In Office Surgical Procedures

For Glaucoma, Cataract And Retina

Selective laser trabeculoplasty (SLT)

Selective laser trabeculoplasty (SLT) is a laser procedure performed in the office to lower eye pressure. The low energy laser is applied directly to the trabecular meshwork, which is the internal drain for intraocular fluid. SLT stimulates the trabecular meshwork to increase the amount of fluid drained from within the eye, which lowers eye pressure. This procedure is typically painless. When performing an SLT, the patient’s eye is first anesthetized with topical drops or gel followed by the application of a special contact lens to allows visualization of the the trabecular meshwork. The procedure takes approximately one minute.
On average, SLT can lower the eye pressure by about 20-30% and is is effective in about 75% of patients. It may take several weeks for the laser to take full effect. The effect may wear off after several years, and the trabecular meshwork can be stimulated again with repeat laser. SLT does not affect the success rates or the eligibility of getting other medical or surgical treatments.
Compared to many other treatments for glaucoma, including eye drops and surgery, SLT has few side effects. Inflammation is possible after the laser, but it is not common. You may be prescribed anti-inflammatory drops on an individual basis. There is a small risk of temporary high eye pressures following the laser treatment, and if this occurs it may be controlled with the temporary use of eye drops. Your doctor will have you wait in the office after the SLT is performed to check your pressure before going home. There are not restrictions after the procedure.

Laser Peripheral Iridotomy (LPI) 

Laser peripheral iridotomy (LPI) is a method by which ophthalmologists create a microscopic hole in the iris to open the angle (location of the internal drain of the eye) in patients with narrow or closed angles. Narrow angles occur with there is an obstruction of normal flow of fluid inside the eye, causing the colored iris to be physically pushed into the trabecular meshwork. This causes a buildup of fluid and high pressures, which may lead to irreversible damage to the optic nerve and vision loss. In some patients, the eye pressure elevation may happen suddenly causing pain, red eye, blurred vision, nausea and rarely vomiting. This condition is called an acute angle closure attack. More commonly, the buildup of fluid is slow and pressure rises slowly. This may not cause typically symptoms. In both cases, performing an LPI improves the drainage of the aqueous fluid and decreases intraocular pressure to prevent permanent damage to the optic nerve.
When performing an LPI, the patient’s eye is first anesthetized with topical drops or gel followed by the application of a special contact lens to prevent blinking and also allow the ophthalmologist to focus clearly on the peripheral iris where the laser is applied.  No injections or needles will be used. The laser treatment will take approximately a minute to complete. During the laser treatment, you may see a bright light, like a photographer’s flash from a close distance. Patients describe a range of sensations from feeling nothing, a pinch, or a static feeling. Generally, the sensation is brief. As a safety measure, your eye pressure will be checked after your procedure and you will be asked to take a topical anti inflammatory drop for a few days. There are no restrictions after the procedure.

YAG Laser Capsulotomy

A YAG laser capsulolomy is a medical procedure used to treat posterior capsular opacification (PCO), a condition that commonly occurs months to years after cataract surgery. With cataract surgery, the cloudy natural lens of the eye (crystalline lens) is removed from its capsular support and an artificial lens is implanted. PCO may arise due to the growth of residual, microscopic crystalline lens cells, which can multiply on the back surface of this capsule and cause it to become cloudy. This cloudiness can lead to vision problems similar to those experienced with a cataract, leading to the antiquated terminology for PCO, a “secondary cataract.”
A YAG laser capsulotomy is a quick and non-invasive procedure used to treat PCO. The procedure is performed in the office. On the day of the visit, vision and eye pressure are checked and the pupil is dilated. The laser microscope is nearly the same as the examination microscope, with a chin and forehead rest and easy upright positioning. At your doctor’s discretion, a temporary contact lens may be to placed to perform the procedure, although many times the procedure can be performed without a contact lens. The YAG laser emits short pulses of energy that are focused onto the cloudy posterior capsule. These laser pulses create a small, precise opening in the capsule, allowing light to pass through to the retina unobstructed. The procedure is painless, and is typically finished in under a minute. Most patients experience an improvement in their vision immediately after the treatment, although the full benefit may not be appreciated until dilation wears off 3-4 hours after the procedure. There is no need for a patch or bandage after the procedure, and patients can return to normal activities right away. At your doctor’s discretion, a topical eye drop may be prescribed for a few days.
YAG capsulotomy is considered a safe and effective procedure. However, like any medical procedure, it carries some risks, albeit very low. Theoretical risks include retinal tears, eye inflammation, or increased intraocular pressure. Your eye doctor will discuss these risks with you before the procedure. Many patients experience small floaters for a day or two after the procedure, which then dissipate.
YAG capsulotomy has become a standard treatment for PCO because of its effectiveness and non-invasiveness. It allows patients to regain clear vision without the need for a major eye surgery. If you have had cataract surgery and are experiencing cloudy vision or other vision problems, consult your doctor to determine if YAG capsulotomy is an appropriate treatment option for you.

