Graefe’s Arch Clin Exp Ophthalmol
(2006) 244: 413–414
DOI 10.1007/s00417-005-0106-4
Harsh Kumar
Parul Sony
Received: 24 May 2005
Revised: 11 July 2005
Accepted: 20 July 2005
Published online: 25 August 2005
# Springer-Verlag 2005
Neither of the authors has a financial or
proprietary interest in the subject
matter of the presentation.
H. Kumar
Apollo Hospital,
New Delhi, India
P. Sony
Dr. Rajendra Prasad Centre for
Ophthalmic Sciences, All India
Institute of Medical Sciences,
New Delhi, India
P. Sony (*)
E7 Ayur Vigyan Nagar,
New Delhi, 110049, India
e-mail: paruladi@yahoo.com
LETTER TO THE ED ITOR
Argon laser-assisted reopening of peripheral
iridotomy
Sir,
Seclusio pupil, with 360° posterior syn-
echiaeand iris bombe, is frequently
encountered in eyes with recurrent
anterior uveitis [2]. Nd:YAG periph-
eral iridotomy is a widely accepted
conventional treatment to break the
pupillary block and relieve the iris
bombe [1]. However, recurrent epi-
sodes of severe inflammation may
result in closure of the iridotomy with
finely pigmented inflammatory
strands, thus requiring creation of a
fresh iridotomy [4]. Delayed and
inadequate treatment of uveitic recur-
rences lead to repeated closure of the
iridotomy, and it may not be very
infrequent when one encounters a
uveitis eye with multiple, blocked,
peripheral iridotomies. We report on
the argon laser reopening of such
closed iridotomies.
We had four patients (five eyes)
with bilateral recurrent uveitis, re-
ferred to us for management of
seclusio pupil with secondary glauco-
ma. All patients had 360° posterior
synechiae, seclusio pupil with iris
bombe and 2–4 closed peripheral
iridotomies. Repeat trial of reopening
of the iridotomies had resulted in
corneal endothelial damage at some
of the sites. Along with this the YAG
shot invariably caused a bleed from
the edge of the iridotomy, resulting
in loss of clarity and inability to open
the iridotomy. Failure of the patency
was resulting in repeated attacks
of glaucoma.
All such eyes underwent an argon
laser reopening of the closed irido-
tomies. The eye was anaesthetized
with 0.5% proparacaine. An Abraham
iridotomy lens was used. The aiming
beam was focused at the centre of the
previous closed iridotomy; an argon
green laser was used, and 2–3 spots,
on average, were applied (50 μm spot
size, 0.8 W power and 0.1 s duration)
to make the opening patent. The post-
laser treatment regimen included
topical 1% prednisolone acetate eye
drops four times daily, 0.5% timolol
maleate eye drops twice daily for
1 week. The procedure was successful
in all the eyes at the site of the partial
iridotomies.
Follow-up after argon laser treat-
ment was 4–16 months. Four eyes had
1–3 episodes of uveitis, yet all eyes
had a patent iridotomy at the last
follow-up.
A study by Spencer et al., on the
evaluation of survival of Nd:YAG
laser peripheral iridotomy in eyes with
uveitis and angle closure glaucoma
and iris bombe, showed a high early
failure rate of Nd:YAG iridotomy in
patients with uveitis [4]. They showed
that 11 patients with uveitis required
28 iridotomies, compared to 66 irido-
tomies in 65 patients of a control
group. Making an initial YAG irido-
tomy or repeating treatment of closed
peripheral iridotomy with YAG laser
in eyes with iris bombe and extremely
shallow anterior chamber may be
difficult and cause corneal damage
414
due to the close proximity of the iris to
the cornea. Risk of lens damage also
exists, along with the invariable
bleeding that clouds up the chamber
and prevents the completion. Our
observations suggest that Nd:YAG
iridotomies may be more prone to
repeated closure following an inflam-
matory insult. Argon, being a photo-
coagulative laser [3], may lead to
contraction of the tissue at the edges
References
1. Klapper RM (1984) Q-switched
neodymium YAG iridotomy.
Ophthalmology 91:1017–1021
of the iridotomy, therefore helping in
achieving the long-term patency of the
iridotomy in these eyes. Nd:YAG laser
results in tissue cavitation, which may
result in an enhanced inflammatory
response, whereas the argon laser
creates thermal damage and probably
larger scarring around the opening.
Restricting the treatment to the area
of previously existing crypt eliminates
the problem of argon laser-induced
2. Krupin T, Feiti ME, Karalekas D
(1996) Glaucoma associated with
uveitis. In: Ritch R, Sheilds MB,
Krupin T (eds) The glaucomas, 2nd
edn. Mosby Year Book, St Louis, Mo,
pp 1225–1258
3. Mainster MA (1989). Laser light
interaction and clinical systems. In:
L’Esperance FA Jr (ed) Ophthalmic
lasers, 3rd edn. Mosby, St Louis
charring. Additionally, argon laser
absorption, being pigment-dependent,
obviates the risks of cornea or lens
damage as seen in our patients.
Our experience, from the above
few cases, suggests that argon laser-
assisted reopening of a closed pe-
ripheral iridotomy is effective in
maintaining the patency of irido-
tomy in uveitic eyes.
4. Spencer NA, Hall AJ, Stawell RJ
(2001) Nd:YAG laser iridotomy
in uveitic glaucoma. Clin Exp
Ophthalmol 29:217–219