Laser Peripheral Iridotomy (LPI)
Laser Peripheral Iridotomy (LPI)
Opening the drainage pathway in angle-closure. This patient-education article is written by the glaucoma service at Suraj Eye Institute, Nagpur.
Laser Peripheral Iridotomy (LPI)
Who Needs Laser Iridotomy?
LPI is indicated for primary angle-closure suspect (PACS) with significant anatomical risk, primary angle closure (PAC), primary angle-closure glaucoma (PACG), the fellow eye after an acute angle-closure attack (often on the same day), and in any eye with narrow angles before pharmacological dilation or intraocular surgery. In India and Asia, PACG is particularly common and laser iridotomy is an important public health tool for prevention.
The LPI Procedure
Pre-treatment with pilocarpine 2% drops constricts the pupil and thins the peripheral iris, making laser penetration easier and safer. An Abraham iridotomy lens or Wise lens is placed on the anaesthetised cornea to focus the laser. The iridotomy is placed in the superior peripheral iris at the 11 or 1 o’clock position, ideally under the upper eyelid, to minimise dysphotopsia. In dark, thick irides (common in Indians), argon laser pre-treatment may be applied first to thin the stroma before YAG penetration. The endpoint is a through-and-through hole with a gush of pigment (Tyndall effect). IOP is checked 30–60 minutes after the procedure.
After the Procedure
A short course of topical steroid drops is prescribed to control post-laser inflammation. IOP is rechecked at 1 hour and at 1 week. Gonioscopy and/or AS-OCT at 4–6 weeks confirms whether the angle has widened satisfactorily. If IOP has not improved or the angle remains narrow despite a patent PI, further evaluation for non-pupil-block mechanisms (plateau iris, lens-based closure) and additional treatment (iridoplasty or clear lens extraction) is arranged.
Suraj Eye Institute offers laser peripheral iridotomy using state-of-the-art Nd:YAG laser systems with precision targeting. Our glaucoma specialists assess each patient with gonioscopy and AS-OCT before treatment to confirm the mechanism of angle closure and select the optimal treatment strategy. Post-procedure monitoring includes angle re-assessment and IOP trend tracking. We also counsel all patients on the bilateral nature of angle-closure risk and the importance of treating the fellow eye.