What is a laser peripheral iridotomy?
A laser peripheral iridotomy is a treatment used to treat angle closure or eyes suspected of having angle closure as a prevention measure.
If you have healthy eyes, the fluid in your eye (aqeous humour) flows through your pupil into the front of your eye, and drains away through drainage channels called the trabecular meshwork.
However, if you have angle closure, these drainage channels are blocked by the iris (the coloured part of your eye) which has moved forward. Because of this, aqueous humour cannot leave your eye, causing your eye pressure to increases.
The build up of pressure injures your optic nerve – the nerve that carries information from your eye to your brain – and damages your vision.
A peripheral iridotomy uses a laser beam to create a small hole in your iris. This forms a permanent passage through which aqueous humour can flow through and pushes the iris tissue backward, thus unblocking the drainage channels.
Aqueous humour is a completely different fluid to your tears – they will not be affected by the operation.
What happens during a laser peripheral iridotomy?
Peripheral Iridodomy procedure typically takes 3 to 5 minutes for each eye to do.
A special contact lens is used to keep your eyelids open. Anaesthetic eye drops are applied to ensure that your eye is comfortable with the lens in your eye. The laser machine looks very similar to the microscope used for examining your eyes. You may hear some beeping sounds produced by the laser machine.
You may feel slight stinging sensation during shots of laser. Most patients do not experience any significant discomfort, although some may feel a little pressure inside the eye or a slight headache during or after the laser procedure.
Treatment can be done to one eye or both eyes in a single sitting.
After the procedure, you will return to the waiting area. Your doctor or assistant will check the eye pressure about half hour later. He or she will then examine the eye to check the newly formed opening is working well.
In general patients will have only one eye treated at any visit, less commonly both eyes can be treated in one visit.
What are the benefits of having a laser iridotomy?
It is important to remember that this procedure is performed to save the sight you still have. It will not restore any sight you may have already lost; neither will it improve your sight.
The laser treatment is to prevent a sudden (acute) rise in pressure within your eye. Without having this treatment, you are at risk of developing sudden glaucoma and irreversible blindness.
Are there any risks associated with a laser iridotomy?
Complications after this treatment are uncommon.
Occasionally your eye pressure will rise immediately after laser treatment. If this happens, you may need extra treatment before you can go home. This treatment usually comes in the form of eye drops, but may come in the form of tablets. Your doctor will let you know which treatment you need and will advise you of how long you need to take the treatment for.
If we do treat you with eye drops, a doctor or nurse will put them in your eye before you leave our clinic.
Occasionally the laser beam opening on the iris is incomplete, or not big enough. This will be discovered either after your treatment, or on your follow-up visit. If this is the case, we will have to repeat the treatment at a later date.
A small number of patients find that extra light enters through the new opening, which can be a little distracting at first. However, most patients find they are soon able to ignore this.
Other complications are haemorrhage in the eye from the laser and inflammation – this is usually small and can be treated with more frequent steroid drops.
Certain symptoms could mean that you need to be treated quickly, including:
loss of vision
your eye becoming increasingly red.
If you experience any of these symptoms, telephone our clinic immediately (Or contact Royal Victorian Eye and Ear Hospital during public holidays/weekend/after hours on 03 9929 8666).
Are there any alternatives?
An alternative to laser treatment is a cataract operation, which is not suitable for everyone. It also carries a greater risk of complications. There are no other alternatives to open up the drainage channels in your eye. Some patients with this condition also develop a long-term (chronic) rise in their eye pressure. In this case, you may need drops or other treatments in the long-term to keep your eye pressure within safe limits.
What do I need to do to prepare for laser treatment?
As this is an outpatient treatment, you can eat and drink as normal.
Asking for your consent
We want to make sure you understand your condition and the treatment choices available to you. Before you receive any treatment, the doctor will explain what he or she is recommending and will answer any questions you might have. No treatment is carried out without your consent unless it is an emergency and you are unconscious.
What happens after the procedure?
You will be seen in the our clinic a week or two later to make sure your eye has responded well to treatment. You will have another check-up to see if the treatment was successful. You should be given a follow-up appointment before you leave the clinic after your treatment. If you have discomfort once you get home, we suggest that you take your usual pain reliever following the instructions on the packet. It is normal to have gritty, sticky eyelids and mild discomfort for a couple of hours after laser treatment. The eye drops can also take some time to wear off, and you should not be alarmed if your pupils are still small for several hours after treatment.
The eye drops can also cause a mild to moderate headache across your brow. You may also find that your vision is a little blurred. This is normal, and your vision should return to how it was before the laser by the end of the day.
What do I need to do after I go home?
We will prescribe anti-inflammatory drops after your laser treatment. Generally this is:
Maxidex 1% eye drop taken one eye drop 3 times per day in the treated eye.
The eye drop will help to minimise inflammation (but not infection) within the eye. People normally only have to take these for a week at most – the doctor will tell you how long you need to take them for.
If you are using glaucoma drops, please continue using them unless your doctor has said otherwise.
If you are using glaucoma drops to the untreated eye, please continue to use them unless clearly instructed otherwise.
You can do all of your daily activities as you would normally without any problems
Information and support
We hope you have found this information helpful. If you have any questions or anxieties, please feel free to speak to a member of our staff.