Acute Angle-Closure Glaucoma
Laser iridotomy is the treatment of choice for angle-closure glaucoma. Iridotomy is performed using either an argon laser or an Nd:YAG laser.
The laser beam creates an opening in the iris through which the fluid (aqueous humor), which is trapped in the posterior chamber, can reach the anterior chamber and the trabecular meshwork (or drainage channels). As the fluid flows into the anterior chamber through this opening in the iris, the pressure behind the iris (ie, inside the eye) falls, allowing the iris to return to its normal position. This procedure opens the angle of the anterior chamber and relieves the blockage at the trabecular meshwork.
If the cornea is extremely cloudy or if the person cannot cooperate, a surgical (or incisional) iridectomy may be performed instead of a laser procedure. With a surgical iridectomy, the ophthalmologist creates the hole in the iris by making surgical incisions.
Laser gonioplasty is sometimes used as a treatment of angle-closure glaucoma or as a temporary measure to open the angle until a laser iridotomy can be performed.
During a laser gonioplasty, a laser beam is used to create burns in the iris. These burns cause the iris to contract and flatten, which, in turn, causes the angle of the anterior chamber to deepen (ie, opens the angle).
Next Steps - Follow-up
Because you may experience temporary increases in IOP after an iridotomy, your IOP is checked 1 hour after laser treatment. A visit is then arranged for the next day. At this visit, your eye is examined, and your IOP is checked again. Your other eye will probably be examined at this time, so your eye doctor can determine if it is at risk for angle-closure glaucoma and possibly prevent its occurrence.
You should continue using the medicines that were chosen to treat the acute attack of glaucoma for 1 day after leaving the hospital or clinic following the iridotomy; after 1 day, you may stop taking these medications. To help reduce any inflammation, your ophthalmologist may also prescribe drugs called corticosteroids for 1 week following your surgery.
If a laser iridotomy is not successful in reducing the pressure, your ophthalmologist may repeat the gonioscopic examination to rule out the presence of peripheral anterior synechiae. If peripheral anterior synechiae are found, you may need a laser gonioplasty or a surgical iridotomy. Your eye doctor will discuss the next appropriate step in your treatment plan with you.
Regular eye examinations with an ophthalmologist may identify people who are at risk for acute angle-closure glaucoma. In some people who are at high risk, a laser iridotomy may be performed to prevent an attack of acute angle-closure glaucoma.
The prognosis is favorable with early detection and treatment. Vision loss can occur without prompt treatment. If pain and/or decreased vision occur, you should promptly seek professional treatment from an ophthalmologist.