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Laser Peripheral Iridotomy (LPI)

What is Laser Peripheral Iridotomy?
Laser Peripheral Iridotomy (LPI) attempts to "open" alternative pathways for fluid to drain from the eye and prevent more serious glaucoma disease. The "angle" is the part of the eye that drains fluid from the eye, and narrowing in its structures can put the eye at risk for an acute attack of angle closure glaucoma. During the LPI, a laser is used to make a small opening in the peripheral iris (the colored part of the eye). This changes the fluid dynamics in the eye and "opens" the angle. If a patient already has acute angle closure glaucoma, the small opening that is made in the peripheral iris allows fluid to drain more normally and also lowers the eye pressure.

When is LPI indicated?
Laser peripheral iridotomy is generally recommended for patients with narrow angles, narrow angle glaucoma, or acute angle closure glaucoma. When LPI is used in patients with narrow angles, it is considered to be a prophylactic procedure that prevents these patients from developing acute angle closure glaucoma, which they are at higher risk of developing. This is significant in that an acute attack of angle closure glaucoma usually presents with high eye pressures, pain, and loss of vision. When LPI is used in the treatment of patients who already have acute angle closure glaucoma, it is used to help lower the pressure as well as to prevent another attack of angle closure glaucoma.

If I am having the LPI for preventing an acute attack of angle closure glaucoma, will this lower my eye pressure or improve my vision?
No, the LPI will not improve your vision or lower your eye pressure. It will only try to prevent your eye from developing an acute attack of angle closure glaucoma.

If I am having the LPI for treatment of an acute attack of angle closure glaucoma, will this lower my eye pressure and improve my vision?
In general, the LPI will help to lower your eye pressure, which may then lead to improvement of your vision. The amount of eye pressure lowering and the degree to which your vision will improve depends on the severity and duration of your acute attack of angle closure glaucoma. Sometimes, other medications or even glaucoma filtration surgery may be needed to ultimately control the eye pressure.

What should I expect if I have a laser iridotomy?
The procedure is an outpatient procedure that can usually be done in the eye doctor's office. You are seated at a slit-lamp with your forehead resting against a headpiece and your chin resting in a chinrest. After some numbing eye drops are put in the eye, a lens will be placed on your eye. This will prevent you from blinking and will also minimize your eye movements. The lens also helps to direct the laser light into your eye. The laser, which is attached to the slit-lamp equipment, is then directed into the eye. The procedure usually takes a few minutes.

Most people experience minimal discomfort during the procedure. After the laser, you may experience some irritation in the eye and some blurry vision, but this is largely resolved after a day or two. Usually, you will have your eye pressure checked one hour after the laser procedure. Then, you are seen the day after the laser procedure and/or the following week. The number and frequency of visits after the laser may vary and depends on the condition of your eye. Most people will need to be on an eye drop four times a day for one week to help the eye heal from the laser. The main long-term symptom that you may notice after the laser is that some patients may experience a light reflex or linear light in their vision if they are in a bright room or if the upper eyelid transiently crosses a successfully-created laser iridotomy opening.

What are some risks of laser surgery?
All laser procedures have some risks. Laser treatment is not done unless the benefits outweigh the risks. Risks include, but are not limited to, bleeding, inflammation, eye pressure elevations, and vision loss. In general, serious risks are not common, however, you may want to discuss the benefits and risks with your doctor should you have any further questions.