Complications of Argon Laser Retinal Buckling Performed in Myopic Subjects Presenting Rhegmatogenous Degenerations

Menchini, Ugo; Davi, G.; Leoni, Giovanni; Azzolini, Claudio; Brancato, Rosario

doi:10.1159/000309867

Cited by 6 publications

(6 citation statements)

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“…Posterior and peripheral argon PRP were then performed sequentially in the right eye. Both produced diminished responses to electrical stimulation and supersensitivity to pilocarpine early on, followed by essentially complete recovery (Fig 3, rows [9][10][11][12][13][14]. Similar findings were seen following PRP and HRMP in several other animals (48).…”

Section: Refraction and Accommodationsupporting

confidence: 63%

“…This niay be accompanied by paresis of the iris sphincter muscle, yielding a dilated pupil which reacts poorly to direct or consensual photic stimulation (9)(10)(11)(12). Similar occurrences may follow peripheral retinal photocoagulation (7,13) or cryotherapy (14) for myopic or lattice degeneration.…”

Section: Introductionmentioning

confidence: 84%

“…Injury to the parasympathetic motor nerves coursing anteriorly through the choroid or suprachoroid just beneath the sclera has been postulated to explain these phenomena (7,(9)(10)(11)13,15).…”

Section: Introductionmentioning

confidence: 99%

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Parasympathetic denervation of the ciliary muscle following panretinal photocoagulation

Kaufman¹,

Rohen

Gabelt

et al. 1991

Current Eye Research

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Cynomolgus monkeys underwent unilateral panretinal scatter photocoagulation (PRP) and/or nasal and temporal horizontal retinal meridional photocoagulation (HRMP) with xenon arc or argon or krypton laser light. Shortly thereafter, in the PRP-treated eyes, accommodative responsiveness to topical eserine and electrical stimulation of the Edinger-Westphal nucleus (EWN) was diminished, accommodative responsiveness to intramuscular (i.m.) pilocarpine was enhanced, and the number of muscarinic receptors in the ciliary muscle was reduced compared to the contralateral controls. In most instances, these parameters returned to normal over 6-12 wks and the abnormalities could be induced again by another round of PRP. However, in some PRP-treated eyes, accommodative responsiveness to EWN stimulation and topical eserine remained subnormal permanently (greater than 1 yr). Shortly after HRMP alone, accommodative responses to i.m. pilocarpine, topical eserine, and central stimulation did not differ markedly in the treated and control eyes. Morphologic studies 1 to 78 wk following PRP revealed that myelinated and unmyelinated nerves within the entire circumference of the choroid and ciliary muscle were severely damaged early on. The number of unmyelinated nerves between the individual ciliary muscle fibers was drastically reduced, those which remained were swollen or deteriorated, and agranular synaptic vesicles were rarely seen. Thereafter, the nerves in the choroid and ciliary muscle gradually regenerated. Following HRMP, only the choroidal nerves which passed through the photocoagulated areas and the ciliary muscle nerves in the corresponding meridians showed signs of deterioration, and there was minimal effect on the physiologic responses examined. These findings collectively indicate that intraocular parasympathetic denervation of the ciliary muscle is produced by PRP, although all nerve types are likely damaged.

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Section: Refraction and Accommodationsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 84%

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Parasympathetic denervation of the ciliary muscle following panretinal photocoagulation

Kaufman¹,

Rohen

Gabelt

et al. 1991

Current Eye Research

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“…It has been suggested that thermal injury to the parasympathetic motor nerves running in the short ciliary nerves anteriorly through the choroid and suprachoroidal space could explain this complication. 2,5,7,8 We have seen this in four cases following diode PRP with subTenon's local anaesthetic injection given as described by Stevens. 9 The cases are presented and the possible causes discussed.…”

Section: Introductionmentioning

confidence: 80%

Dilated pupils and loss of accommodation following diode panretinal photocoagulation with sub-tenon local anaesthetic in four cases

Patel¹,

Jenkins

Benjamin

et al. 2002

Eye

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Aim To describe pupillary abnormalities associated with diode laser photocoagulation with subTenon's local anaesthetic. Methods We describe four cases of tonic pupils following diabetic panretinal photocoagulation with subTenon's local anaesthetic. Results Six pupils of four patients became dilated and sustained loss of accommodation with denervation hypersensitivity with 0.1% pilocarpine after undergoing panretinal photocoagulation with a subTenon's local anaesthetic. The numbers of burns were not excessive and in one patient it even occurred after only 1200 laser burns. Conclusion Diode laser causes histological changes deeper in the retina and the choroid than in Argon laser. Intense diode laser burns may cause damage to the short ciliary nerves traversing the choroid. In the unanaesthetised patient, pain arises when the laser burn hits these nerves and so may protect the eye from excess damage to the nerves. When the eye is anaesthetised with a subTenon's, local anaesthetic damage to the choroidal nerves may occur without the laser operator being aware that the burns are too intense.

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“…Internal ophthalmoplegia has also been shown in myopic subjects after retinal equa torial buckling with argon laser photocoagula tion [7], Schiodte [4] related these effects partially to the use of retrobulbar anesthesia before each laser session.…”

Section: Discussionmentioning

confidence: 99%

Argon versus Krypton Panretinal Photocoagulation Side Effects on the Anterior Segment

et al. 1990

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The modification of corneal sensitivity, accommodation, pupillary diameter and endothelial cell density after argon versus krypton panretinal photocoagulation were studied prospectively in 88 eyes of 64 diabetic patients with proliferative diabetic retinopathy, randomized for one of the two laser treatments. In both groups a marked internal ophthalmoplegia and reduction of corneal sensitivity occurred after laser photocoagulation. At no time, 2, 90 and 180 days after PRP, were these parameters significantly different. Endothelial cell loss was non significantly greater in the krypton group. The results indicated that the side effects commonly observed on the anterior segment after PRP are comparable using argon or krypton lasers.

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Complications of Argon Laser Retinal Buckling Performed in Myopic Subjects Presenting Rhegmatogenous Degenerations

Cited by 6 publications

References 0 publications

Parasympathetic denervation of the ciliary muscle following panretinal photocoagulation

Parasympathetic denervation of the ciliary muscle following panretinal photocoagulation

Dilated pupils and loss of accommodation following diode panretinal photocoagulation with sub-tenon local anaesthetic in four cases

Argon versus Krypton Panretinal Photocoagulation Side Effects on the Anterior Segment

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