Laser coagulation of the retina is a therapeutic procedure used to treat various retinal diseases. The treatment is carried out using a laser that closes leaking blood vessels or small retinal holes. Laser coagulation can therefore halt the progression of certain retinal diseases.
Laser coagulation of the retina goes back to the German physician Gerhard Meyer-Schwickerath. Today, the procedure is widely used in medicine.
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The medical effects of laser coagulation can be used in various ways in ophthalmology. The main conditions that are treated using laser coagulation include
The retina, also known in medicine as the retina, is a multi-layered nerve tissue that is located on the inside of the eye and surrounds the vitreous body. Light falls through the pupil onto the retina, where it is converted into electrical signals and sent to the brain via the optic nerve for conversion into images.
The structure of the human eye
Influencing factors such as myopia (short-sightedness) or traction exerted on the retina by the vitreous body of the eye can lead to local retinal damage. For example, it is possible that the retina of those affected may show thinning or even small holes.
Laser coagulation of the retina is a common treatment option here: By emitting targeted laser radiation, the edges of a retinal hole are connected to the respective substrate. In this way, laser coagulation can prevent hole enlargement and the threat of retinal detachment.
Retinal detachment is an emergency situation in ophthalmology, as it leads to blindness if left untreated @ bilderzwerg /AdobeStock
In the course of so-called wet macular degeneration, pathological vascular growth can occur, from which fluid often escapes. With targeted laser treatment, these vessels can be obliterated - and the fluid leakage stopped.
However, laser coagulation is less suitable for treating new vascular formations below the fovea - in order to avoid treatment risks such as scotomas (the perception of black dots), ophthalmologists usually switch to other treatment methods.
Macular oedema is when there is an accumulation of fluid in the area of the macula (the so-called "yellow spot" at the back of the retina). This is often due to the presence of diabetes mellitus.
Drawn diagram of the eye with iris, cornea, lens, retina and its blood vessels, macula
Laser coagulation is one of the most effective treatment methods for reducing macular oedema. With the help of targeted laser radiation, the pumping activity of the affected tissue can be stimulated so that the edema can then subside.
In addition, the treatment of macular oedema via laser coagulation has a number of other effects. For example, the localized therapeutic destruction of cells by laser beams leads to a reduction in the oxygen consumption of the retina (which means that the oxygen supply to the retina improves). As a result, the formation of new blood vessels in the retinal area decreases, while the permeability of existing blood vessels also decreases.
Successful laser coagulation can counteract progressive vision loss by reducing macular oedema.
Macular oedema
The preferred form of laser coagulation for the treatment of macular oedema depends on the individual symptoms. In so-called focal paracentral laser coagulation of the retina, treatment is limited to areas of the macula that are particularly affected by fluid accumulation.
Laser coagulation in the form of a laser dot grid (grid laser coagulation), on the other hand, can be useful if diffuse macular oedema is present.
In grid laser coagulation of the retina, the entire macula is included in the laser treatment.
In diabetic retinopathy, microscopic damage to the retinal blood vessels increasingly leads to damage to the retina itself. Various areas of the retina often show an undersupply of oxygen. In addition, it is not uncommon for new blood vessels to form, although these are comparatively less stable. This can lead to bleeding in the affected area of the retina and, in the worst case, to blindness.
Illustration of a healthy eye (above) compared to a retinopathy damaging the retina
Effective laser coagulation as part of retinopathy treatment usually involves several laser foci with a comparatively large diameter. The treatment covers the entire retinal surface and only spares the macula (the yellow spot). To avoid undesirable consequences of treatment, such as a reduction in the visual field, it is important to maintain a sufficient distance between individual laser points.
An improvement in visual acuity can only be achieved using laser coagulation in very rare cases. However, the treatment can help to prevent impending loss of visual acuity due to retinal damage. Depending on the patient's findings, the use of laser coagulation can delay more complex surgical procedures.
Prior to laser coagulation, the patient's medical history is clarified and a detailed eye examination is carried out. To assess the fundus of the eye, a short-term pupil dilation is first induced using eye drops. Further examinations carried out in individual cases depend on the patient's individual symptoms.
Depending on the clinical picture, different variants of laser coagulation can be used. A distinction is made between laser coagulation directed specifically at individual areas of the retina and grid laser coagulation. This is primarily used when disease foci merge into one another and therefore no locally delimited treatment areas can be defined. If retinal changes only occur locally, grid laser coagulation is generally not necessary.
Different lasers can be used for this procedure. However, laser coagulation is predominantly performed with an argon laser, which emits green-blue laser beams. Infrared, dye or krypton lasers are also suitable for the treatment.
In most cases, treatment is carried out on an outpatient basis. The patient is in a sitting or lying position. At the beginning of the treatment, surface anesthesia (i.e. local anesthesia) is administered and the pupils are dilated with eye drops.
Laser coagulation is performed using a so-called slit lamp, which is connected to the laser device. A corneal contact lens (a special magnifying glass) is placed on the eye to be treated with the patient in a sitting position. Laser beams are then emitted, which lead to local tissue destruction. The subsequent scarring of the treated retinal areas causes them to fuse with the underlying tissue structures. Several consecutive sessions are often necessary to achieve a satisfactory treatment result.
The extent of treatment depends primarily on the patient's condition. If, for example, a patient is at risk of a detached cornea, the treating doctor will usually place relatively large laser dots as part of laser coagulation of the retina of the eye.
If a patient's retina shows holes or similar defects in the outer area, the corresponding damage is usually demarcated from the surrounding tissue by laser foci arranged in a ring. This prevents treated retinal damage from spreading to areas of the retina that are still unaffected.
If, on the other hand, impaired blood vessels in the area of the macula are to be treated, this is usually done by placing smaller laser points.
After outpatient laser coagulation of the retina, the patient should not drive for about 24 hours. In the first few days after successful treatment, it is also advisable to avoid heavy physical exertion. It may be necessary to use special eye ointments or drops.
If any abnormalities or complaints occur following treatment, the treating ophthalmologist should be contacted at an early stage. Even if there are no complications during the healing process, a check-up by an ophthalmologist should follow after 3 months at the latest. The purpose of such an examination is to have the intended success of the treatment checked by a doctor.
The specific post-treatment and control steps that should ideally be taken after laser coagulation depend on the individual case. Depending on the patient, regular medical checks of the intraocular pressure, for example, may be useful.
Occasionally, follow-up checks may reveal that the treatment has not had sufficient effect. In this case, additional further treatment steps (such as repeated laser coagulation) may be useful. However, as repeated treatment sessions also increase the treatment risks, the patient and treating specialist should carefully weigh up the decision.
As laser coagulation involves the targeted destruction of tissue, the treatment procedure is associated with various risks. For example, if larger areas of a patient's retina need to be treated or if it is medically necessary to perform the procedure repeatedly, the treated person's vision may deteriorate.
Corresponding negative effects can be expressed by the fact that colors are harder to distinguish from one another or that vision deteriorates at dusk or in the dark. It is also possible that the treatment may result in a restricted field of vision.
Other treatment risks associated with laser coagulation of the retina include a possible change in intraocular pressure. If the treatment is carried out in the central area of the macula or fovea, for example, scotomas may occur after the procedure - this means that black holes are perceived in the field of vision.
Due to the various treatment risks mentioned above, ophthalmologists must therefore carefully consider how often or to what extent laser coagulation of the retina is medically advisable for individual patients.
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