YAG Laser Iridotomy Complications

I informed my doctors that, in many cases, the positioning of the hole is temporal, as you mentioned. However, right after that, she informed me that it would be very bad. During my next visit, I plan to ask her why. Many specialists even advise selecting the right position based on individual anatomy, preferably at the 3 and 9 temporal positions, as far away from the eyelids as possible (source: MD Roundtable: Iridotomy Decisions for the Narrow Angle.) Dr. Asrani's last comment supports the same viewpoint.
- Please search it online as I am not eligible to post links as I am newly registered -

I was surprised when my doctor had never heard of such a side effect. Nonetheless, after conducting a comprehensive online search, it seemed that the McCannel structure could be a solution for me (source: McCannel Suture Technique Resolves Persistent Dysphotopsia Following Laser Peripheral Iridotomy in Phakic Eyes). However I don't have Phakic Eyes but these patients have their original lenses just I have.

My doctor informed me that she sutures the iris quite frequently. In my case, there are two options. One involves potential damage to my lenses from the suturing process, necessitating the replacement of my original lenses with intraocular lenses (artificial). (I am too young for this)The other option may involve reaching the hole from the outside, but this is considered very challenging. Since the McCannel suture is a US invention, it is more likely available there than here. Many doctors refer to this technique in cases similar to mine. I also came across an individual whose hole was successfully sutured; however, it didn't help much because his eyes were blue. Fortunately, I have brown eyes.

On a side note, my glaucoma was well-treated with two types of eyedrops. In 2022, my eyes were dilated, and nothing went wrong. However, I underwent two laser procedures since then to eliminate the need for any eye drops. The first procedure, SLT, was successful, allowing me to discontinue one eye drop. The second, femtosecond laser trabeculectomy, is still in the research phase and is only available in my country. God knows but may be these procedures affected my angles. The first was successful, but the second had no beneficial effect. I was told that I was the 1 in 1000 case where the procedure did not work as expected. 🙁

I am not in a rush as some doctor advice it would be better and it resolves on there own. However based on the comments on internet I am very sceptical. Of course I will try more contact lenses and see how improve my quality of my life.

Anyway, I really appreciate your effort to convey my message to your GS. Let's see if she has any suggestion.

I informed my doctors that, in many cases, the positioning of the hole is temporal, as you mentioned. However, right after that, she informed me that it would be very bad. During my next visit, I plan to ask her why. Many specialists even advise selecting the right position based on individual anatomy, preferably at the 3 and 9 temporal positions, as far away from the eyelids as possible (source: MD Roundtable: Iridotomy Decisions for the Narrow Angle.) Dr. Asrani's last comment supports the same viewpoint.
- Please search it online as I am not eligible to post links as I am newly registered -

I was surprised when my doctor had never heard of such a side effect. Nonetheless, after conducting a comprehensive online search, it seemed that the McCannel structure could be a solution for me (source: McCannel Suture Technique Resolves Persistent Dysphotopsia Following Laser Peripheral Iridotomy in Phakic Eyes). However I don't have Phakic Eyes but these patients have their original lenses just I have.

My doctor informed me that she sutures the iris quite frequently. In my case, there are two options. One involves potential damage to my lenses from the suturing process, necessitating the replacement of my original lenses with intraocular lenses (artificial). (I am too young for this)The other option may involve reaching the hole from the outside, but this is considered very challenging. Since the McCannel suture is a US invention, it is more likely available there than here. Many doctors refer to this technique in cases similar to mine. I also came across an individual whose hole was successfully sutured; however, it didn't help much because his eyes were blue. Fortunately, I have brown eyes.

On a side note, my glaucoma was well-treated with two types of eyedrops. In 2022, my eyes were dilated, and nothing went wrong. However, I underwent two laser procedures since then to eliminate the need for any eye drops. The first procedure, SLT, was successful, allowing me to discontinue one eye drop. The second, femtosecond laser trabeculectomy, is still in the research phase and is only available in my country. God knows but may be these procedures affected my angles. The first was successful, but the second had no beneficial effect. I was told that I was the 1 in 1000 case where the procedure did not work as expected. 🙁

I am not in a rush as some doctor advice it would be better and it resolves on there own. However based on the comments on internet I am very sceptical. Of course I will try more contact lenses and see how improve my quality of my life.

Anyway, I really appreciate your effort to convey my message to your GS. Let's see if she has any suggestion.

I read every article imaginable before I decided not to have the iridotomy, but yours was an emergency unfortunately.
I looked on Youtube and found the procedure being done by a Dr. Rami Shasha, a renowned Ophthalmologist. He seems to work in the US and Canada. I looked to see where he worked, but could not find a specific hospital.
I checked Linkedin and found him.
Rami Shasha
Ophthalmologist
Grey Bruce Health Services
Owen Sound, Ontario, Canada
Perhaps you can contact him and find out if he still does the procedure and where?
Here is the contact number from Linkedin.

You'll have to get on Linkedin, to contact him
linkedin.com/in/rami-shasha-8010ba42

Please let me know if you can find out where he does the McCannel Suture technique.

