Glaucoma: Laser Surgery on the Iris

________________________________________________________________________

KEY POINTS

• Glaucoma is an eye disease that damages the nerve that carries messages from the eye to the brain. This is usually caused by high pressure inside the eye. The fluid in the front of the eye is constantly flowing from where it is formed into drainage channels, and is then reabsorbed by the body. In angle-closure glaucoma, fluid is not able to drain from the eye.
• Laser iridotomy is a procedure that uses a laser to create a small hole in the colored part of the eye, called the iris. This procedure helps restore the proper flow of fluid in the eye and reduce eye pressure.
• Ask your provider how long it will take to recover and how to take care of yourself at home.
• Make sure you know what symptoms or problems you should watch for and what to do if you have them.

________________________________________________________________________

What is laser iridotomy?

Laser iridotomy is a procedure that uses a laser to create a small hole in the colored part of the eye, called the iris. This procedure helps treat or prevent angle-closure glaucoma.

Glaucoma is an eye disease that damages the nerve that carries visual messages to the brain (optic nerve). This is usually caused by high pressure inside the eye. Damage to the optic nerve can cause a permanent loss of vision. Glaucoma needs to be diagnosed and treated early to prevent blindness.

Normally, the fluid in the front of the eye is constantly flowing from where it is formed (the ciliary body) to the front of the eye. This fluid nourishes your eye and helps to keep its shape. The area between the iris (colored part of the eye) and the cornea (the clear outer layer on the front of the eye) is called the angle. Fluid drains out through the angle, into drainage channels, and is then reabsorbed by the body. When fluid flows out too slowly, eye pressure builds up.

In angle-closure glaucoma, the angle between the iris and the cornea is blocked or narrowed. When this happens, fluid is not able to drain from the eye. This can cause a pressure buildup.

When is it used?

Laser iridotomy helps restore the proper flow of fluid in the eye and reduce eye pressure. In many cases, this laser operation can successfully control eye pressure and preserve your vision. Without the procedure, you could permanently lose your vision.

If you have had an attack of angle-closure glaucoma, you may be in pain and may have nausea and vomiting in addition to sudden loss of vision. The iridotomy is done as an emergency procedure in these cases.

This procedure is also done in some people who are at high risk for getting angle-closure glaucoma. You may be at high risk if:

• You have narrow angles (where fluid flows out of the eye).
• You have had an attack of angle-closure glaucoma in one of your eyes but not the other.

Ask your healthcare provider about your choices for treatment and the risks.

How do I prepare for this procedure?

• Plan for your care and a ride home after the procedure.
• You may or may not need to take your regular medicines the day of the procedure. Tell your healthcare provider about all medicines and supplements that you take. Some products may increase your risk of side effects. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• Do not wear eye makeup on the day of the surgery.
• Follow any other instructions your healthcare provider gives you.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do. You have the right to make decisions about your healthcare and to give permission for any tests or procedures.

What happens during the procedure?

Your eye provider will put drops in the eye to lower pressure and numb the surface of your eye. Your provider may also put a special contact lens on the surface of the eye. A very short laser pulse will then be pointed at the eye. You may feel a quick pinch in your eye and hear a snapping noise. It is important to try to keep your head and eye still during the procedure and avoid jumping back. If you have an angle-closure glaucoma attack, this is an emergency procedure.

What happens after the procedure?

The provider will remove the contact lens and give you some steroid eye drops. If this was an emergency procedure, it may take some time for your vision to return to its previous level and for the eye pressure to come back to a more normal level. In rare cases, another surgery is needed to control the eye pressure.

You will need a follow-up appointment to check your eye pressure and the results of the procedure.

You may need to have the same laser procedure in the other eye to prevent angle closure.

Ask your healthcare provider:

• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

What are the risks of this procedure?

Your healthcare provider will explain the procedure and any risks. Some possible risks include:

• You may develop a cataract that could limit your vision after any laser procedure.
• Your eye pressure can go up, but this is usually temporary.
• You may develop blurry vision, double vision, or problems with glare after this procedure.

Every procedure or treatment has risks. Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.