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In acute angle-closure glaucoma cases, surgical iridectomy has been superseded by Nd:YAG laser iridotomy, because the laser procedure is much safer. Opening the globe for a surgical iridectomy in a patient with high intraocular pressure greatly increases the risk of suprachoroidal hemorrhage , with potential for associated expulsive hemorrhage .
A laser peripheral iridotomy (LPI) is the application of a laser beam to selectively burn a hole through the iris near its base. LPI may be performed with either an argon laser or Nd:YAG laser. [6] [7] There is currently no sufficient evidence to show any benefit on the use of iridotomy versus no iridotomy to slow down visual field loss.
The CPT code revisions in 2013 were part of a periodic five-year review of codes. Some psychotherapy codes changed numbers, for example 90806 changed to 90834 for individual psychotherapy of a similar duration. Add-on codes were created for the complexity of communication about procedures.
The same laser is used to cut a small incision along the periphery of the lenticule about 1/5th the size of a standard LASIK flap incision. The surgeon then uses a specially designed instrument [ clarification needed ] to separate and remove the lenticule through the incision, leaving the anterior lamellae of the cornea intact.
If narrow angle glaucoma persists after iridotomy, it is called plateau iris syndrome and subsequently managed either medically (miotics) or surgically (laser peripheral iridoplasty). This condition is sometimes discovered after an iridotomy causes a rapid increase in eye pressure. [1]
A 2016 Cochrane Review sought to determine the effectiveness of YAG laser iridotomy versus no laser iridotomy for pigment dispersion syndrome and pigmentary glaucoma, in 195 participants, across five studies. [5] No clear benefits in preventing loss of visual field were found for eyes treated with peripheral laser iridotomy. [5]
Laser peripheral iridotomy has high efficacy in the treatment of pigmentary glaucoma. Argon laser trabeculoplasty is effective in the management of corticosteroid and pigmentary glaucoma. [ 2 ] However, this is often contraindicated due to high rates of failure in patients with uveitic glaucoma. [ 6 ]
Trabeculoplasty is a laser treatment for glaucoma. It is done on an argon laser equipped slit lamp, using a Goldmann gonioscope lens mirror. Specifically, an argon laser is used to improve drainage through the eye's trabecular meshwork, from which the aqueous humour drains. This helps reduce intraocular pressure caused by open-angle glaucoma. [1]