Laser Peripheral Iridotomy

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About Laser Peripheral Iridotomy

In a normal, healthy eye, the fluid in the eye (aqueous humour) flows through the pupil into the front of the eye (anterior chamber) and drains away through drainage channels called the trabecular meshwork.

Angle closure glaucoma is due to blockage of these drainage channels, much like a washbasin with something covering the plughole. Angle closure is associated with the drainage pathway not being as wide and open as it should be. When the pupil suddenly or excessively enlarges, as could happen when one enters a dark room, the outer edge of the iris bunches up & obstructs the eye’s drainage channels.

Laser Peripheral Iridotomy is an outpatient clinic procedure in which the ophthalmologist applies a very focused beam of light to form a small hole, not visible to the naked eye, on the outer rim (edge) of the iris, which is the coloured part of the eye.

This permanent opening allows fluid (aqueous humour) to flow between the anterior chamber, the front part of the eye, and the area behind the iris, the posterior chamber so that the fluid pushes the iris tissue backwards, thus opening & unblocking the drainage channels.

If performed at an early stage of the disease, two thirds to three quarters of such cases are “cured” of the condition. The procedure is still worth doing at later stages of the disease because further progressive loss of vision can be slowed or stopped. However, in advanced disease, additional treatment with medication and/or surgery may be necessary.
Laser Peripheral Iridotomy helps preserve sight in people with, or at risk of, angle-closure glaucoma by restoring the flow of fluid into the drainage channels using a hole made by the laser beam in the rim of the iris.

The Laser Peripheral Iridotomy procedure is quick and typically painless, and can be performed as an outpatient procedure.

Complications after Laser Peripheral Iridotomy are uncommon.
It is uncommon to have complications after Laser Peripheral Iridotomy.

Nevertheless, the following complications are possible following the procedure and careful monitoring is a routine part of the post-treatment care:

Increased pressure in the eye: This can occasionally occur immediately after the laser treatment. About 10% of early stage cases and 33% of advanced stage cases develop this post-laser complication. Before you are discharged to go home, additional treatment with tablets or eye drops will be provided, and you may be asked to remain in the clinic until the eye pressure has dropped to a satisfactory level. Typically, this may take a few hours at most.

The laser beam opening is occasionally not large enough or is incomplete: The treatment will need to be repeated at a later date.

The new laser beam opening may allow extra light to enter the eye: A small minority of patients may find this a little distracting at first but most are typically soon able to ignore this.

A possible complication is minor inflammation in the eye. Treatment with anti-inflammatory eye drops for a week may be required. Minor bleeding inside the eye from the laser hole is common and can cause misty vision which usually clears after 24 hours.

Changes in your vision: Small changes in vision have been reported in about a quarter of patients undergoing this treatment, but in the majority of such cases, the vision returns to normal within a month. The visual symptoms sometimes reported include glare, “ghosting” around objects, shadows and lines. Deterioration or loss of vision, or the need for urgent surgery following Laser Peripheral Iridotomy is very rare.

An alternative to Laser Peripheral Iridotomy is to perform a surgical lens extraction. This, however has a greater risk of permanent loss of vision, and so is normally only recommended for those already also suffering from cataract related visual problems.
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