A system and method for combined tissue imaging and image-guided laser therapy is provided. The apparatus has one or more imaging modalities and lasers that are controlled by a controller. The setting configuration of the laser is determined by the location of designated boundaries and the structures of the target tissue that have been imaged. Intra-operative imaging of the target tissue allows a real time evaluation of the laser administration and determines the laser configuration if the contemporary images indicate a re-treatment is necessary. Over treatment and under treatment by the laser is avoided by image-directed laser ablation or non-ablative laser therapy.