What is LPI or laser peripheral iridotomy?
Laser peripheral iridotomy is the treatment for angle-closure disease. Your doctor may advise a LPI in the following cases:
- You have angle closure glaucoma (acute or chronic)
- You are at risk for angle closure glaucoma.
- Before an ICL implant for vision correction.
- In the other eye, if one of your eyes has angle closure glaucoma
During the procedure, your eye doctor will use a laser to create a tiny hole in the coloured part of your eye, the iris. This little hole provides an alternate drainage pathway for the fluid inside the eye. Remember, this impaired fluid drainage can lead to an increase in eye pressure, leading to glaucoma.
Therefore, the LPI has two functions: one, to prevent eye pressure from going up, and two, if the eye pressure is high, to bring it down to normal.
What should I expect on the day of my laser peripheral iridotomy?
On the day of your procedure, your doctor will measure your eye pressure and record your vision, as always. She will also explain the risks and benefits of the procedure, and also talk to you about possible alternative procedures. After that, you will be asked to sign a consent form.
A technician will instil pilocarpine eye drops to prepare you for the laser. In the laser room, you will sit on a machine that looks exactly like the laser slit lamp in your doctors examination room.
Once you are comfortable, she will put anaesthetic or numbing drops in your eye. She will then use a special contact lens with gel on it, which is similar to the one used for gonioscopy. This lens will focus the laser energy onto your iris. The laser usually feels like a minor stinging sensation, or a knock like sensation on the eye.
Once the procedure is over, you will have no pain. Your doctor will assist you in cleaning your eyes. She may advise some eyedrops to be put immediately after the procedure, check your eye pressures again.
Your vision will be blurred after the procedure for some time, but it usually becomes normal by the next morning.
Precautions and instructions following LPI
You will be asked to use anti-inflammatory eye drops by your doctor to help the eye heal. You will be asked to continue glaucoma medication also. Sometimes, your doctor may change your glaucoma eyedrops following the LPI.
You can continue your day to day activities, but it may be prudent to avoid screens (both television, and computer screens, or mobiles) for a day. You will have to see your doctor either the next day, or after a few days of the iridotomy.
What are the possible complications of laser peripheral iridotomy treatment?
Laser peripheral iridotomy is a very safe procedure. However, any surgery, carries a chance of a complication. Possible complications of LPI include:
- Mild pain and vision blur on the day of the procedure is normal, and expected. The doctor will give you eyedrops to help the eye heal from the procedure. In case of persistent pain, or increased pain, you must contact your doctor immediately.
- Increase in eye pressure from the procedure. This can be either due to the inflammation, or the steroids given to help the eye heal. Your doctor will use anti-glaucoma medicines to treat this.
- Inadequate size of the hole in the iris: Eitehr the hole made can be too small, or can sometimes scarring can close the hole. In this case, your dotor may repeat the procedure to ensure adequate drainage.
- Inflammation: You may have persistent inflammation after the procedure and need eye drops for longer than one week.
- Vision blur: Some patients may experience a blurred vision for more than a day or two. This will settle as the eye heals, and some patients may require a new pair of glasses.
- Glare or double vision: Very rarely, you may experience some glare or a shadow image, which results in a blurred vision.
