peripheral iridotomy

What is LPI?

Laser Peripheral Iridotomy (LPI) is a laser procedure performed in the office to prevent or treat closed angle glaucoma.

What is angle closure glaucoma?

The drainage site is found within the “angle” where the iris (the colored part of the eye) and the cornea (the clear covering forming the front of the eye) meet. 

Angle closure is when the natural flow of fluid inside the eye is blocked near the drainage site of the eye by the colored part of the eye (iris). This causes a buildup of fluid within the eye leading to high eye pressures, irreversible damage to the optic nerve and permanent vision loss. In some patients, the eye pressure elevation may happen suddenly causing pain, red eye, blurred vision, nausea and rarely vomiting. This condition is called an acute angle closure attack.

How does LPI work?

A tiny opening is created in the iris (the colored part of the eye) to help widen the pathway to the drain of the eye. This greatly reduces the chance of the drainage pathway closing, which prevents rapidly increasing eye pressures, irreversible damage to the optic nerve and permanent loss of vision.

What happens during an LPI?

Once you have been checked in, drops will be used to numb your eye and check the pressure. No injections or needles will be used.

Then, you will receive some drops in your eye. The first drop is called pilocarpine and is used to make your pupil smaller. This stretches and thins your iris, which makes it easier for the laser to make a tiny hole. Some patients develop a mild headache after receiving this medication. The second drop is called apraclonidine. It is used to prevent bleeding and a rise in the eye pressure after the procedure.

Next, your doctor will place a special lens on your eye to help focus the laser on the iris. This lens also prevents your eye from blinking and keeps the eye still during the treatment. A clear gel is placed between the eye and the lens to protect the surface of your eye. This gel may remain on your eye for up to an hour, leading to blurred vision or a feeling of heaviness.

The laser treatment will take approximately 5 minutes to complete per eye. During the laser treatment, you may see a bright light, like a photographer's flash from a close distance. Patients describe a range of sensations from feeling nothing, a pinch, or a static, shock-like zap to feeling similar to a snap of a rubber band on skin. Generally, the sensation is brief.

As a safety measure, your eye pressure will be checked after your procedure.

Will LPI cure my glaucoma in those who have glaucoma? 

The simple answer is “No”. Glaucoma is a chronic disease that requires constant monitoring and treatment. The LPI procedure may help to lower your eye pressure and widen the drainage angle. However, it will not reverse any loss of vision that has already occurred.

What are the risks of LPI? 

Although LPI is very safe, there are no medical procedures with zero risk. Serious complications such as losing vision are extremely rare. The main risk of an LPI is that your iris may be difficult to penetrate, requiring more than one treatment session. Rarely, the laser spot in your iris may close requiring another procedure to open it again. Glare or visual disturbance, although uncommon, can occur in some patients. Symptoms often decrease with time and rarely require intervention. Lastly, the pressure in the eye may increase shortly after the laser. This typically can be controlled with pressure lowering eye drops and goes away on its own. It is extremely rare needing a surgery to lower the elevated eye pressure after LPI.

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