Glaucoma is a disease caused by degeneration of the optic nerve head, resulting in patients having vision problems… and is a major cause of blindness. The main factor causing glaucoma is usually high intraocular pressure due to abnormal circulation of the aqueous humor. LPI (Laser Peripheral Iridotomy) is a procedure that uses laser light through the iris margin to create a hole, helping the aqueous humor drain better.
Indications for LPI treatment
- To prevent acute glaucoma, which may occur in patients with narrow angles or congenitally narrow anterior chamber angles, often associated with hyperopia (farsightedness).
- To treat patients with angle-closure glaucoma who cannot normally drain aqueous humor from the eye.
Complications if left untreated
- Patients with narrow angles at risk of acute glaucoma have less than 10% chance of developing acute glaucoma, and if not treated with LPI, acute glaucoma can increase the risk of sudden vision loss by ≥ 80%.
- Patients with angle-closure glaucoma who do not receive treatment will gradually lose vision completely (100%).
LPI procedure steps
1. Instill pupil-constricting drops (2% Pilocarpine eye drop) for about 30-60 minutes to prepare the iris before laser treatment (during instillation, headache/nausea/vomiting may occur as side effects; if severe headache or nausea/vomiting occurs, please inform the nurse).
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- Instill anesthetic drops
- Sit in front of the laser machine, place chin on the chin rest, the doctor places a lens on the cornea (patient keeps eyes wide open and steady)
- The doctor fires the laser through the lens, taking about 1 minute (some may experience slight pain)
2. After the procedure, the doctor/nurse will instill antibiotic and anti-inflammatory drops (additional medication will be given to the patient to continue at home for 7 days).
Patient instructions
Before the procedure
- Avoid medications that increase bleeding risk such as blood thinners, NSAIDs, supplements containing Omega 3, vitamin E, and herbal medicines (ginseng, reishi mushroom) for 7 days before laser treatment, as these increase the risk of eye bleeding during the procedure.
- Do not drive to the appointment as vision will be blurry after the procedure; please have a companion for safe transportation home.
After the procedure
- Avoid driving and using your eyes extensively (blurred vision may last about 2 days).
- Continue using anti-inflammatory drops as prescribed for 7 days.
- Avoid or refrain from heavy exercise or lifting heavy objects for 7 days.
- Resume normal daily activities, you may get the eye wet and eat normally.
- If you take blood thinners (which must be stopped before laser), you may resume them the day after the procedure.
Possible side effects
- May see floating black shadows in the eye (in patients with pre-existing vitreous opacities or degeneration) due to laser disturbing the vitreous humor, but this is very rare.
- Eye pain (may occur rarely).