Punctal Plugs

Punctal plug occlusion is a treatment option for individuals suffering from aqueous deficient dry eye (insufficient tear production). Punctal plugs are tiny devices that are inserted into the tear ducts of the eyelid to help retain tears and reduce eye pain, discomfort, irritation and blurry vision associated with dry eye. There are two types of punctal plugs- temporary (dissolvable) and permanent plugs (silicone or other long-lasting, inert material). Temporary plugs are designed to provide short-term relief from dry eye symptoms and can be used as a diagnostic tool to assess the effectiveness of punctal occlusion. Permanent plugs are meant to be left in place and provide long-term relief, although they can be removed at any time if necessary.
The insertion of punctal plugs is a quick and painless procedure that is performed in the office. The eye is numbed with topical anesthetic drops, and the plug is gently inserted into the tear duct opening in the eyelid.
It’s important to note that while punctal plugs can be highly effective for many people with dry eye, they may not be suitable for everyone. Proper evaluation is essential to determine the best treatment approach for each individual, as the causes and severity of dry eye can vary widely. Other treatments and lifestyle modifications may also be recommended alongside punctal plug occlusion to manage dry eye effectively.

Nasolacrimal Probing and Irrigation

Nasolacrimal probing and irrigation is a medical procedure used to treat nasolacrimal duct obstruction (NLDO), a blockage or narrowing in the tear drainage system of the eye. NLDO can lead to excessive tearing, discharge, and eye discomfort, and it increases the risk for infection of the tear duct system. Probing and irrigation is a standard treatment to both diagnose and restore proper tear drainage, and it is typically recommended when conservative treatments such as warm compresses, massage, and antibiotics have not resolved the issue. During the procedure, patients are positioned in a reclining chair and the eye is numbed. A small amount of saline water is then gently flushed through the tear duct system. The act of flushing may help remove blockages and restore tear drainage function. Afterwards, patients may experience some mild discomfort or tearing, which is typically temporary. A topical antibiotic eye drops or ointment may be prescribed at your doctor’s discretion to help with healing.
Probing and irrigation can be highly effective in alleviating NLDO, however in cases where probing and irrigation is not successful, surgical treatment options may be considered and referral to a specialist may be warranted.

Chalazion

A chalazion is caused by the blockage of a meibomian gland in the eyelid. Meibomian glands produce oil that lubricates the eye’s surface. When a meibomian gland becomes blocked, oil production continues yet does not have an outlet. This leads to the formation of a bump within the eyelid. Often times a chalazion may respond to conservative treatments such as warm compresses, digital massage and oral or topical medications. In cases were a chalazion does not resolve and causes irritation or cosmetic issues, a minor surgical procedure can help drain the chalazion. This is performed in the office and takes approximately 5 minutes. The procedure involves a small numbing injection followed drainage of the chalazion from the inside portion of the eyelid, so as not to leave an external scar. A patch is placed over the eye for a few hours and patients are prescribed medication for a few weeks to help the healing process. Most patients experience rapid healing with a few days. Chalazion surgery is considered a minimally invasive, safe and effective procedure, with a high success rate.

Amniotic Membrane Treatment For Dry Eye

Amniotic membrane placement is an advanced therapeutic approach for managing severe dry eye or corneal inflammatory disease, particularly when standard treatments have been ineffective. Amniotic membrane is sourced from placental tissue that is rigorously screened and processed to ensure safety and sterility. With many unique benefits, amniotic tissue reduces inflammation and promotes healing and regeneration of damaged corneal tissue. This treatment is performed in the office and involves the placement of amniotic membrane tissue onto the surface of the eye. A bandage contact lens or patch may be placed at your doctor’s discretion, and the tissue slowly dissolves over a few hours. The therapeutic benefits persist well beyond the disappearance of the amniotic membrane. Other treatments and lifestyle modifications may also be recommended alongside amniotic membrane therapy.

