Barricade Laser Photocoagulation: Explained


Barricade argon laser retinopexy is an important preventative procedure in mitigating the risk of retinal detachment, one of the most common causes of permanent vision loss. Dr. Kavoussi would recommend this procedure after examining a patient in the clinic and discovering evidence of a high risk retinal finding that may predispose to future retinal detachment.

Which retinal conditions are treated with barricade laser?

A horseshoe-shaped tear in the peripheral retina is the most important lesion to laser because nearly 99% of these tears progress to retinal detachment, and most only take a few days before it happens. A horseshoe tear for this reason is considered an emergency and should be lasered upon discovery.

Lattice degeneration and round retinal holes are other peripheral retinal findings that may predispose to retinal detachment, though their respective risk levels are lower than that of the horseshoe tear. Often these need not be lasered upon first discovery, but depending on their appearance, laser may be recommended at a later visit, or sooner if their discovery is associated with symptoms such as flashing lights or new floaters from the same eye.

Why am I seeing flashing lights and floaters in one eye?

We all have a clear vitreous jelly that fills the eye’s largest cavity, and normal age-related changes in the vitreous create the sudden onset of these symptoms in the 5th or 6th decade. The vitreous rests in front of the retina and was attached to the retina when we are young, but as we age into the 5th and 6th decades of life, the vitreous separates.

The process is called a posterior *vitreous* detachment (PVD). This *vitreous* detachment results in new floaters visible from the eye, and a bit of vitreous tugging on the retina can stimulate nerve signals that appear as flashing lights, often described as lightning bolts seen from the outside corner.

At the time of PVD, 10-15% of patients with a *vitreous* detachment may have a concurrent hole or tear in the retina. If the torn retina progresses to a *retinal* detachment, a blind spot may first be noticed in the peripheral vision, and the blind spot eventually enlarges to involve the central vision and the entire visual field.

Any patient who calls the office with sudden onset of flashes or floaters is instructed to come to the office as soon as possible. If the patient makes it into the office with sufficient urgency, the hole can be treated with an in-office laser that seals the edges and prevents it from evolving into a detached retina. In other words, barricade laser is a vision-saving procedure.

How does argon laser treat a torn retina?

The laser is absorbed by the pigmented tissues behind the retina. Dr. Kavoussi will place a 4-row pattern of laser spots to the normal retina that surrounds the torn area. In the days that follow, the laser spots will evolve into a confluent circular scar that acts as a barricade to prevent fluid entry through the tear.

Is the barricade laser procedure painful?

Most patients tolerate the procedure very well with minimal pain. The strangest sensation is the flickering green light as the laser fires. But the level of pain associated with the procedure depends on the location of the tear. If the tear happens to be located over one of the two horizontal ciliary nerves behind the peripheral retina, there will be some aching pain with each laser pulse, and Dr. Kavoussi will slow down the treatment to make it more comfortable.

If the tear is especially peripheral, Dr. Kavoussi will tilt the exam chair into a reclining position and put gentle pressure on the outside of the eyelid to create an indent that brings the farthest border of the tear into view for treatment. Since barricade laser is a vision-saving procedure, all maneuvers are intended to provide thorough treatment that effectively seals the torn area to prevent retinal detachment and vision loss.