Diabetic Laser Treatment
Laser surgery is often recommended for people with macular edema, PDR, and neovascular glaucoma.
For macular edema, the laser is focused on the damaged retina near the macula to decrease the fluid leakage. The main goal of treatment is to prevent further loss of vision. It is uncommon for people who have blurred vision from macular edema to recover normal vision, although some may experience partial improvement. A few people may see the laser spots near the center of their vision following treatment. The spots usually fade with time but may not disappear.
For PDR, the laser is focused on all parts of the retina except the macula. This panretinal photocoagulation treatment causes abnormal new vessels to shrink and often prevents them from growing in the future. It also decreases the chance that vitreous bleeding or retinal distortion will occur. (Further information on panretinal photocoagulation follows this section.)
Multiple laser treatments over time are sometimes necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further loss of vision.
Vitrectomy: In advanced PDR, your ophthalmologist may recommend a vitrectomy. During this microsurgical procedure, which is performed in the operating room, the blood filled vitreous is removed and replaced with a clear solution. Your ophthalmologist may wait for several months or up to a year to see if the blood clears on its own before performing a vitrectomy.
Vitrectomy often prevents further bleeding by removing the abnormal vessels that caused the bleeding. If the retina is detached, it can be repaired during the vitrectomy surgery. Surgery should be done early because macular distortion or traction retinal detachment will cause permanent visual loss. The longer the macula is distorted or out of place, the more serious the vision loss will be. For further information, see the Vitrectomy Surgery section on this website.
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Proliferative retinopathy is a condition in which abnormal new blood vessels may rupture and bleed inside the eye. When this advanced stage of retinopathy occurs, pan-retinal photocoagulation is usually recommended.
During this procedure, a special laser is used to make tiny burns that seal the retina and stop vessels from growing and leaking. Hundreds of tiny spots of laser are placed in the retina to reduce the risk of vitreous hemorrhage and retinal detachment. Targeted laser applications can treat specific areas in the central vision that are leaking. The laser is used to destroy all of the dead areas of retina where blood vessels have been closed. When these areas are treated with the laser, the retina stops manufacturing new blood vessels, and those that are already present tend to decrease or disappear.
The goal of pan-retinal photocoagulation is to prevent the development of new vessels over the retina and elsewhere, not to regain lost vision.
Pan-retinal photocoagulation is for those:
- who have been diagnosed with proliferative retinopathy
- whose doctor has determined that pan-retinal photocoagulation is the appropriate treatment for their condition
What to expect on procedure day:
Your treatment will be performed in a specially equipped laser room. It does not require a hospital or surgery center. It is usually performed without anesthesia, although some will want a local anesthetic.
Before your procedure begins, an eyelid holder will be placed between your eyelids to keep you from blinking. Next, your ophthalmologist will begin laser treatment with an argon laser. The laser treats the peripheral (outside) and middle portions of your retina. It does not treat the central or macular region.
The initial treatment usually consists of approximately 1,500-2,000 spots of laser per eye. This will be done in two or more sessions.
Your vision will be poor immediately after the treatment, but will recover to the pre-treatment level over time. You should plan to have someone drive you home, and you should relax for the rest of the day. Most patients resume activities within a few days. Regular follow-up visits are required.
The goal of pan-retinal photocoagulation is to prevent the development of new vessels over the retina and elsewhere, not to regain lost vision. There is no improvement in vision after the laser treatment. Vision may decrease due to edema/swelling of the retina, after the laser treatment. It may improve to its previous level in two to three weeks or may remain permanently deteriorated. Recurrences of proliferative retinopathy may occur even after an initial satisfactory response to treatment.
This procedure sacrifices peripheral vision in order to save as much of the central vision as possible and to save the eye itself. Night vision will be diminished. After pan-retinal photocoagulation, blurred vision is very common. Usually, this blur goes away, but in a small number of patients some blur will continue forever.
Serious complications with pan-retinal photocoagulation are extremely rare, but like any surgical procedure, it does have risks. .
If you and your doctor decide that laser treatment for diabetic retinopathy is an option for you, you will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed. Be sure you have all your questions answered to your satisfaction.