I read every article imaginable before I decided not to have the iridotomy, but yours was an emergency unfortunately.
I looked on Youtube and found the procedure being done by a Dr. Rami Shasha, a renowned Ophthalmologist. He seems to work in the US and Canada. I looked to see where he worked, but could not find a specific hospital.
I checked Linkedin and found him.
Rami Shasha
Ophthalmologist
Grey Bruce Health Services
Owen Sound, Ontario, Canada
Perhaps you can contact him and find out if he still does the procedure and where?
Here is the contact number from Linkedin.

You'll have to get on Linkedin, to contact him
linkedin.com/in/rami-shasha-8010ba42

Please let me know if you can find out where he does the McCannel Suture technique.

How is your eye? Did you get to see the main ophthalmologist or is your regular MD helping? Hope it's better

I'm scheduled for an iridotomy in May, no elevated eye pressures ever. Went to get eyeglasses in Dec '22 and was diagnosed with narrow angles, was told to see an opthamologist in one month. I've been full of anxiety about going blind since then.

I went to see an opthalmologist one month later and only had the gonioscopy done, pressures were normal. MD diagnosed me with Chronic closed narrow angle glaucoma. I asked him why the diagnosis, and he told me to read the glaucoma pamphlet. Asked him why he didn't check my optic nerve or visual fields, do an OCT scan? He said my eyes needed to be dilated for these tests, but I had researched this and eyes do not need to be dilated for a comprehensive exam to rule out glaucoma. While I was in the office, he scheduled me for an iridotomy in 2 weeks?

I was suspicious about the diagnosis and why I didn't have a comprehensive exam with him, I let him know via phone, he then referred me to a glaucoma specialist. I went one month later, (hard to get an appointment). All tests were done, optic nerve was perfect, peripheral vision was normal, OCT scan normal. My narrow angles measured about the same (mild, according to one chart I found )? The glaucoma specialist changed my diagnosis to narrow angles. Said I did not have glaucoma and was confused about the diagnosis. She gave me 2 to 3 months to schedule the LPI, but said the majority of people with my anatomical narrow angles, no glaucoma never have acute attacks, but suggested I have the iridotomy at the 9 o'clock position on the left eye. My eyes are light brown! Will it be noticeable? She said she read a lot of research about less side effects post with the 9 o'clock position. I have a call in for her to return to find out how many patients she's done the laser on at the 9 o'clock position, side effects, and about my daily stress headaches for 23 years, also other things that I didn't mention.

My vision has not decreased, been wearing glasses since a child only inside. I've had a bad astigmatism in left eye since I was 7 years old. Of course I'm nearsighted and the farsighted came with age.

I'm planning on getting a third opinion, have not chosen an opthalmologist specialist yet, since I don't need a glaucoma specialist anymore, hopefully it will be soon.

I'm so nervous about this whole thing, I can't live with side effects from the iridotomy due to my stress level. I work from home every day. I want my life to be normal. I know the devastating effects of angle closure and DO NOT want to go blind or be miserable the rest of my life.

These posts, mostly from 2016 have been mostly helpful, but got progressively more disheartening as they went on due to side effects post LPI. I don't think I have a choice 🙁

Any newer experiences with post laser iridotomies, positioning of the laser shots, especially the 9 o'clock position, and side effects would be greatly appreciated.

I do live in US. I have thick corneas so pressure runs 19 at the lowest. They do all the testing every 6 months. No glaucoma. My right pupil is large after surgery and he tried restriction drops 2x that temporarily made it a little smaller. He said he’d never seen this with surgery, only with trauma. 300 laser zaps sounds like trauma to me. Eye is so blurry and tender. It aches. Even when I blink.

Hi everyone! I'm writing this to help add to the body of information available on this topic. A month ago, my optometrist identified narrow angles in both of my eyes. She then gave me a referral for an ophthalmologist who specializes in glaucoma. The doctor confirmed narrow angles and informed me that as I have a very narrow-angle PLUS mild cataracts (diagnosed at 39; I'm now 42) which will continue to grow and push my iris and cornea even closer together, an LPI is the best course of action. I then spent about two weeks doing my own research (which brought me here) and just generally spiraling due to the many horror stories and imperfect science that is narrow angles and LPI. I had my procedure in late March of this year. Everything was fine and my IOP didn't spike afterwards. The first day without the drops, I was still fine. Then day two I woke up with painful light sensitivity. I went to the doctor's office and was informed that not only was my iris inflammed but my iridotomy hole had apparently closed up in a record 6 days (possibly less). Needless to say I was NOT happy and seriously questioned my doctor and the care that I had received, even though he has all the top credentials. After meeting with him again for a follow-up, going back on prednisolone 1%, and being prescribed a more aggressive preventative routine and strategy going forward, I decided to get the revision done. Mostly because this whole situation is seriously stressing me out and putting my life on hold. In other words, unsustainable. I had the revision and it hurt much more afterwards this time, but took a lot fewer 'shots'. I have very dark irides and it took 117 shots the first time. Advil resolved my pain within 30 minutes and so far I haven't need more. I'm currently on day two of an aggressive course of prednisolone and cosopt. No pain, but I do have a bit of visual disturbance (halos) when I look at recessed ceiling lights but so far no other issues. I'm hoping this minor light issue will go away in a few weeks. Baring no other complications, I will have the second eye done in a couple of weeks.