in the great majority of cases

Does the Pressure Lowering Effect with an ALT last a Lifetime?
In most cases, the pressure lowering effect with an ALT will last 3 to 5 years. If the initial treatment is effective, a second ALT, in which the opposite half of the trabecular meshwork is treated, may be appropriate.

Are there any Complications with an ALT?
The risks with an ALT procedure are rare, and when they do occur, are even more rarely serious. In general, the risks include post-operative inflammation, pressure spikes, and worsening of glaucoma. The latter complication is likely to be due to the underlying disease, and not the ALT procedure itself.

Is an ALT Procedure More Likely to be Helpful for Certain Types of Glaucoma?
Yes. ALT seems to work best in patients with primary open angle glaucoma, pseudoexfoliation (exfoliation) syndrome, and pigmentary dispersion syndrome (pigmentary dispersion glaucoma). It is also likely to be more efficacious for patients who have significant pigmentation in the trabecular meshwork. This latter characteristic is determined by the ophthalmologist when examining the angle of the eye, in a diagnostic procedure called gonioscopy.

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