Precision Neodymium-doped YAG laser peripheral iridotomy for acute and chronic angle-closure glaucoma.
Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) Laser Peripheral Iridotomy (LPI) is the primary preventative and therapeutic laser procedure for patients with narrow angles, angle-closure glaucoma, or pupillary block. In narrow-angle eyes, aqueous fluid gets trapped behind the iris, pushing it forward against the cornea and obstructing natural drainage.
Using focused, ultra-short pulses of infrared laser energy, the Nd:YAG laser creates a microscopic opening (iridotomy) in the far periphery of the iris. This creates an alternative bypass route for aqueous fluid, immediately equalizing pressure between the anterior and posterior chambers, flattening the iris root, and reopening the natural filtration angle.
The procedure is performed entirely as an outpatient slit-lamp treatment without hospital admission. Pilocarpine drops are administered beforehand to constrict the pupil and stretch the iris taut. Topical anesthetic drops ensure complete numbness throughout the procedure.
A specialized Abraham or Wise contact lens is placed to concentrate the laser beam onto a pre-selected peripheral iris crypt—typically positioned under the upper eyelid to prevent visual glare. With just a few micro-bursts of laser energy, Dr. Amola Gandhi creates a tiny, safe opening. The entire laser delivery takes only 2 to 3 minutes.
An acute angle-closure attack is one of the most painful and rapidly blinding medical emergencies in ophthalmology. For patients diagnosed with anatomically narrow angles on gonioscopy, Nd:YAG iridotomy acts as a definitive preventative barrier.
By relieving pupillary block before an attack can occur, this simple 5-minute laser procedure provides permanent protection against acute pressure spikes.
Why Nd:YAG Laser Iridotomy is the preferred first-line therapy for angle closure:
No. With topical anesthetic drops, you will feel only the contact lens resting on your eye. You may notice tiny clicks or mild snapping sensations as the laser fires, but there is no sharp pain.
No. The iridotomy is microscopic (less than 1 mm) and deliberately positioned beneath your upper eyelid, making it completely invisible to anyone looking at your face.
Dr. Gandhi will prescribe anti-inflammatory eye drops for approximately one week to soothe the eye and prevent temporary pressure elevations.