Selecta
PBL200051, Rev J
114 Professional Use Instructions
Corneal damage
Localized corneal endothelial lesions have been produced above the iridotomy
site in 10%-20% of eyes treated with Nd:YAG laser. These opacities may
interfere with visualization of the iridotomy. In most eyes these opacities clear
within a few days, but occasionally there is a permanent non-progressive small
diameter opacity. The changes do not interfere with visual function. Careful
laser focusing and the lower energy settings may decrease the likelihood of this
problem.
Retinal damage
Nonrhegmatogenous retinal detachment in nanophthalmic eyes and micro-
perforations of the retina have been reported following Nd:YAG iridotomy.
Closure of the iridotomy with time
Closure of iridotomy has been reported in a small percentage of cases weeks or
months after Nd:YAG laser treatments. This closure occurs most frequently in
eyes with chronic uveitis. The closure rate for Nd:YAG laser iridotomies is
much lower than for argon laser iridotomies. In a randomized study reported
in the literature in bilateral primary chronic angle-closure glaucoma, each
patient received treatment in one eye with a Nd:YAG laser and with an argon
laser in the other eye. Within the first postoperative month, 9 of 50 argon
laser treated eyes experienced iridotomy closure, compared to none of the
Nd:YAG laser-treated eyes.
Failure to control glaucoma
Successful iridotomies are not necessarily accompanied by long-term control
of glaucoma, for several possible reasons:
• the eye may have developed peripheral anterior synechiae (PAS)
• the angle may be open but the eye may have residual open angle
glaucoma
• a combination of the above
Patients should be monitored for persistent glaucoma.
Patients at special risk
The following categories of patients are at special risk when undergoing
Nd:YAG laser iridotomy:
• patients with chronic uveitis have an increased tendency towards
both early and late iridotomy closure
• patients with vascularization of the iris or engorgement of iris
vessels are at increased risk of bleeding
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