How to perform a Laser Iridotomy (Video)

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This video shows a laser iridotomy performed on an eye with angle-closure glaucoma. A laser periphery iridotomy (LPI) is a procedure where you use a laser to blast a hole through the iris. This allows fluid from behind the iris to flow forward into the anterior chamber … and eventually drain out of the eye. This “hole” thus allows the pressure to equilize on either side of the iris plane and thus prevents attacks of acute “angle-closure” glaucoma.

In this case, a Yag laser is being used. The key to success is to locate an iris crypt (an area of natural thinning) through which to aim your shots. Keep going until you see the plume of pigment/fluid come forward … watch this video, and it will make more sense.

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Laser Iridotomy
This photograph shows the view your ophthalmologist has during a laser iridomy. A LPI (laser peripheral iridotomy) is a procedure where a laser is used to blast a hole through the iris. This hole allows the fluid in the eye to drain properly and can be of great help in cases of acute glaucoma, and to keep those prone to acute glaucoma from developing it.
Laser Peripheral Iridotomy
This is when you create a hole in the iris to equalize the pressure between the anterior and posterior chambers of the eye. This procedure is typically performed on patients with acute angle-closure glaucoma or those at risk for angle closure.
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Dr. Timothy Root is a practicing ophthalmologist and cataract surgeon in Daytona Beach, Florida. His books, video lectures, and training resources can be found at:

20 COMMENTS

  1. This video shows how an iridotomy is done, but it doesn’t show the consequnces: severe double vision, white horizontal line that obstructs the view, strange flashes of light, blurred vision and – quite commonly – a rise in IOP that may cause a glaucoma attack.
    Itidotomies shoudn’t be done!!!

    Editor’s Note: I have made a lengthy response to this issue at this page. Thank you.

  2. Thank you. I feel a bit of relief being able to view this prior to my family member having this procedure.

  3. Of course, this debris can cause many complications. It obstructs the trabecular meshwork and thus leads to an increase in IOP which is difficult to control.
    Research done on enucleated eyes has revealed that even after 12 or 15 years there are still particles of this debris to be found in the eye.
    It also leads to blurred vision. It’s like having floaters. Some people get accustomed to this, others don’t.
    The debris will leave the eye via the trabecular meshwork after a few weeks, but only if that meshwork is healthy. If it isn’t, e.g. if the patient, besides having narrow angles, has also open angle glaucoma, the debris may remain in the eye for years, increasing the IOP. So invasive surgery may be necessary.

  4. I just had an iridotomy the other day. The onyt side effects I experienced were very minor discomfort(pain) and significant floaters for about 9 hours afterwards. 48 hours after I can not tell any difference to before the procedure. Will have the other eye done next week after this eye’s follow up….

  5. I had the Laser Peripheral Iridotomy done in june 2008 in both eyes. My right eye is sore and hurts every day, is this normal? Can I expect this is go away? My last check I was told everything looked good and the doctor did not want to hear anything I had to say.
    thank you
    tricia

  6. I had YAG done with no side affects a slight headache. I have noticed since the surgery I can stay on the computer longer with less fatique. Can’t expect any procedure to be done without a little discomfort. I am thankful we live in a time when this option was available to well trained doctors. Viewing video alleviated stress or feeling anxious prior to surgery. Thankyou.

