Page 97 - NAME OF CONDITION: REFRACTIVE ERRORS

Both Argon and Nd-YAG lasers can be used either alone or sequentially to achieve an
iridotomy. Use of Nd-YAG laser for iridotomy has been described above. In sequential use,

photocoagulative effects of argon laser are combined with photodisruptive effects of Nd-
YAG laser. This is especially useful in cases of thick irides and to reduce the risk of bleeding.
Argon laser is used first to thin the iris and then the Nd-YAG laser is used for penetration.

Parameters (Argon laser)
Stretch Burns:
Spot size: 200-500 µm
Exposure time: 0.2-0.5 sec
Power: 200-600 mW
Penetration burns:
Spot size: 50 µm
Exposure time: 0.02 sec
Power: 800-1000 mW

Argon laser peripheral iridoplasty.

(3) Surgery

Trabeculectomy alone or combined with cataract surgery

Cataract surgery alone-helps to reduce crowding of the angle and relative pupillary block.

Tube implant surgery

Management of complications of glaucoma surgery causing secondary closure of angle
Malignant glaucoma
 Aqueous suppressants/ cycloplegics (miotics are contraindicated)

 Nd-YAG hyaloidotomy along with posterior capsulotomy in pseudophakics
 -Pars plana vitrectomy
Secondary closure choroidal effusion
-Topical steroids/ cycloplegics with or without systemic steroids
- Choroidal drainage if conservative measures fail
Acute primary angle closure
Other modalities attempted include iridoplasty and paracentesis for temporary lowering of

IOP. In case LPI is not possible, iridoplasty or surgical iridectomy can be attempted. Cataract
surgery alone or combined with goniosynechiolysis have been reported with varying success
rates. This approach may be attempted in eyes not amenable to laser iridotomy or surgical
iridectomy, however the risks and benefits should be weighed beforehand.

Genetic counseling: This forms an important tool to educate and inform patients about
higher risk of glaucoma in close relatives and children.

Standard Operating procedure

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