Laser Peripheral Iridotomy (LPI) is a treatment used to prevent or treat narrow angle glaucoma. It uses a laser beam to create a small hole in the iris, which allows drainage of intraocular fluid. Laser peripheral iridotomy is generally recommended for patients with narrow angles or those at risk for angle-closure glaucoma. It can reduce eye pressure or prevent acute glaucoma. Laser peripheral iridotomy is often used in conjunction with medication. For patients with narrow angles or acute and chronic angle-closure glaucoma, laser peripheral iridotomy can be done to prevent or manage the condition. It is a simple procedure with rare complications. It is usually done on both eyes and takes approximately 10 to 20 minutes per eye. It does not require a hospital stay.
Laser peripheral iridotomy (LPI) is indicated to prevent or overcome a suspected relative pupillary block by creating an alternative pathway for aqueous flow. It is mainly performed for patients in the primary angle closure spectrum, it can also be useful in secondary angle closure glaucoma and in the management of other types of glaucoma with associated pupillary block. The conditions below are common indications for LPI:
1. Acute Primary Angle Closure (APAC)
2. Contralateral Eye in Acute Primary Angle Closure
3. Primary-Angle Closure suspect (PACS), “narrow” or “occludable” angle
4. Primary Angle Closure (PAC) and Primary Angle-Closure Glaucoma (PACG)
5. Secondary Angle-Closure Mechanisms
-LPI has low risk of side effects and is a very safe procedure that prevents a potentially devastating eye condition.
-Risks including; bleeding, light sensitivity and experiencing 'ghost image' may occur.
Here’s what you can expect from your LPI surgery: First, the eye is anesthetized. This is done using the same types of eye drops used for measuring eye pressure. Some additional preparatory eye drops may also be used. Next, the patient is set up in front of the laser, which looks like the typical examination microscope. Then a contact lens is temporarily placed on the eye. The laser beam is aimed and multiple laser “shots” are placed into the iris. (Laser surgery is not painful although the patient may feel a “pop” in the eye or an occasional pin-prick type sensation.) At the end of the laser peripheral iridotomy surgery, the contact lens is removed and the eye rinsed out. Another eye drop may then be given. Your eye pressure will be checked 30-60 minutes after the procedure is completed. After your iridotomy, you may notice some blurry vision, mild discomfort, or a foreign body sensation in your eye. These symptoms are usually transient and are gone within a few hours to a few days. You may also be given some anti-inflammatory medication to use for a few days to a week to prevent any significant inflammation.
No special preparation is required for the procedure. The laser peripheral iridotomy can be done immediately after you are examined by their doctor. You can drink and eat as normal. The procedure will be thoroughly explained before the procedure. Wearing jewelry that makes reflection (such as stainless watch, diamond ring, diamond necklace, etc.) is not allowed during the procedure. It is recommended not to bring any jewelry or other valuable objects to the hospital on the procedure day, or please leave all valuables with your accompanying person.
1. After drops are administered to constrict the pupils, less light will enter the eye. You will experience blurry vision for 6-9 hours, after which your vision will seem sharper than normal. Your vision should return to normal within 24 hours.
2. You may feel some tightness in your eyes. You may take the prescribed pain medication to alleviate discomfort as needed.
3. Some patients may experience a little nausea after the procedure.
4. Please avoid rubbing your eyes for at least 2 days.
5. Avoid strenuous exercise and heavy lifting for at least 7 days.
6. You can wash your face normally and return to your normal activities.
7. You may need to continue using eye drops as recommended by the doctor. Please follow your doctor’s instructions closely.
8. Avoid driving and using eyes for a long time.
1. Loss of vision
2. Severe eye pain or persistent eye pain even after taking medication
3. Nausea, vomiting, or severe coughing
4. Ghost images
6. Mild bleeding
What causes closed angle glaucomas?
You may have narrow angles because of certain anatomical conditions, such as having a shorter eye than the average person, being hyperopic (far-sighted), or having a growing cataract that gradually narrows the angle over time. You may also have a closed angle because of inflammatory conditions, such as uveitis, or vascular conditions, such as diabetes, that gradually cause what is termed “secondary angle closure” over time.
Who is a candidate for this procedure?
It is recommended in eyes which have the angle closed for at least half the eye and have high eye pressure or glaucoma. In eyes which have a closed angle but normal eye pressure and no optic nerve damage, laser iridotomy may be recommended as a preventive treatment. In a recent large prospective study of such eyes, it was shown that there was overall a low risk of developing high eye pressure but the risk was lower among eyes that received laser iridotomy compared to those that did not.
What if this procedure is not performed?
There will be a risk of acute glaucoma.
What are the travel restrictions?
There are no limitations for travel before or after the procedure.