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Why is LPI necessary?
Laser peripheral iridotomy (LPI) is performed usually for patients with narrow angles or angle closure glaucoma (ACG). This condition is more common in farsighted eyes.
What is a narrow angle?
The angle of the eye refers to the space in the very front of the eye, between the iris (colored part of the eye) and cornea (clear front part of the eye). Our eyes produce a fluid called aqueous humor that provides nourishment to the structures in the front part of the eye. This aqueous fluid is drained by structures that reside in the angle. In people who have narrow angles, this space can become progressively narrower to the point where fluid cannot drain through the drainage structures in the angle. When this happens, the affected person can be at risk for a form of glaucoma called angle closure glaucoma. In angle closure glaucoma, the optic nerve can be damaged from high eye pressure caused by impaired aqueous fluid drainage. Some people with this condition can develop a very sudden, painful rise in intraocular pressure with optic nerve damage; this is referred to as acute angle closure glaucoma.
What are the symptoms of Angle Closure Glaucoma?
For the most part, people do not experience any symptoms. Some people may experience mild headaches or eye pain. Your ophthalmologist may notice changes in the optic nerve over time. A visual field test may show blind spots developing in your peripheral vision. Age and family history may be risk factors. Your ophthalmologist will use a mirrored lens to examine the angle to see if there is risk of blockage.
What are the symptoms of acute Angle Closure Glaucoma?
Not all people with angle-closure glaucoma experience an attack. When angle closure glaucoma develops slowly, there are no obvious symptoms. However, your doctor may recognize your risk for angle closure glaucoma before you experience any symptoms.
Symptoms of an angle closure glaucoma attack are:
- Headache or eye pain which can be severe and unrelenting
- Blurred vision
- Haloes around lights
- Red, painful eye
- Nausea and vomiting usually due to associated eye pain
If pressure is not relieved within a few hours, there may be permanent vision loss.
Glaucoma Closed Angle
How does laser peripheral iridotomy work?
Laser peripheral iridotomy (LPI) uses a laser beam to make a small hole in the iris, the colored part of the eye. The hole allows the fluid that is trapped behind the iris to drain more freely into the trabecular meshwork (the drainage pathway) of the eye. This typically results in resolution of the forwardly bowed iris thereby opening up the angle of the eye and exposing access to the drainage pathway.
What is involved in performing a LPI?
The LPI is completed in the office. Prior to the procedure, the pupil is often constricted with an eye drop medication known as pilocarpine. The procedure itself is completed with the patient seated at the laser, and requires no sedation. Usually, a special contact lens is placed on the eye after topical anesthetic drops are applied. The laser procedure takes a few minutes. In general, only a few very brief episodes of slight discomfort are associated with this procedure. Some people experience a small “pinching” sensation when the laser light is applied. After the procedure, your eye surgeon may recommend anti-inflammatory eye drop medications for the next few days. A follow-up visit will be scheduled. There are few to no restrictions in your activity following the procedure. In general, it is recommended you have someone drive you home after the procedure.
What are the potential complications?
PI 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. These complications are usually self-limiting and mild and do not result in permanent damage. Very rarely, double vision, ghosting, or glare may result. If the iris is difficult to penetrate, you may require more than one treatment.
Loss of Vision can be prevented
Laser iridotomy is an effective procedure with few risks. While glaucoma treatments cannot restore vision already lost from glaucoma, early detection and treatment of glaucoma offers the best chance of preserving your vision.
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