What narrow angle is?
The angle is situated in the front part of the eye where the front clear cornea meets the iris and where the drainage system of the eye exists. The drainage system takes the water (aqueous fluid) from inside of the eye to outside of the eye to maintain a good intraocular pressure. If the flow of aqueous fluid to the drainage angle is obstructed by a forwardly bowed iris, the patient is said to have narrow angles. This condition may predispose the patient to an acute episode of angle closure glaucoma. If the angles are never acutely closed, but glaucoma is still present, the patient is diagnosed with narrow angle glaucoma.
What is a LPI?
A Laser peripheral iridotomy (PI) is performed almost exclusively for patients with narrow angles, narrow angle glaucoma, or acute closure glaucoma.
Laser peripheral iridotomy involves creating a tiny opening in the peripheral iris, allowing aqueous fluid to flow from behind the iris directly to the anterior chamber of the eye. This typically results in resolution of the forwardly bowed iris and thereby an opening up of the angle of the eye. The narrow or closed angle thus becomes an open angle.
The laser peripheral iridotomy procedure is usually done in the office or as a brief outpatient procedure; the pupil is often constricted with an eye drop medication known as pilocarpine. The procedure itself is done with the patient seated at the laser, and requires no sedation. Usually, a lens is placed on the eye after topical anesthetic drops are applied to better control the laser beam. The entire procedure only takes a few minutes. The lens is then removed from the eye, and vision will quickly return to normal. After the procedure, your eye surgeon recommends anti-inflammatory eye drop medications for the next few days. A post-op visit will be scheduled.
What to expect on procedure day:
You will be given two drops in each eye that will be having laser treatment. The drops take 15 minutes to take effect. Pilocarpine may cause headaches; please bring Advil or Tylenol or pain medication that you would normally take for a headache. Everyone is different, some people never get a headache and some people may get a more severe headache, please come prepared.
The laser procedure will take about 5 minutes, after you will wait 30 minutes and have a pressure check.
You will be given a prescription for Pred-forte; to be taken as follows:
- 1 drop in each treated eye 4 times a day for 5 days
- Sometimes Dr. Strungaru may increase the dose frequency and/or duration on an as needed basis. Follow the written instructions on the prescription as explained by the pharmacy.
- You will continue taking any other drop medications that have been previously prescribed waiting 5 minutes between each set of drops.
You will then have an appointment in Dr. Strungaru’s office after treatment. At that time you will be given dilating drops. You will need sunglasses and a driver for this visit.
PLEASE BE AWARE THAT YOU WILL BE IN THE OFFICE FOR AT LEAST 1 – 2 HOURS AND YOU WILL BE UNABLE TO DRIVE YOURSELF, PLEASE HAVE ALTERNATE ARRANGEMENTS.
Does laser peripheral iridotomy reverse glaucoma?
In general, glaucoma is not reversed by any procedure or medicine. The goal of treatment is either prophylaxis against the development of glaucoma or treatment of existing glaucoma. In either case, if an ophthalmologist recommends a laser peripheral iridotomy, he/she believes this procedure is appropriate for the prevention of, or treatment of, glaucoma.
Is the procedure painful?
The surface of the eye is numbed with topical anesthetics for this procedure, but the iris is not numbed for the procedure. Therefore, when the laser beam hits the iris to create the peripheral iridotomy, mild discomfort may occur. In general, only a few very brief episodes of slight discomfort are associated with this procedure. Also, there is absolutely no discomfort postoperatively in the great majority of cases.
What are the potential complications?
A laser peripheral iridotomy is an extraordinarily safe procedure. Complications, fortunately, are very rare. These potential complications include bleeding in the eye, inflammation in the eye, and transient pressure elevations. As such, most ophthalmologists will treat the patient with eye drop medications (following the procedure) to prevent these potential complications.