Laser Argon Peripheral Iridotomy
Argon laser peripheral iridoplasty (ALPI) is a laser procedure used to treat acute angle closure glaucoma by opening the anterior chamber angle. It works by placing contraction burns on the outer edges of the iris, causing the iris tissue to shrink and pull away from the angle, which then opens up and allows for better fluid drainage. ALPI is often used when other treatments like laser iridotomy (LPI) are not effective or cannot be performed.
Laser Argon Peripheral Iridotomy
How ALPI Works:
Contraction Burns: The argon laser creates small, precise burns on the outer edges of the iris.
Iris Shrinkage: The heat from the laser causes the iris tissue to contract and shrink.
Angle Opening: This shrinkage pulls the iris away from the angle, opening up the space and improving fluid flow.
When ALPI is Used:
Acute Angle Closure Attacks:
ALPI is particularly helpful in reversing an acute angle closure attack, either as a primary treatment or when medical therapy is not effective.
Ineffective LPI:
If LPI alone does not eliminate pupillary block or the angle remains closed despite iridotomy, ALPI can be used to help open the angle.
Other Causes of Angle Closure:
ALPI can be used when angle closure is due to mechanisms other than pupillary block, such as plateau iris, lens-induced angle closure, or other conditions.
Procedure:
Direct Technique:
Laser energy is directed through a lens to the peripheral iris.
Indirect Technique:
Laser energy is directed through a single-mirror lens at an angle to the peripheral iris.
Contraction Burns:
Long duration, low-power, and large spot size laser burns are placed on the extreme iris periphery.
Post-Procedure:
Post-operative care includes medication to control inflammation and monitor intraocular pressure.
Benefits of ALPI:
Effective: ALPI can effectively open a closed angle and lower intraocular pressure.
Surgical Alternative: ALPI is a non-surgical procedure, offering an alternative to surgery for some cases of angle closure.
Versatile: ALPI can be used in various situations, including acute angle closure attacks, Plateau Iris Syndrome, and other causes of angle closure.
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