ThermoCyclo como tratamiento de último recurso
¿Qué es ThermoCyclo?
Además de ser conocida como ciclofotocoagulación transescleral láser, o TSCPC, ThermoCyclo es una técnica láser destructiva para el manejo del glaucoma avanzado incontrolable o resistente al tratamiento.
Los procesos ciliares y el cuerpo ciliar reciben una onda continua de 810 nanómetros de energía láser durante el tiempo suficiente como para desnaturalizar el tejido térmicamente, lo que da lugar a la reducción de la producción de humor acuoso y, en consecuencia, a una menor presión intraocular (PIO).
Durante esta técnica, a veces es posible oír un sonido por el estallido de los procesos ciliares.
Tecnología
El tratamiento se realiza con el láser Vitra 810 de Quantel Medical utilizando los ajustes de tratamiento ThermoCyclo y la sonda láser SubCyclo® con la base colocada.
La base garantiza un ángulo de sonda correcto para la emisión láser, en paralelo al eje visual y en perpendicular al plano del iris.
Directrices de tratamiento
Al manipular un láser, utilice siempre gafas de seguridad con un nivel de protección adecuado.
ThermoCyclo es indicado para: |
|---|
|
Cuando los pacientes: |
|
ThermoCyclo está contraindicado: |
|---|
|
Anestesia |
Se requiere anestesia local; inyección retrobulbar o peribulbar, o anestesia subtenoniana con mepivacaína al 2 % o equivalente. |
Advertencia |
El exceso de energía del tratamiento puede ocasionar quemaduras en la superficie ocular o hemorragia en el cuerpo ciliar. La potencia láser máxima de este equipo es 2500 mW. |
Preparación del paciente
Puede utilizarse un blefarostato palpebral para mantener un acceso adecuado a la fisura palpebral. Aplique metilcelulosa en el ojo cada cuatro disparos, asegurándose de que la sonda láser siempre permanezca en contacto húmedo con la esclerótica.
Utilice iluminación transescleral para localizar el cuerpo ciliar (aproximadamente a 2,5-3,5 mm limbo). La emisión láser es transescleral. Procure evitar las zonas de adelgazamiento de la esclerótica o donde haya una fuerte pigmentación en la conjuntiva perilímbica.
Configuración láser
La selección de la configuración del láser y los ajustes realizados para cada paciente son responsabilidad del médico.
Los ajustes de potencia generales son 1250 mW durante 4000 milisegundos para iris con pigmentación oscura y de 1500 mW durante 3500 milisegundos para iris de colores más claros.
La sonda láser debe sostenerse en paralelo al eje visual y en perpendicular al plano del iris. Además, deben aplicarse 5-7 puntos láser por cuadrante, como mínimo con un espacio de un punto completo entre cada pulso.
Por lo general se intenta con tres cuadrantes, evitando las posiciones de las 3 y las 9 horas, además de la región del cuadrante temporal.
Datos clinicos
Titre
Texte
Clinical articles
Videos
Webinars
Interviews
Symposium
SLT: Positive implications from the LiGHT study
07/03/2023
Glaucoma is a lifelong disease that requires continual monitoring and management. For many patients, glaucoma can be controlled medically—at least for a time—but the treatment is far from perfect. Complications, side effects, and compliance are common issues for those who rely on eye drops to control IOP. Other barriers to medical treatment include nonresponse to a medication, tachyphylaxis, and financial burden.
SLT as Frontline Therapy
19/12/2022
Selective laser trabeculoplasty (SLT) has come a long way in the last few years. The practice is gaining adherents as a first-line treatment for open-angle glaucoma for multiple reasons. And to give SLT a boost and provide an uber-coherent overview of the reasons in favor of SLT, Dr. Paul Singh spoke on its behalf at ESCRS 2022 in Milan.
The role of Selective Laser Trabeculoplasty as a primary and secondary treatment
04/03/2022
Glaucoma is the most common optic neuropathy. The only clinically proven treatment is to reduce IOP by using medical, laser, and surgical therapies. Treatment is typically selected depending on the level of IOP, stage of the disease, pace of progression, and current and past treatment history. Glaucoma management with drops can be problematic, mainly because they can be difficult for patients to instill properly and because of the related side effects.
Selective Laser Trabeculoplasty: A Safe and Effective First-line Therapy for Glaucoma
09/06/2021
In treating glaucoma, the typical route is often to prescribe medications.
If topical drops fail to achieve a reduction in intraocular pressure (IOP), then the alternative is to try laser trabeculoplasty, and finally surgery.
Let There Be (Laser) Light
09/05/2021
From 2019 to 2020, I co-chaired the European Glaucoma Society (EGS) Guidelines Committee with Carlo Traverso. The 5th Edition of the EGS guidelines was published in October 2020, after a superb team effort among a large number of colleagues (1). We aimed to promote evidence-based clinical practice and, to that end, followed GRADE methodology, including identification of key questions, critical evaluation of published literature, and formulation of recommendations.
Ranking Laser in Glaucoma Treatment
09/02/2021
Glaucoma management has traditionally taken a stepped approach based on the level of risk involved. The low-risk treatment option is medication. Next are laser/selective laser trabeculoplasty (SLT), MIGS, and incisional surgery. It ends with the highest risk option of cyclodestructive procedures.
Terminology and Guidelines for Glaucoma
18/11/2020
Download the EGS Guidelines on the European Glaucoma Society website.
Visual Field Outcomes from the Multicenter, Randomized Controlled Laser in Glaucoma and Ocular Hypertension Trial (LiGHT)
18/10/2020
To compare visual field outcomes of ocular hypertensive and glaucoma patients treated first with medical therapy with those treated first with selective laser trabeculoplasty (SLT).
SLT earns a place as first-line therapy
09/03/2020
Glaucoma specialists have traditionally viewed topical therapy as first-line treatment for glaucoma. Recently, however, this paradigm has been challenged. Selective laser trabeculoplasty (SLT), though FDA approved since 2001, has gained acceptance as first-line treatment over the last 5 to 10 years.
Selective Laser Trabeculoplasty Updates and Tips
09/09/2018
The glaucoma surgical landscape is bombarded with a variety of new microinvasive glaucoma surgery (MIGS) procedures daily. These new procedures are altering the paradigm and treatment concepts of glaucoma surgery and are accelerating the importance of earlier surgical intervention aimed at reducing morbidity of progression, reducing the need for more aggressive surgical options (while preserving those options), and reducing the burden of medication along with patientcompliance issues, which is one of the most prevalent problems in glaucoma treatment today.
Selective Trabeculoplasty in the Management of Open Angle Glaucoma: Retrospective Analysis at 1 Year
09/12/2017
In order to prevent the progressive and irreversible loss of optic nerve fibres, the treatment of glaucoma aims to effectively and lastingly reduce Intraocular Pressure (IOP) in affected patients. To this end, in addition to medical and surgical techniques, means of weakening the trabeculum by laser have been developed since the 1980s, following the pilot study by Wise and Witter.
Médicos
Hable sobre la terapia ThermoCycloLaser
Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.
No data was found
Referencias clínicas
Les références