Laser Retinopexy

Laser retinopexy is a surgical procedure that uses a laser to repair a tear or hole in the retina. The goal of the procedure is to seal the tear or hole and prevent it from progressing into a retinal detachment, a serious condition that can cause permanent vision loss and that requires emergency surgery.
During the procedure, our ophthalmologist uses a special laser to create small burns around the tear in the retina. The burns cause scarring, which seals the tear or hole and helps to hold the retina in place and therefore prevents formation of a detachment.
Laser retinopexy is typically performed in the office on an outpatient basis and typically does not require any activity restrictions or post operative drops. The procedure itself is usually well tolerated without much discomfort.
Patients typically will need to return to the office for follow-up visits to monitor the healing process and ensure that the retina remains attached.
Laser retinopexy is considered a safe and effective treatment for retinal tears and holes and may help prevent the need for more involved and invasive surgery.

Intravitreal Injections

Intravitreal injections are performed to place a medication directly into the vitreous cavity of the eye. The vitreous is a clear, jelly-like substance that fills the inside of the eye and helps maintain its shape. These treatments are necessary in order to deliver medicine to the retina, as drops on the surface of the eye are unable to penetrate that far.
Intravitreal injections are typically used to treat a variety of eye conditions, including macular degeneration, diabetic retinopathy, and retinal vein occlusion. The medication delivered through the injection is typically an anti-VEGF (vascular endothelial growth factor) or steroid medication. These medications work to reduce inflammation, leakage and swelling in the retina, which can help improve vision and prevent further damage.
The injection is performed in the office and the patient may be given local anesthesia or numbing eye drops to minimize discomfort during the procedure. The injection itself lasts only a matter of seconds and is typically well tolerated without significant discomfort. After the injection, the patient is advised to use lubricating drops or gels for mild irritation, which typically lasts less than 24 hours.
Intravitreal injections are generally considered very safe and effective, but they do carry some risks, including infection, bleeding, and retinal detachment – all of which are extremely rare. The retina specialists at Arlington Eye Physicians will discuss the risks and benefits of the procedure with the patients, if this treatment is deemed to be necessary. Patients may need to receive multiple injections over a period of time to achieve the desired therapeutic effect.

Pan Retinal Photocoagulation

Pan retinal photocoagulation, also known as scatter laser treatment, is a surgical procedure used to treat proliferative diabetic retinopathy, a complication of diabetes that can cause abnormal blood vessels to grow on the retina and potentially cause vision loss.
During the procedure, an ophthalmologist uses a special laser to create small burns in the peripheral retina, away from the macula (the central part of the retina responsible for sharp, detailed vision). These burns destroy the abnormal blood vessels and help to reduce the risk of bleeding and other complications associated with proliferative diabetic retinopathy.
The procedure is typically performed on an outpatient basis, and patients may be given local anesthesia or numbing eye drops to minimize discomfort during the procedure. The laser treatment may be completed in a single session or may require multiple sessions over several weeks or months.
After the procedure, patients may experience some discomfort or sensitivity to light, but this typically resolves within 24 hours. Patients will also need to return for follow-up visits to monitor the healing process and ensure that the treatment was effective.
Pan retinal photocoagulation is a safe and effective treatment which may be used in combination with other therapies such as intravitreal injections to manage diabetic retinopathy, retinal vein occlusions and other vascular disorders of the retina.

Focal Retinal Laser

Focal laser treatment, also known as macular laser treatment, is a surgical procedure used to treat macular edema, a swelling of the macula (the central part of the retina responsible for sharp, detailed vision) that can occur as a result of a variety of conditions, including diabetic retinopathy, macular degeneration, and retinal vein occlusion.
During the procedure, an ophthalmologist uses a special laser to create small burns in the macula. These burns help to seal leaking blood vessels and reduce fluid buildup, which can improve vision and prevent further damage to the retina.
The procedure is typically performed on an outpatient basis, and patients may be given local anesthesia or numbing eye drops to minimize discomfort during the procedure. The laser treatment may be completed in a single session or may require multiple sessions over several weeks or months.
After the procedure, patients may experience some discomfort or sensitivity to light, but this typically resolves within a few days. Patients will also need to return for follow-up visits with their ophthalmologist to monitor the healing process and ensure that the treatment was effective.
Focal laser treatment is a safe and effective treatment which may be used in combination with other therapies such as intravitreal injections to manage diabetic retinopathy, retinal vein occlusions and other vascular disorders of the retina.