    Jeanette

  7. I just had a laser iridotomy on 2-28-09. I gotta tell ya, its a mixed bag. I was told this would not change or improve my vision. My ocular pressure went up from 17 to 28 after the procedure, so I had to stay until it was down. At that time my vision was crystal clear. I could read small print without my readers which I have used for about 4 years now. When I got home, I put the anti-inflammatory drops in my eyes and all hell broke loose. My eyes watered for about 3 hours, my vision was like I was standing in a cloud bank and I couldn’t see any further than 10-15 feet in front of me. The pain was incredable. It felt like someone was squeezing lemon juice in my eyes and I had scabs on my eye balls. Called the doctor and spoke to the residnet on call. He told me he would meet me at the office if it did not stop and I should call back if it kept up. I had a few glasses of wine to calm me as I was paniced and really scared. I decided to just go to bed. When I woke up, the pain was gone and vision was somewhat normal. I went to work like the doctor said I should be able to do, but soon realized that I couldn’t read anything clearly. I didn’t use the drops again for fear of the same sort of excruciating pain I had experienced the night before. I called the doctore looking for a different kind of drop and he said he wanted to see me that day. I went in Pressures were normal (17R& 16L)My vision was not as good as it was prior to this procedure. He reinforced the use of the drops and told me the what happened the night before was most likley from the inflammatory process. Scared to use the drops again, I placed them in 1 eye and waited 15 minutes. Nothing happened. So Ive been useing the drops and most all is well. I can tell my eyes are getting better. My left eye is pretty fine, my rigt eye, I’m not so sure. I do see a faint horizontal line in my right eye sometimes and my vision is blurrier than before in both. This could be from the drops. I can feel pressure in my right eye and then like magic it clears and my vision is clear and pressure is gone. I think there is stuff clogging my drains and then it flushes out. I dunno. Would I do it again? I dunno, the choices either way are bad.

  8. I am scheduled to have a laser peripheral iridotomy tomorrow and so far I have read more negative feedback than positive. The reason I am having it is to ward off possible glaucoma attack. Maybe I should cancel and just take my chances going forward.

  9. Just had a laser peripheral iridotomy this morning as a preventative measure because of narrow angles. No problems at all. A little scratchy and burning sensation when putting in the drops afterward. Blurry for a couple of hours and per my Doctors orders have been putting steroids drop in the eye every two hours today. It is now 6:00 pm and I can barely tell I’ve had it done. No more burning. I do, however on occaision see a faint horizontal light, but it isn’t always there and doesn’t bother me. I’m having the other eye done next week. I have a history of glaucoma in my family and I would much rather go through this procedure to ward off having an angle closure attack and possibly losing vision. Glad I did it.

  10. Renee,

    you see a horizontal line, and I am so sorry you are having that side effect. This line will be with you for the rest of your life. It will gradually become larger and larger, until you will hardly be able to see anything.
    I hope you didn’t have the other eye done! If you have you will have lost most of your vision, because you won’t be able to see with a large, bright, flickering white line in the center of your vision in both eyes.
    I have had iridotomies in both eyes. I can no longer drive, I lost my job, and my life is as miserable as my vision. All this of that horrid white line which has ruined the lives of so many people.
    I will now try and get some special tinted lens to cover the iridotomy holes. You should not wear them when your eyes are inflamed. My eyes are still inflamed, but I will buy the lens nevertheless.
    I wish you all the best. If you want the address of the companies producing these lenses, please tell me.
    These companies make enormous money with these lenses, as there are so many patients out there who have devastating side effects after this so called ‘harmless’ procedure.

  11. Had both eyes done about a month ago. I had no symptoms of acute angle closure, but it was discovered during a routine eye exam. Doctor told me it was very important to have the surgery and that if I did not have it done he could not keep me on as a patient due to the risk of permanent damage without the surgery.

    Since the surgery I have had a constant mild headache and occasional floaters in the periphery.

  12. Some of the comments I read here are scary, I hope I won’t be one of those cases.

    Just had it 2 days ago. I felt weird after the operation. My right eye recovered faster than my left eye. It took about half a day until my left eye could see clearly but not as clear as before the operation. The next day I felt slight dizziness that made me feel that I want to puke. So I went to get my eye pressure checked to a different doctor near our home since my original doctor’s clinic is far and the weather’s stormy.

    And yup there goes the IOP of my left eye hitting 24, the highest record I had. Then he prescribed me another drop just for the left eye. My right eye is now normal hopefully. He mentioned that he saw a lot of damages in my eye already
    that’s probably why my original doctor recommended the operation and hopes that it would suffice.

    Other observation… yes I also have floaters, no i don’t see a horizontal line, yes I’m sensitive to light coz my eye hurts and that’s the only time my head aches, no I didn’t experience any eye or headache when using the anti inflammatory although my orig dr. told me about it.

    I hope my left eye will quit making tantrums so that I can go back to my normal life and vision again.

