iridoplasty

Iridoplasty is a surgical procedure that modifies iris tissue to treat conditions affecting the anterior chamber of the eye, most notably angle-closure glaucoma. The term most often refers to laser peripheral iridoplasty, in which laser energy is applied to the peripheral iris to alter its configuration.

The mechanism involves thinning and contraction of the iris stroma at the iris circumference. By creating controlled burns or indentations, the iris is pulled away from the trabecular meshwork, widening the anterior chamber angle and reducing pupillary block. This makes aqueous humor outflow easier and can help lower intraocular pressure in susceptible eyes.

Indications include narrow or closed iridocorneal angles, plateau iris configuration, and recurrent or persistent angle-closure where laser peripheral iridotomy alone is insufficient or not feasible. It is often considered as an adjunct to other glaucoma therapies or after an acute angle-closure episode to prevent future attacks.

The procedure is usually performed under local anesthesia with topical anesthesia supporting patient comfort. Laser iridoplasty typically involves applying multiple laser spots around the peripheral iris, often in several clock hours, to create angle-opening indentations. Postoperative care may include anti-inflammatory and IOP-lowering medications, with follow-up to monitor iris changes and intraocular pressure.

Risks are generally low but can include transient inflammation, IOP spikes, corneal or iris burns, iris notching or distortion, hyphema, or pigment dispersion. Iridoplasty offers an option to widen the angle and reduce glaucoma risk in selected patients, particularly when other treatments are inadequate or unsuitable.