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Iridotomy is a simple, fast and very effective laser procedure. It is used to prevent angle-closure glaucoma.
Iridotomy is a surgical procedure on the eyes that is carried out with a laser.. It is almost always done as a preventive or prophylactic treatment for closed-angle glaucoma. It also applies to cases of iris melanoma and pigmentary glaucoma.
This procedure has been used since 1984 and replaced the traditional treatment that required the opening of the eyeball and the manual removal of part of the iris. With iridotomy, only a YAG laser is used in the ophthalmologist’s office. It is a fast and very safe procedure.
What is an iridotomy?
Iridotomy is a surgical treatment performed to facilitate drainage in the eye. It consists of making a small hole, the size of a pinhead, in the outer edge of the iris. This helps prevent damage to the optic nerve and loss of vision.
Most commonly, iridotomy is performed after diagnosing a narrow angle in the ophthalmology office. This is usually accomplished through a test called gonioscopy, which is performed in the office.
Therefore, in many cases it is a preventive treatment that seeks to prevent the advancement of closed-angle glaucoma. It also applies to people who have had an acute episode of glaucoma.
Why is this intervention carried out?
In the front of the eye there is a clear fluid called aqueous humor. This fluid is produced in an area behind the iris, which is the colored area of the eye. The substance leaves the eye through channels of the trabecular meshwork.
The network is at the point where the iris and the cornea meet, which is the transparent layer that covers the front of the eye. Such a point is called angle. If something obstructs the exit of aqueous humor at the angle, the pressure in the eye increases and this can damage the optic nerve in the long term.
Also, the abnormal increase in pressure in the eye can push the iris out. Under these conditions, the drainage system is completely closed.
Therefore, when the ophthalmologist detects that there is a closed angle, the usual thing is that he opts for iridotomy as a means. to prevent the problem from progressing, damage occurs and even total loss of vision.
How the iridotomy is performed
Iridotomy is a simple, fast and outpatient procedure. Uses YAG type laser (yttrium aluminum garne), which works based on photodisruption or tissue rupture and cutting. Its main advantage is the high degree of precision it has.
Half an hour before the iridotomy, a few drops are applied that contract the pupil. Just before the intervention, other drops containing a local anesthetic are applied. This avoids discomfort to the patient.
The person should sit up and support the jaw on a support. Then you need to fit each eye at the same time into a camera with a kind of lens. The procedure is carried out with a special microscope that has a built-in laser.. The ophthalmologist, who is on the opposite side, directs the laser towards the edge of the iris and applies it.
The iridotomy takes a total of about 5 minutes for each eye. The person may experience a mild stinging sensation and notice a flash. The laser acts like a high-precision scalpel.
Recovery and results after iridotomy
In most cases, the patient recovers completely within 24 hours. There may be some discomfort after the intervention. Despite this, the person can carry out their normal activities, except driving.
It is plausible to experience blurred vision and sensitivity to light at first. The eye may be a little red and a mild headache is common.
The most common is that anti-inflammatory eye drops are prescribed for a few days. In a maximum of 72 hours, normal vision will have returned. Iridotomy is close to 100% effective.
On some occasions, it is necessary to supplement the intervention with additional treatment. Likewise, a few patients require several successive interventions, since the open hole may be closed with the laser.
Who gets an iridotomy?
In most cases, iridotomy is used as a prophylactic treatment for people at risk of developing angle-closure glaucoma. Likewise, to care for those with acute glaucoma.
Less commonly, this procedure is used to treat pigment dispersion syndrome or pigmentary glaucoma. This is a condition in which the iris sags back, rubs against the lens, and releases excess pigment.
In a few other cases it is used to treat melanoma of the iris. This is a rare condition that has to do with the presence of a uveal tumor.
Possible risks and complications
Iridotomy is a very safe procedure with very rare complications.. The most common of these is inflammation. This can lead to a temporary increase in intraocular pressure. Only exceptionally does this require medical treatment.
There is a risk of bleeding into the anterior chamber of the eye. This is usually temporary and does not require additional measures. The iridotomy may also be closed, as previously noted.
In 25% of cases the angle does not open. If this happens, it is also necessary to repeat the iridotomy or carry out other treatments. Sometimes clouding of the lens is produced by the impact of the laser, but it does not usually have significant repercussions.
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