English
Ελληνικά What is YAG laser iridotomy?
Laser iridotomy is a very small hole (a very small opening) made in the periphery of the iris (in the colored tissue of the eye). It is very small, it cannot be seen with the naked eye except with a microscope and is usually done in the upper part so that it is covered by the upper eyelid or in other places around the iris.
Why is an iridotomy performed?
An iridotomy is usually done to prevent an acute angle-closure glaucoma attack in which the pressure in the eye rises sharply. If the pressure remains at very high levels even for a few hours, it can cause significant damage to the optic nerve. The small hole opened by the laser in the iris allows the aqueous humor (the liquid that fills the anterior chamber of the eye) to circulate freely and thus the sudden increase in pressure is prevented. Sometimes an iridotomy can also be performed in patients with chronic angle-closure glaucoma in an attempt to relatively open the drainage angle and thus inhibit the worsening of the glaucomatous damage. The purpose of laser iridotomy is to preserve the vision you have, not to improve your vision.
What happens before and after laser iridotomy?
First we check your vision and intraocular pressure. Then we put drops to make the pupil smaller. It usually takes 20 to 30 minutes for the drops to work. Pilocarpine used to constrict the pupil often causes headache as well as blurred vision because it affects the eye’s ability to focus. These side effects are transient and pass a few hours after instillation of the drops.
Benefits and potential complications are discussed with the patient and an informed consent is obtained. The laser treatment usually lasts 5 to 10 minutes, but the appointment can last long enough (2-3 hours) to do all the necessary checks.
How is the laser done?
The laser treatment is done in a slit lamp (similar to the one you are examined in during the clinical examination) which is connected to a YAG laser. We put anesthetic drops in the eye and usually also a special lens that is in contact with the cornea. For the vast majority of patients, laser treatment is painless. Very rarely you may feel a mild discomfort which stops when the procedure is completed. The laser light is indistinguishable from the patient, the eye is illuminated by the light of the slit lamp and usually the patient can hear the sound (a click) from each pulse of the laser.
What happens after the laser?
Once the laser treatment is finished, you need to wait about 1 hour to check the intraocular pressure. You will need to use anti-inflammatory drops for 1 week. We usually give dexamethasone drops once every hour on the day of the laser and then 4 times a day for 1 week. If the pressure rises after the laser you may need to use pressure drops for a short time. If you are already using anti-glaucoma drops, you need to continue your treatment as usual. We recommend that you do not drive on the day of the laser. You can usually return to your activities immediately, from the next day. You usually come back for a follow-up in 1 week.
What are the possible complications?
Increased intraocular pressure. A transient increase in intraocular pressure may occur in 1 in 10 patients. An increase in pressure is perhaps more common in patients receiving antiglaucoma drops. Usually the pressure subsides with eye drops or medication and extremely rarely further treatment such as surgery is needed.
Inflammation. It is common to have a little inflammation after the laser, so we also use anti-inflammatory drops for 1 week.
Bleeding of the iris. Sometimes a small vessel in the iris can bleed and this creates a temporary blurring of vision. Bleeding usually stops by applying pressure to the eye for a few seconds. If you are taking anticoagulant treatment you must let us know as it sometimes needs to be stopped or changed before the laser.
Change in vision. You may notice a slight change in your vision in the first few weeks after the laser. Most of the time vision returns to normal levels in 2-3 weeks. Very rarely you may notice horizontal or vertical lines or a discomfort from bright light. These symptoms are usually self-limiting and do not require any treatment.
Pain. It is very rare to feel pain or discomfort. Taking common pain relievers will give you relief.
Further treatment. Some patients may need additional laser or, more rarely, surgical treatment.
Cataract. Very rarely, laser treatment can accelerate the onset of cataracts.
Vision loss. Loss of vision after treatment or the need for emergency surgery to reduce intraocular pressure is extremely rare (1:5000 patients).
In case you have any of the following symptoms, you must contact us immediately:
- Pain that does not go away with the usual pain relievers
- Intense redness in the eye
- Significant blurring of your vision
- Lightning or a black shadow/curtain that blocks vision