Ophthalmic diseases are widespread. More often they are found in older people. A serious pathology that can lead to complete blindness is glaucoma. This disease is characterized by increased pressure inside the eyeball. Laser iridectomy is considered one of the methods for treating glaucoma . It is carried out in specialized ophthalmological clinics and has several advantages compared with open surgery.
What is laser iridectomy?
Laser iridectomy is an ophthalmic procedure that is performed to reduce intraocular pressure. The main goal of this intervention is to improve the outflow of fluid in the organ of vision. The operation consists in the formation of small holes in the iris of the eye. There are several laser iridectomy techniques. These include:
- Simultaneous operation.
- Stage iridectomy.
- Layered operation.
A simultaneous iridectomy is performed using a pulsed laser. The power of this device is from 5 to 15 mJ. Laser applications are performed 1-3 times. As a result, it is possible to form a through hole in the iris. The advantage of this method is the speed of its execution. It is possible to perform a simultaneous iridectomy in patients with any eye color.
The phased operation is performed in several sessions. Moreover, the interval between laser exposure to the eye is 2-3 weeks. As a result, the formation of an opening in the iris is delayed for several months. A similar operation is carried out for people with a light eye color. Phased iridectomy is necessary in order to avoid damage to the thin iris and other structures of the organ of vision. The power of the laser system is from 600 to 1000 mW, and the exposure time is up to 0.5 seconds.
A layered iridectomy is performed for people with a dark iris. The laser power in this case is up to 1500 mW, and its exposure time is 0.2 seconds. The hole in the iris is formed gradually, by layer-by-layer destruction of the pigment tissue. For such an operation, a short-pulse or argon laser is used.
Indications for the operation
To establish the outflow of intraocular fluid, an iridectomy is performed. The laser procedure minimizes the risk of damage to the organ of vision. Indications for this operation are conditions accompanied by stagnation of fluid and increased pressure inside the eyeball. These include:
- Angle or mixed glaucoma.
- Excessive amount of pigment.
- Anomalies in the development of the anterior chamber of the eye.
- Pupil block.
Laser iridectomy of the eyes is performed as a prophylaxis of acute attacks of glaucoma. Increased pressure leads to loss of visual fields and a decrease in its severity. Long-standing glaucoma is dangerous for the development of complete blindness. The disease occurs due to fluid stagnation between the chambers of the eye. It can be congenital and acquired. In the first case, glaucoma is a consequence of abnormalities in the development of the organ of vision. An acquired increase in intraocular pressure occurs with recurrent inflammatory pathologies and a violation of the blood supply to the eyes. Laser iridectomy is more effective in angle-closure glaucoma. Excision of the pigment membrane leads to an improvement in the outflow of fluid from the anterior chamber of the eye and reduces pressure.
Contraindications to performing iridectomy
In some cases, surgery with a laser is unacceptable. The following conditions are contraindications to iridectomy:
- Clouding of the cornea or lens (cataract).
- Insufficient depth of the iris.
- Corneal edema resulting from inflammatory processes.
- Detachment of the retina.
- The lack of one eye.
- Slit-like front camera.
- Pupil sphincter paralysis.
- Progressive decrease in visual acuity.
- Immunodeficiency conditions.
In the absence of contraindications, laser iridectomy can be performed several times. The need for this operation is determined by the ophthalmologist after performing diagnostic tests.
The technique of iridectomy
Laser basal iridectomy consists in the formation of an artificial hole in the inner corner of the cornea. It allows you to establish the outflow of fluid from the posterior chamber of the eye to the anterior. This procedure is performed under local anesthesia. In addition to the pain medication, it is necessary to instill a 1% solution of Pilocarpine. This is necessary to narrow the pupil during laser intervention.
A lens is applied to the eye, which allows you to maximize the overview of the surgical field. Then choose the place of formation of the hole. It can be located in any area of the iris. It is not recommended to puncture at 12 o'clock, as gas bubbles accumulate in this zone. Ophthalmologists prefer to form a hole in the area of a large crypt or in a thinned area of the iris.
The laser beam penetrates the tissues of the eye through the lens. It focuses on a specific place. In the selected area, the laser acts for 0.2-0.5 seconds. As a result, a hole necessary in depth is formed. The circulation of aqueous humor is established, which helps to reduce intraocular pressure.
Laser iridectomy: postoperative period, limitations
To avoid the dangerous consequences of the operation, you must follow the recommendations of an ophthalmologist. Only in this case will laser iridectomy be effective. The postoperative period lasts for 2-3 weeks. During this time, the patient must observe visual peace, as well as refrain from driving. Anti-inflammatory drugs and carbonic anhydrase inhibitors are required for 1 week . These include eye drops "Dorzolamide", "Azopt."
During the postoperative period, it is recommended to sleep on your back, and also to avoid the increased humidity of the room (do not visit baths and saunas). Water should not get into the eyes for 1 week.
Advantages and disadvantages of the technique
The advantages of this method of treatment include: the rapid achievement of the effect and the creation of a natural outflow of aqueous humor between the cameras of the eye. In addition, laser iridectomy is a painless and quick procedure. The risk of bleeding and damage to adjacent tissues is minimized.
The disadvantage is that some patients are forced to do the operation again due to the occurrence of synechia - fusion of the iris at the site of the hole formed.
Laser iridectomy: reviews of ophthalmologists
Ophthalmologists respond positively to this method of treatment, especially when it comes to uncomplicated glaucoma. With a pronounced and uncontrolled increase in pressure in the eyeball, laser trabeculoplasty or open surgery is recommended.