An iridectomy is a surgical procedure that involves creating a small opening in the iris, the colored part of the eye. This intervention aims to facilitate the movement of fluid within the eye, thereby managing intraocular pressure. This helps address ocular conditions that can impact vision.
Why an Iridectomy is Performed
An iridectomy is performed primarily to address conditions that lead to elevated intraocular pressure, with angle-closure glaucoma being a prominent reason. In this condition, the angle where the iris meets the cornea, which contains the eye’s drainage system (trabecular meshwork), becomes narrowed or blocked. This blockage prevents aqueous humor, the fluid that nourishes the eye, from draining properly, causing pressure to build up inside the eye.
The procedure creates a new pathway for the aqueous humor to flow from the posterior chamber (behind the iris) to the anterior chamber (in front of the iris), bypassing the narrowed angle. This equalization of pressure between the two chambers helps to push the iris away from the drainage angle, allowing fluid to exit the eye more effectively. Without this intervention, sustained high pressure can damage the optic nerve, leading to irreversible vision loss. An iridectomy may also be considered as a preventive measure in individuals with narrow angles who are at risk of developing angle-closure glaucoma.
How an Iridectomy is Performed
Iridectomies are performed using a laser, known as a laser peripheral iridotomy (LPI), or through traditional surgical methods. Laser iridotomy is the more common approach due to its minimally invasive nature and is often performed in an outpatient setting. Before the laser procedure, the eye is usually pre-treated with drops to constrict the pupil, which helps to thin and stretch the iris, making it easier for the laser to penetrate.
During a laser iridotomy, the patient sits at a slit-lamp microscope, and anesthetic eye drops are administered to numb the eye’s surface. A specialized contact lens is then placed on the eye to help focus the laser beam and keep the eye still. A YAG laser is commonly used to create a tiny hole in the outer edge of the iris, typically in the upper portion where it is covered by the eyelid. The patient may hear a soft clicking noise and feel a brief “flicking” or “pin-prick” sensation during the laser pulses.
In cases where a laser iridotomy is not feasible, such as with significant corneal cloudiness or an inability to cooperate with the laser technique, a surgical iridectomy may be performed. This involves making a small incision in the cornea to access the iris, and a portion of the iris is then surgically removed. While less common, surgical iridectomy may also be combined with other eye surgeries like trabeculectomy for glaucoma management.
What to Expect After an Iridectomy
Following an iridectomy, patients can expect a relatively quick recovery, as it is typically an outpatient procedure. Immediately after the procedure, vision may be temporarily blurred due to eye drops used during and after the treatment. Patients might also experience mild discomfort, a scratchy sensation, or light sensitivity for a few hours to a few days. A slight headache is also possible due to temporary changes in intraocular pressure.
The eye pressure is usually checked within 30 to 60 minutes after the procedure. Anti-inflammatory eye drops are often prescribed for a few days to a week to manage inflammation. Patients can generally resume normal activities almost immediately, but should arrange for a ride home due to potential blurred vision. The success rate for laser iridotomy in opening the angle is high, though some patients may still require ongoing medication or additional treatments. Complications can include bleeding from the iris, a temporary spike in eye pressure, or the iridotomy closing over time, which may necessitate a repeat procedure.