Acute angle-closure glaucoma and iridotomy

Acute angle-closure glaucoma and iridotomy

You suffer from an abnormality or damage to the iris and/or the iridocorneal angle that is responsible for visual problems or glaucoma. Your ophthalmologist will suggest laser treatment as the most appropriate way to remedy this.

This sheet contains information on the operation proposed to you, its results and its risks.

The iris
This is the coloured diaphragm directly visible in the eye, centred by an orifice: the pupil.
The intraocular circulation of the aqueous humor (liquid which gives the eye its pressure), takes place through this orifice, then in the iridocorneal angle (space between the iris and the cornea).
The blockage of the circulation of the aqueous humour by the abnormal position of the iris can lead to an increase in intraocular pressure with the risk of blindness.
Only your ophthalmologist is qualified to assess the risk of blockage and its harmful effect on vision.

Why operate on the iris?
1/ Iridotomy is the creation of an opening in the iris. It is intended to prevent the occurrence of acute glaucoma or its recurrence. It allows the passage of aqueous humor from the back to the front of the iris in case of blockage at the pupil.
2/ Iridoplasty, by modifying the shape of the iris, allows the base of the iris to be slightly retracted, so as to facilitate the passage of the aqueous humour towards the iridocorneal angle.

Why treat with laser?
In the presence of iris anomalies with a risk of blockage, eye drops are insufficient to avoid this risk. Surgery requires an opening of the eyeball.
The lasers used act like a scalpel to create an opening, or make a burn to create a retractile scar.

The laser treatment
Hospitalization: The procedure is performed on an outpatient basis: the patient sits in front of the machine.
Anaesthesia: A local anaesthetic using drops makes it possible to apply a lens to the eye.
Laser procedure: It is carried out in one or two sessions spaced a few days or weeks apart. Incidents or difficulties during the operation: They are rare and unpredictable.
Some pain may be felt. A haemorrhage may occur, always minimal.
These difficulties may lead to a second session being proposed, and more rarely a subsequent surgery.

Usual postoperative evolution
The care is reduced to the instillation of drops and the possible taking of tablets during a period which will be specified by your ophthalmologist.
In the vast majority of cases, the operated eye is painless.

A certain degree of irritation or inflammation of the eye, as well as a momentary increase in visual difficulties may be observed.
A transient increase in intraocular pressure is possible, which may require the temporary addition of eye drops.

After laser iridotomy, it is possible to see a luminous line in certain circumstances: it corresponds to the passage of light through the hole in the iris. This perception is usually temporary.
The effectiveness of the laser treatment can be judged after a few days or weeks. In most cases, the risk of blockage and a sudden rise in eye pressure is eliminated.
In some cases, it may be necessary to enlarge or complete an iridotomy or to complete an iridoplasty that is loosening.

The associated continuation of medical treatment is sometimes necessary.
In very rare cases, if the laser is not available or in case of insufficient effect of the laser, as in certain malformations, it is necessary to resort to surgery (iridectomy or even filtering surgery).
The treatment can in no way claim to improve vision.

Complications of iris laser
Discomfort during the treatment or immediately afterwards, as with any examination with a contact lens.
Although it is perfectly standardised and usually followed by good results, laser iris surgery does not escape the general rule that there is no surgery without risk.
It is therefore not possible for your ophthalmologist to formally guarantee the success of the procedure.
However, severe complications of iris laser surgery are exceptional.