Laser Peripheral Iridotomy Procedure and Its Role in Glaucoma Management

Laser Peripheral iridotomy is an office procedure performed with lasers which involves making a hole in the periphery of the iris to create a communication between posterior chamber (the space between lens and iris) and anterior chamber (the space between iris and cornea).

It is mainly used in narrow angle glaucoma and some other conditions (e.g.: plateau iris) where the aqueous needs to flow freely from posterior chamber to anterior chamber.

Laser peripheral iridotomy is a simple procedure in which a small hole is made in the iris to help facilitate the flow of aqueous humor from the posterior chamber of the eye to the anterior chamber.

Remember, in eyes that are predisposed to angle closure glaucoma, the lens advances forward and causes aqueous humor to accumulate behind the iris. This pushes the iris forward so that the trabecular meshwork is blocked, which in turn causes an increase in intraocular pressure.

The small hole created by the laser peripheral iridotomy enables aqueous humor, which has been accumulating in the posterior chamber of the eye and raising intraocular pressure, to enter the anterior chamber. Flow of aqueous humor into the anterior chamber pushes the iris back away from the trabecular meshwork, allowing the fluid to escape and lower intraocular pressure.

Acute primary angle closure glaucoma is an emergency situation that must be seen by a physician as soon as possible. If you experience any of the the symptoms of glaucoma described here, especially pain in your eye, you should see a physician immediately.

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Lasers Used for Iridotomy

There are many types of lasers used in laser iridotomy procedures. Nd:YAG laser, argon laser and diode lasers are used. To get better results, a combination of argon and Nd:YAG laser or a combination of diode and Nd:YAG laser can also be used.

Side Effects of Laser Peripheral Iridotomy

The side effects of peripheral iridotomy procedure are minor. Bleeding may occur during the procedure which can easily be managed by applying pressure on the eye. A short-duration rise in IOP (intraocular pressure) and mild inflammation (uveitis) are common after the procedure. Both the spike in IOP and inflammation are controlled with eye drops for one to two weeks.

Success Rate of Laser Iridotomy

If the size of the iridotomy hole is adequate, the patient will no more need any eye medication to treat or prevent narrow angle glaucoma and its consequences. Most of the laser iridotomy procedures are successful. If for any reason the size of the hole is not adequate or is not patent, the procedure can be repeated to enlarge the iridotomy.

Iridectomy vs Iridotomy

Some ophthalmologists use the term laser ‘iridectomy’ instead of iridotomy but the term iridectomy is traditionally used when the opening in the iris is made with an eye surgery using scissors rather than with laser.

Laser Iridotomy Video

Here is a video which explains the laser iridotomy peripheral procedure:

Recovery After Laser Iridotomy

Since laser iridotomy does not require admission and the procedure takes only a few minutes, the recovery is fast. The patient may feel a little heaviness and glare after the procedure but that is only transient. The treatment prescribed after the procedure takes care of these symptoms.

Complications of Laser Peripheral Iridotomy

Following is the list of possible but uncommon complications with laser iridotomy:

  1. Localized lens opacity (cataract)
  2. Corneal burn
  3. Retinal burn
  4. Prolonged inflammation (anterior uveitis)
  5. Closure of iridotomy

The above complications are not serious in nature and can be managed easily if noticed early. In good hands, such complications happen rarely.

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