  13. Lain,

    I do hope you will be able to go back to your normal life and vision, but in almost all cases vision changes considerably after iridotomies: glare, double vision, photophobia, cataracts, inflammation… This surgery has so many adverse effects, and the long – time side effects are still completely unknown.
    Hopefully you will be spared those side effects, but you must know that vision after iridotomies will never be as good as it was before the procedure.

  14. I had both eyes done less than one year ago. Aprox. Jan. 2009. My original eye Dr. wanted to send me to a specialist for a narrow angle gloucoma oppion. Pressure was high. I had a small change in my vision so my original eye Dr. prescribed me a perscription for new glasses. I ask should I wait until I see the specialist. The answer was (the periphial irridotomy will not change the vision and that if the specialist thinks that you need it, it will keep me from having an attack in the future.) I went for the new glasses because I felt that I needed them for distants. After seeing the specialist, he sent me for the periphial irridotomy. One eye at a time. The first eye was very painful after they put some drops into it, I guess for numbing. I had the worst headache behind the eye, that I walked out in the hall to see if the Dr. was coming back in. I really thought that I was going to have a stroke. He finally entered and did the l.p.I. in the right eye. I had to lay in the back seat going home, I was in so much pain. When I went for the follow up visit,another Dr. did the 2nd. eye. I explained to the nurse how much pain I was in the first time from the drops and she ask if I thought if it would help, if I took something for pain before the l.p.I. The Dr. o.k. it and I had very little pain. The Dr. came in and said that it was rare for it to happen, thats why it was never mentioned to me. I’m going on my 3rd. pair of glasses in aprox. 8 months. I have to wait until Nov.3, 2009 before my insurance will pay for part of them. My eyes are Blury all the time. I have many floaters also. I can’t see distance very well at all. I can’t drive after dark. I have double vision. All cars coming towards me, blinds me. Red stop lights and green go lights look like I am seeing through a glide a scope. My specialist wants to see me back in six month because there is a big change. Mean time he want me to see my original eye Dr. for the new perscription. With my insurance I walk out paying apox. 300.00 after the Insurances part. So I have to wait or it will be much more. I feel like I’m going blind. I break down alot when I can’t see the clock without being close to it. I have to be on top of the T.V. almost. Now I have to wait six more month before the specialist sees me again. I just don’t know whats going on and neither does the specialist. I have one of the best primary Drs. I’ve ever been to ,so I’m looking forward to seeing him again in Nov. and maybe he can give me a clue or hope. I wish all my prayers and luck to all that have this done. I’m sure not everyone has this effect.

  15. EDITORS NOTE:

    I’m closing down the comments section on this particular video. The purpose of this site is to provide education to ocular health professionals. Unfortunately, many of these posts are becoming counter-productive rants from a very vocal minority of patients who have had complications after their LPI.

    Many of the statements made by this minority (see above) are just plain false and based upon selection bias – if you spend your days in online forums discussing your complications with like-minded people who ALSO had complications, there is a natural tendency to believe that the complication rate is high. This is a false assumption and I do not want to promote this ignorance.

    Overall, laser iridotomy is a low-risk procedure and the rates of visual complications afterwards are small (I estimate less than 1% in my hands, but I tend to make very small holes and place them in the far-periphery, so results may vary).

    With ANY procedure, there is some risk. No matter how small the procedure, things WILL happen. There are 5 billion people on the planet, and SOME are bound to have problems (and they’ve all seem to have found this website to complain about it).

    Keep things in perspective. The purpose of the iridotomy procedure is to keep you from going into acute-angle glaucoma. Acute glaucoma is an EMERGENCY associated with extreme pain (so bad that I’ve seen cases in the emergency room where my patient is keeled over and vomiting) with permanent vision loss and even blindness. Yes, blindness. Your doctor is trying to keep you from going blind.

    If you are worried about this surgery, please speak to your doctor and make sure you have ALL your questions answered before this laser procedure. They are YOUR eyes, and you are taking the RISK, so you have the right to ask QUESTIONS. If you are still unsure, then see another eye doctor that you trust.

    This is the first time I’ve shut down video comments at RootAtlas, and hopefully the last time I’ll need to. Thanks!

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