Laser iridotomy – Treatment of narrow-angle glaucoma
Laser iridotomy is a procedure frequently performed to treat narrow-angle glaucoma, acute glaucoma, or to prevent its onset. The procedure takes place in the office; you are seated with your head resting against a slit lamp (tabletop microscope). Anesthesia is not always necessary but may be more comfortable. A few pulses of the YAG laser are made to create a tiny opening in the iris. The resulting hole is microscopic, invisible to the naked eye, but it restores normal flow to your aqueous humor and prevents spikes in intraocular pressure.
What is laser iridotomy?
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Laser iridotomy is a procedure performed by ophthalmologists for the treatment of narrow-angle glaucoma and the prevention of angle-closure glaucoma.
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The procedure involves using the YAG laser (cutting laser) to create a microscopic hole in your iris.
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This hole will allow the aqueous humor to circulate from the ciliary bodies (secreting organ) to the trabecular meshwork (draining organ) without getting stuck behind the iris as is the case in narrow-angle glaucoma.
Why have a laser iridotomy?
Laser iridotomy is performed for several indications, often as a scheduled procedure, sometimes as an emergency:
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Acute angle-closure glaucoma (AAC).
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As a preventative measure on the contralateral eye in case of GAFA.
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In cases of a narrow iridocorneal angle at risk of angle closure.
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In cases of primary or secondary angle-closure glaucoma.
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For pigmentary glaucoma WITHOUT visual field involvement (early-stage glaucoma).
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In the case of a plateau iris (iris anatomy responsible for a closure of the angle).
How is an iridotomy performed?
Laser iridotomy is performed in the office, using a slit lamp equipped with a YAG laser module. You will therefore be seated with your head resting against the chin rest, as during a standard examination.
Before the laser
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No special precautions are necessary before the laser treatment. Use your usual eye drops if appropriate and do not wear your contact lenses.
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To achieve the most precise treatment possible, pilocarpine drops are instilled 20 to 30 minutes before the laser. They help to constrict the pupil.
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3 to 5 minutes before the laser treatment, the ophthalmologist will instill a few drops of anesthetic to limit discomfort.
During the laser
Sit comfortably on the stool facing the laser table, centered and at a comfortable distance. The ophthalmologist will adjust the height of the table and, if necessary, your seat.
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Depending on the ophthalmologist's habits, a lens may be placed on your eye to limit movement.
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The ophthalmologist then begins the laser treatment by making successive impacts until the iris is pierced. The operation lasts 1 to 3 minutes.
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In case of poor visibility, you may be asked to wait a few minutes in the waiting room before resuming the procedure or to return another day.
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The laser is not particularly painful, but some patients are surprised and find the procedure unpleasant.
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Except in emergencies, laser treatment is usually performed on only one eye at a time. Treatment of both eyes can be spaced one week apart.
What are the next steps after an iridotomy?
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Immediately after the laser, vision is blurry and hazy. A few filaments are sometimes visible.
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The eye was not pierced, so there is no risk of infection and no special precautions to take.
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Begin treatments a few hours after the laser in order to contain inflammation.
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You can work the same day without worry, including on a computer, play sports, party.
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A check of the laser's effectiveness is usually carried out within a month of the procedure.
Risks and complications of laser iridotomy?
Laser iridotomy is a frequently performed procedure. While minor issues such as incomplete laser treatment or slight bleeding are common, complications are extremely rare. The main risks are:
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The peak of intraocular pressure, prevented by anti-inflammatory treatments.
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Iris bleeding and hyphema require monitoring and additional laser treatment.
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Photopsias – the perception of small flashes of light at the outer corner of the eye. Rarely bothersome and often transient, a few patients find them debilitating.
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Corneal decompensation (exceptional).
Frequently Asked Questions
How is an iridotomy performed?
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Peripheral iridotomy is performed in the office, under local anesthesia with drops.
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The ophthalmologist places a lens on your eye to better focus the laser.
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A few laser impacts are made. The iris may be sensitive at this time.
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In case of bleeding (rarely serious), pressure is maintained on your eye.
What happens if the laser is incomplete?
In the event of an incomplete iridotomy, the procedure can be completed a few days later.
Can an iridotomy close up?
No! A complete iridotomy remains patent. However, the iridocorneal angle can close through other mechanisms a few years after the laser procedure.