Laser Peripheral Iridotomy (LPI) attempts to “open” alternative pathways for fluid to drain from the eye and prevent more serious glaucoma disease. The “angle” is the part of the eye that drains fluid (aqueous) from the eye, and narrowing in its structures can put the eye at risk for an acute attack of angle closure glaucoma. During the LPI, a laser is used to make a small opening in the peripheral iris (the colored part of the eye). This changes the fluid dynamics in the eye and “opens” the angle. If a patient already has acute angle closure glaucoma, the small opening that is made in the peripheral iris allows fluid to drain more normally and also lowers the eye pressure.
Laser peripheral iridotomy (LPI) is generally recommended for patients with narrow angles, narrow angle glaucoma, or acute angle closure glaucoma. When LPI is used in patients with narrow angles, it is considered to be a prophylactic procedure that prevents these patients from developing acute angle closure glaucoma, which they are at higher risk of developing. This is significant in that an acute attack of angle closure glaucoma usually presents with high eye pressures, pain, and potential permanent vision loss.
The laser peripheral iridotomy procedure is performed in the Surgery Center. Usually, a lens is placed on the eye (after topical anesthetic drops are applied) in order to better control the laser beam. The entire procedure takes only a few minutes. The lens is then removed from the eye, and vision will quickly return to normal. After the procedure, we may recommend anti-inflammatory eye drops for the next few days and a post-operative visit will be scheduled.
The surface of the eye is numbed by topical anesthetics for this procedure, but the iris is not; therefore, when the laser beam hits the iris to create the peripheral iridotomy, mild discomfort may occur. In general, only a few brief seconds of slight discomfort may be associated with this procedure.
There is absolutely no discomfort postoperatively in the great majority of cases. A laser peripheral iridotomy is an extraordinarily safe procedure and complications, fortunately, are very rare. Potential complications include bleeding in the eye, inflammation in the eye, transient pressure elevations, and in rare circumstances, glare or a streak of light from the new hole in the iris. We institute treatment with an anti-inflammatory drop for 1 week following the procedure.