Are There Any Complications
All procedures have a potential for complications. Indeed, prior to the advent of laser technology, iridotomy was performed in the operating theatre using a surgical approach. LPI has been performed around the world for millions of people for many years with good success, and minimal risk of complications.
One potential complication of LPI is to suffer a significant rise in eye pressure, preventable with the use of eye drops before the laser surgery. If there is a rise in eye pressure, it is often temporary and manageable with eye drops or tablets. There is a small risk of <1:500 for the need to proceed to surgery if the pressure remains high on medications.
Patients who take blood thinning agents (eg. aspirin, warfarin) are at slightly higher risk of minor bleeding at the site of the laser iridotomy. Some patients develop post-laser inflammation of the eye. It is very important to use the anti-inflammatory eye drops that we routinely prescribe to prevent this.
Very rarely, patients report side effects of glare or double vision.
You will be prescribed eye drops to use for several days after LPI. Your doctor will discuss this with you how to use these drops before you leave.
Some patients notice a dull headache or a bruised sensation after the laser procedure. This is often associated with the preparatory eye drops (pilocarpine) instilled before the laser surgery.
Pilocarpine has the action of (1) stretching the iris tissue making it thinner for easier laser penetration with less laser energy and (2) lowering the intraocular pressure to prevent the post-laser pressure rise. It is acceptable to take additional paracetamol / aspirin as directed by your treating doctor.
If the pain does not significantly resolve following the paracetamol / aspirin, contact your eye doctor for further advice.
Laser Peripheral Iridotomy (LPI)
The drainage angle of the eye is main outflow pathway for the exit of aqueous fluid from the eye. Insufficient outflow results in a build-up of pressure that can cause optic nerve damage called glaucoma.
The drainage angle is found at the junction between the peripheral cornea (clear glassy window at the front of the eye) and the iris (coloured part of the eye). This structure drains the aqueous fluid from within the eye.
Patients with narrow or occludable angles are at risk of angle closure, and angle closure glaucoma.
Why Do We Perform LPI?
Intermittent angle closure episodes are often asymptomatic, but these recurrent spikes in intraocular pressure are unhealthy for the eye because it leads to progressive optic nerve damage called glaucoma.
This optic nerve damage remains unnoticed until irreversible visual loss occurs. Intermittent angle closure is preventable with LPI.
More seriously, occludable angles may present suddenly as an acute angle closure crisis. The intraocular pressure rises to extremely high levels that can result in very rapid loss in vision and even blindness. Acute angle closure is a true ophthalmic emergency. Acute angle closure crises can only be reversed a combination of medications, LPI +/- surgery.
Frequently Asked Questions
How is it performed?
LPI is performed as an office laser procedure. This means that we can perform this under local anaesthetic drops, with no need for needles, injections or eye patching.
The entire process takes approximately 1- 2 hours as we need to prepare the eye with drops before the laser procedure, and then recheck the eye after it is all completed. The laser procedure itself usually takes several minutes only. Different lasers are utilized for this procedure including the Argon and YAG laser. Sometimes a combination of the two lasers is required to complete LPI.
How does laser PI work?
Laser Peripheral Iridotomy (LPI) creates a small bypass channel to allow aqueous fluid trapped behind the iris to flow into the anterior chamber and out of the eye through the drainage angle. This reestablishes the normal outflow pathway for aqueous flow within the eye.
Is LPI successful in all cases?
Some patients require an additional laser procedure called Argon laser iridoplasty after LPI if the drainage angle remains narrow. Your doctor will check the drainage angles at your next clinic visit following LPI to decide if iridoplasty is required.
Booking an appointment
You will require a valid referral to claim your consultation fee and associated investigations from Medicare. Referrals from your GP or Optometrist are valid for 12 months, however specialist referrals are only valid for 3 months.
If you require any specific information regarding your eye problem, for example cataract or glaucoma consultations, we ask you kindly ring your desired practice for fees and further information.
If you have any urgent query or problem, we request that patients or referrers ring the practice directly and speak with a staff member. We will always do our best to accommodate for urgent referrals, or direct you in the best possible manner.
How to reach us?
Dr Brian Chua's primary consulting locations are St Vincent's Clinic and Gordon Eye Surgery.
Please ring us if you require any further information or wish to book an appointment.