Name of the Procedure:

Iridectomy, with corneoscleral or corneal section; peripheral for glaucoma (separate procedure)

Summary

An iridectomy is a surgical procedure performed to remove a small portion of the iris to help alleviate eye pressure. This specific type, a peripheral iridectomy, is typically done for patients with glaucoma to improve fluid drainage and reduce intraocular pressure.

Purpose

Medical Condition:

The procedure addresses primary or secondary angle-closure glaucoma.

Goals:

• To create a new pathway for the drainage of aqueous humor.
• To lower intraocular pressure.
• To prevent the progression of glaucoma and preserve vision.

Indications

Symptoms/Conditions:

• Elevated intraocular pressure not manageable by medication.
• Episodes of acute angle-closure glaucoma.
• Narrow anterior chamber angles identified by an ophthalmologist.

Patient Criteria:

• Patients diagnosed with angle-closure or narrow-angle glaucoma.
• Patients who have not responded to other treatment methods such as medications or laser therapy.

Preparation

• Patients are usually advised to fast for several hours before surgery.
• Medications that thin the blood, such as aspirin or anticoagulants, may need to be adjusted.
• Preoperative eye examinations and imaging tests (e.g., Optical Coherence Tomography) to assess the structures of the eye.

Procedure Description

1. Anesthesia: The procedure is typically performed under local anesthesia, with anesthetic eye drops or injections to numb the eye and sometimes mild sedation to relax the patient.
2. Incision: A small incision is made at the junction of the cornea and sclera (the white of the eye).
3. Iris Removal: Through the incision, a small crescent-shaped piece of the peripheral iris is carefully excised using microsurgical instruments.
4. Drainage Pathway: This creates a new passage for aqueous humor to flow more freely, helping to reduce intraocular pressure.
5. Closure: The incision is closed using very fine sutures, if necessary.

Duration

The procedure typically takes about 30 to 45 minutes to complete.

Setting

The surgery is usually performed in an outpatient surgical center or hospital eye clinic.

Personnel

• Ophthalmic surgeon (a specialist in eye surgery)
• Ophthalmic nurse or assistant
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

Common Risks:

• Mild discomfort or irritation post-procedure.
• Temporary blurred vision. ##### Rare Complications:
• Infection.
• Bleeding inside the eye.
• Increased intraocular pressure.
• Inflammation or swelling.
• Damage to nearby eye structures.

Benefits

• Reduction in intraocular pressure.
• Prevention of optic nerve damage and vision loss.
• Improved drainage of ocular fluids.
• Relief from glaucoma symptoms.

Recovery

• Patients may need to wear an eye patch or shield temporarily.
• Use of prescribed eye drops to prevent infection and control inflammation.
• Avoid strenuous activities or heavy lifting.
• Follow-up appointments within a few days and again after a few weeks to monitor healing and intraocular pressure.
• Full recovery typically occurs within a few weeks.

Alternatives

• Medications: Eye drops or oral medications to reduce intraocular pressure.
• Laser Procedures: Such as laser iridotomy or trabeculoplasty.
• Surgical Alternatives: Trabeculectomy or glaucoma drainage implants. ##### Pros and Cons:
• Medications: Less invasive but may have systemic side effects and may not be sufficient for severe cases.
• Laser Procedures: Minimally invasive but may not be effective for all patients.
• Surgical Alternatives: Potentially more effective for severe glaucoma but involve higher complexity and risks.

Patient Experience

• During: Patients typically feel minimal discomfort due to local anesthesia; they may feel slight pressure.
• After: Expect mild discomfort or irritation, controlled with over-the-counter pain relievers if necessary.
• Pain Management: Prescription eye drops and occasional oral pain medication.
• Comfort Measures: Following postoperative care instructions and attending follow-up appointments for optimal recovery.