Section 8-A-3: Laser Iridoplasty

After LPI relieves the pupillary block (Chapter 4, Section 4-D), a narrow angle will usually deepen when observed through a goniolens. If it does not, a patient may have a condition called plateau iris configuration. Plateau iris is caused by a forward rotation of the ciliary body, which causes narrowing of the drainage angle peripherally. Since the condition is not caused by pupillary block, the angle will not deepen after the LPI. To open the peripherally narrow angle, an iridoplasty (or gonioplasty) may be performed. This procedure uses Argon laser to shrink the peripheral iris, which pulls iris away from the trabecular meshwork and improves the aqueous outflow.

Iridoplasty is similar to the other laser procedures with regard to intra- and post-operative care. Topical anesthesia is used as well as a glaucoma medication (e.g. brimonidine) to prevent post-laser IOP elevation. A contact lens is used to visualize the peripheral iris and its contraction with Argon laser energy (Figure 8-5). The laser treatment is usually well-tolerated by patients. Another glaucoma drop is placed post-operatively and the IOP is checked 1 hour post-operatively to rule out IOP spike. A short course of topical steroids is prescribed. The complications are similar to those of the other ocular laser procedures.

Figure 8-5. Goldmann Contact Lens used for laser iridoplasty. This lens is the same as the one used for laser trabeculoplasty.

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