Laser iridoplasty

Introduction

The aim of this information sheet is to answer some of the questions you may have about having a laser iridoplasty. It explains the benefits, risks and alternatives of the procedure as well as what you can expect when you come to hospital. If you do have any questions and concerns, please speak to the doctor or nurse caring for you.

What is a laser iridoplasty?

Laser iridoplasty is a procedure used to treat angle closure. If you have healthy eyes, the fluid in your eye (aqueous humour) flows through your pupil into the front of your eye, and drains away through drainage channels called the trabecular meshwork. However, if you have angle closure, these drainage channels are obstructed by the iris (the coloured part of your eye) which has moved forward. Because of this, aqueous humour cannot leave your eye, so your eye pressure increases (also known as intraocular pressure). If your drainage channels are still closed after laser iridotomy, the pressure can continue to go up injuring your optic nerve – the nerve that carries information from your eye to your brain – and damages your vision. In an iridoplasty procedure, a laser beam is applied to the iris (the coloured part of your eye) next to the drainage channel. This causes contraction of the iris, which helps to open up the drainage channels. As a result, the aqueous humour flows through the channels better, which reduces the pressure in your eye.

What happens during a laser iridoplasty?

You will need to visit the clinic for about 1-2 hours. We will carry out the treatment in one of our laser treatment rooms. You don’t need to do any special preparations such as fasting or changing into operating theatre clothes. The doctor or nurse will assess your eye first, and check the pressure. It is important that you use your regular eye medication drops as normal on the morning of your laser treatment – unless your doctor has told you otherwise. You will then have some more drops put into your eye. These are usually a drop to lower your eye pressure and an anaesthetic drop to numb your eye. You will then sit at a machine similar to the machine used to examine your eyes at the eye clinic. However, there is a special laser attached to this machine.

The doctor will place a special contact lens on your eye before applying the laser beam. This lens allows the doctor to view your damaged drainage channel so that he or she can unblock it with the laser beam. The laser beam will be focused onto the iris (coloured part of the eye) close to the drainage channels, which will cause the channels to open up. The treatment is painless due to the anaesthetic drop used to numb your eye before the laser, but you might get a slight discomfort when the laser is being applied. It takes about 20 minutes.

 

What are the benefits of having a laser iridoplasty?

It is important to remember that this procedure is performed to save the sight you still have. It will not restore any sight you may have already lost; neither will it improve your sight.

The laser treatment is to try and reduce the pressure inside your eye. The laser aims to improve the drainage of the fluid (aqueous) within the eye. Without having this treatment, you are at risk of developing sudden (acute) glaucoma and irreversible blindness.

 

Are there any risks associated with a laser iridoplasty?

Complications after this treatment are uncommon. Occasionally your pupil can become bigger after the laser and can takes a few months to settle.

It can take a few weeks to find out the results of the laser treatment. Sometimes one procedure is not enough and we may need to repeat the treatment. Occasionally, laser treatment does not reduce the pressure within the eye to a satisfactory level. If this is the case, you may continue using eye drops, or you may need a different treatment.

 

Certain symptoms could mean that you need to be treated quickly, including:

 

  • excessive pain
  • loss of vision
  • flashing lights
  • your eye becoming increasingly red

 

If you experience any of these symptoms telephone The Kersley Clinic for advice immediately or visit your nearest accident and emergency department out of hours.

 

Are there any alternatives?

An alternative to laser is a cataract operation, which is not suitable for every patient. It also carries a greater risk of complications. There are no other alternatives to open up the drainage channels in your eye. Some patients with angle closure glaucoma also develop a long-term (chronic) rise in their eye pressure. In this case, you may need drops or other treatments in the long-term to keep your eye pressure within safe limits.

 

What do I need to do to prepare for a laser iridoplasty?

As this is an outpatient treatment, you can eat and drink as normal. You must take your eye medication as normal on the morning of the laser treatment.

 

What happens after the procedure?

You will be seen a few weeks later to make sure your eye has responded well to treatment. You should be given a follow-up appointment before you leave the hospital after your treatment.

If you have discomfort once you get home, we suggest that you take your usual pain reliever following the instructions on the packet.

It is normal to have the following symptoms for a couple of hours after laser treatment:

  • itchy eyelids
  • sticky eyelids
  • mild discomfort

You may also find that your vision is a little blurred. This is normal, and your vision should return to how it was before the laser within two hours.

If any of these symptoms last longer than two hours, or if you are worried about your eyes, please call the Kersley Clinic for advice immediately or visit your nearest A&E department.

What do I need to do after I go home?

We may prescribe anti-inflammatory drops after your laser treatment. These help to minimise inflammation (not infection) within the eye. People normally only have to take these for a week at most – the doctor will tell you how long you need to take them for. You don’t need antibiotics because your eye doesn’t have an open wound.

If you are using glaucoma drops, please check with the nurse or doctor whether or not you need to continue using them on your treated eye. It is usual to continue using them unless your doctor has said otherwise.

If you are using glaucoma drops to the untreated eye, please continue to use them unless clearly instructed otherwise.

Laser iridoplasty