Glaucoma Laser Surgery: Laser Iridotomy

Your doctor has recommended that you undergo laser surgery called laser peripheral iridotomy for your eye. It is done in the laser rooms at the Dean A. McGee Eye Institute.

Fluid that circulates in the front section of the eye leaves the eye through a drainage angle between the cornea (the clear, window portion of the eye) and the iris (the colored portion of the eye). Your doctor has found that this drainage angle in your eye is either closed or narrow. This may prevent proper drainage of the eye’s fluid and, in some individuals, can produce a rapid, painful rise in the intraocular pressure (called an acute angle-closure glaucoma attack), which can rapidly damage the sight. The laser peripheral iridotomy creates a tiny opening in the iris to widen the drainage angle, allow better drainage of fluid, prevent or halt a sudden glaucoma attack, and/or help stabilize a condition known as chronic angle-closure glaucoma.

Before the laser treatment

You may eat and drink, as you like before the treatment. You should continue any glaucoma medications your doctor may have prescribed for you, as well as all other medications you are taking for the rest of your body. If you are taking a blood thinner called Coumadin, please let your doctor know in advance. There is a small risk for bleeding with laser iridotomy. With the permission of your cardiologist or regular medical doctor, your ophthalmologist will usually stop this a few days before the procedure.

An appointment will be made for you to come to the office as usual. When you arrive, your vision and pressure will be checked. A drop of either Alphagan or Iopidine and some drops of a medication called pilocarpine will be placed in the eye that is to have the laser treatment. This latter drop is given to constrict the pupil and may give you a slight headache. Your doctor may also choose to give you a pill, usually Diamox, to lower the eye pressure further before the treatment. When the pupil is adequately constricted, you will be taken to the laser room. For this treatment, typically two different types of laser technology are used to create an opening in the iris that will be less likely to close over time.

During the laser treatment

In the laser room, you will be seated at the laser instrument, and a drop of anesthetic will be placed in the eye. A special lens, which directs the laser beam to focus on the iris, will then be placed on the eye long with some gel to allow the lens to fit properly.

The laser light will not harm the remainder of the eye. Depending on your eye and the type of laser used, several to over a hundred laser spots will be applied until a satisfactory opening is made in the iris. During the treatment, you may feel some tingling or slight stinging, and you will see some bright flashes of light. The treatment usually takes about 15 to 20 minutes to complete.

After the laser treatment

When the laser treatment is completed, the special lens will be removed, the eye will be rinsed, and an additional drop of Iopidine or Alphagan will be instilled. You then will be asked to sit in the reception area for approximately 45 minutes to an hour. At that time, to make sure that your pressure has not risen as a result of the treatment, your pressure will be checked. If it is satisfactory, you may go home. If it is significantly increased, you may be asked to stay in the office for additional medical glaucoma treatment and pressure measurements until the level is acceptable.

Generally, any pressure increase that occurs after the laser treatment is transient and effectively treated with temporary medications. Rarely, however, the pressure increase can persist and, if dangerously high, may necessitate urgent glaucoma surgery. Other, less serious complications include inflammation of the eye (again, usually transient and treated with temporary medications); a scratch or irritation of the surface of the eye from the laser lens; or mild transient bleeding from the site of the laser opening. Rarely, some patients may be aware of a small amount of light or glare through this small peripheral opening in the iris in addition to the normal light entering the eye through the pupil. This does not cause double vision, but sometimes a "line" or "hair" is seen in the peripheral vision under certain conditions. Usually this is not bothersome, is easy to ignore, and does not cause vision problems.

After the laser treatment, you may experience some blurring of vision and irritation, but this should be temporary. You will not be required to wear a patch, and you may continue your usual activities. You will be instructed to instill an anti-inflammatory drop in the treated eye for a few to several days postoperatively. You also may be asked to begin or continue some glaucoma medications. Typically, the first postoperative visit will be approximately one week later.

The opening is usually permanent, but occasionally a "touch-up" laser treatment or retreatment is required to re-open it. Also, there may be a residual chronic glaucoma even if the opening is successful in widening the drainage angle, and your eye may need continued or additional treatment to control the pressure on a long-term basis.

Our goal is to provide you with the best possible surgical care. We hope that this information is helpful. If you should have additional questions or concerns regarding your surgery, please feel free to speak with your doctor or a member of the staff.

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