Laser Iridotomy Side Effects: What You Need to Know

Introduction

Laser iridotomy is a widely used procedure for treating angle-closure glaucoma and preventing acute attacks in at-risk patients. While generally considered safe and effective, it's crucial to understand the potential side effects that can occur. This article will explore the various complications associated with laser iridotomy, from common and temporary issues to rare but serious long-term effects.

Common Short-Term Side Effects

Immediately following laser iridotomy, patients may experience several temporary side effects:

• Blurred vision
• Mild eye discomfort or pain
• Redness
• Light sensitivity
• Seeing spots or floaters

These symptoms typically resolve within a few days to weeks. According to Healthline, other short-term effects may include headaches, eye aches, and watery eyes. If these symptoms persist or worsen, it's important to contact your eye doctor.

Intraocular Pressure (IOP) Changes

One of the most significant immediate concerns following laser iridotomy is a spike in intraocular pressure. A study by Schrems et al. found that laser iridotomy caused average IOP rises of 10 mmHg, peaking around 80 minutes after the procedure. This pressure increase usually resolves within hours but may require medication to manage. In some cases, pre-treatment with pilocarpine eye drops can significantly reduce this pressure spike.

Visual Disturbances

Some patients report persistent visual disturbances following laser iridotomy. Murphy et al. reported that patients may experience monocular blurring or see bluish or colored lines, particularly when the iridotomy is partially exposed by the upper eyelid. These symptoms can often be alleviated by ensuring the iridotomy is fully covered by the eyelid or by using tinted lenses.

Corneal Complications

The corneal endothelium can be affected by laser iridotomy. A study by Wu et al. demonstrated significant endothelial cell loss in the year following Nd:YAG laser iridotomy. This suggests a potential long-term hazard to the corneal endothelium. In rare cases, this can lead to corneal decompensation, particularly in patients with pre-existing endothelial issues.

Lens and Retinal Damage

While uncommon, laser iridotomy can potentially cause damage to the lens or retina. Wollensak et al. reported a case of lens perforation following Nd:YAG laser iridotomy, resulting in a typical perforation rosette of the posterior pole of the crystalline lens. Retinal burns, while rare, have also been reported as a potential complication.

Long-Term Considerations

While laser iridotomy is generally safe, there are potential long-term effects to consider:

• Cataract progression: Some studies suggest a possible link between laser iridotomy and accelerated cataract formation, although this remains controversial.
• Corneal decompensation: In rare cases, especially in patients with pre-existing corneal issues, laser iridotomy may lead to corneal decompensation years after the procedure.
• Chronic inflammation: Some patients may experience prolonged inflammation, which can lead to other complications if not properly managed.

Conclusion

Laser iridotomy remains an important and generally safe treatment for angle-closure glaucoma. However, it's crucial for patients to be aware of potential side effects and complications. Most issues are temporary and manageable, but some rare complications can have long-term impacts. Regular follow-up with an eye care professional is essential to monitor for and address any potential issues. As with any medical procedure, the benefits of laser iridotomy must be weighed against the risks for each individual patient.