Name of the Procedure:

Iridotomy by stab incision (separate procedure); except transfixion

Summary

An iridotomy by stab incision is a medical procedure where a small opening is created in the iris (the colored part of the eye) using a fine incision. This is typically done to relieve intraocular pressure in certain eye conditions.

Purpose

This procedure is mainly used to treat and manage specific eye conditions that cause elevated intraocular pressure, such as angle-closure glaucoma. The goal is to create a new pathway for fluid (aqueous humor) to flow, in order to balance the pressure inside the eye and prevent damage to the optic nerve.

Indications

• Acute angle-closure glaucoma
• Chronic angle-closure glaucoma
• Patients experiencing symptoms like sudden eye pain, blurred vision, halo around lights, or nausea.
• Patients who are at risk of angle-closure glaucoma based on their eye anatomy.

Preparation

• The patient may need to stop certain medications or adjust them as per the doctor's instructions.
• Fasting is generally not required for this procedure.
• Pre-procedure eye drops may be administered to prepare the eye.
• Comprehensive eye examination and measurement of intraocular pressure will be conducted.

Procedure Description

1. The procedure begins with the administration of numbing eye drops to ensure the patient's comfort.
2. The surgeon uses a surgical microscope to get a detailed view of the eye.
3. A fine, sharp instrument is used to make a small incision in the iris.
4. The incision creates a new drainage pathway for the aqueous humor to flow, alleviating intraocular pressure.
5. Additional eye drops may be administered to prevent infection and inflammation.

Duration

The procedure typically takes about 10 to 20 minutes.

Setting

Iridotomy by stab incision is usually performed in an outpatient clinic or an ophthalmologic surgical center.

Personnel

• Ophthalmologist (eye surgeon)
• Assistant or nurse
• Possible presence of an anesthesia provider if sedation is needed

Risks and Complications

• Common risks: mild pain, temporary blurred vision, minor bleeding inside the eye.
• Rare risks: infection, significant bleeding, increased intraocular pressure, damage to the lens, glare or double vision.
• Management: Follow-up visits to monitor healing and intraocular pressure, using prescribed eye drops to control inflammation and prevent infection.

Benefits

• Reduces intraocular pressure effectively.
• Prevents acute attacks and further damage to the optic nerve.
• Relief from symptoms like pain and blurred vision.
• Benefits can usually be noticed shortly after the procedure.

Recovery

• Post-procedure, the patient may need to use anti-inflammatory and antibiotic eye drops for a few days.
• Avoid strenuous activities and bending over for a week.
• Normal activities can usually be resumed within a day or two.
• Follow-up appointments are necessary to monitor intraocular pressure and ensure proper healing.

Alternatives

• Laser iridotomy: A non-invasive method using laser to create the opening in the iris.
  • Pros: No incision, less risk of infection.
  • Cons: May not be suitable for all patients, potential for laser burns.
• Medication management: Use of eye drops and oral medications to control intraocular pressure.
  • Pros: Non-invasive.
  • Cons: May not be sufficient alone, long-term management needed.

Patient Experience

During the procedure, the patient will be awake but should feel no pain due to numbing drops. There may be slight pressure or discomfort. Post-procedure, mild pain or irritation is typical, but can be managed with prescribed medications. Blurred vision and sensitivity to light may occur temporarily but should resolve within a few days. It is important to follow post-procedure care instructions and attend all follow-up appointments for optimal recovery.