iridoplasty
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iridoplasty procedure peripheral iridoplasty indications laser ophthalmology
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Iridoplasty, usually argon laser peripheral iridoplasty (ALPI), is a laser procedure used to open a narrow anterior chamber angle.
- How it works: low-power, relatively long laser burns are applied to the peripheral iris. The resulting stromal contraction pulls the iris away from the drainage angle, improving aqueous outflow.
- Main use: persistent narrow/closed angle due to plateau iris configuration or syndrome, especially when the angle remains narrow after a laser peripheral iridotomy (LPI). It can also be used as a temporizing treatment in acute angle closure that has not responded adequately to initial medical treatment and iridotomy.
- Not the same as iridotomy:
- LPI creates a small hole in the iris to relieve pupillary block.
- Iridoplasty contracts and retracts the peripheral iris to address non-pupillary-block angle crowding, such as plateau iris.
- Technique: topical anesthetic, usually pilocarpine and an IOP-lowering drop, followed by approximately 1-2 peripheral laser burns per clock hour. Typical parameters described are 500 μm spot size, 100-400 mW, for 0.2-0.5 seconds, titrated to mild visible iris contraction. Kanski's Clinical Ophthalmology: A Systematic Approach, 10th ed., p. 416.
- Aftercare: IOP is checked shortly after laser treatment; a short topical anti-inflammatory course is commonly prescribed.
- Possible adverse effects: transient IOP rise, mild inflammation, discomfort, and transient alteration in accommodation. Heavier treatment, particularly in a deeply pigmented iris, can cause a more substantial persistent IOP elevation. Kanski's Clinical Ophthalmology: A Systematic Approach, 10th ed., p. 416.
The AAO plateau iris review similarly describes ALPI as an adjunct after LPI when appositional angle closure or elevated IOP persists. It is generally an adjunct or temporizing measure, not a substitute for lens extraction when lens-related crowding is the dominant mechanism.
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