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How many times the laser iridotomy can be done in your whole life span and can filtration surgery be avoided if laser iridotomy helps ?

Hello, I am a 43 year old male. This is an ophthalmology related question. Two months back I had a severe pain in my right eye and after a few days in my left eye too. I started seeing halos in the evening sometimes in one and sometimes in both eyes accompanied with severe pain. I went to an eye surgeon who on examination told me that I had a high eye pressure of 20 and 29 in my eyes respectively. He further told me that I had narrow angles, but still there was no optic nerve damage done. I was put in the glaucoma suspect category. I was told to put Dorzox eye drops twice (once in the morning and once at night time), one drop in each eye and Lupitros (Travoprost) eye drops once in the night. I started administering these prescribed eye drops but still the seeing of halos and the eye pressure didn’t go down completely. On some days my eye pressure would be 12-12 and on the other day it would be 20-30.I told my doctor regarding this and then he told me to undergo a YAG laser iridotomy which according to him would resolve the issue of the high pressure. The only test he had conducted was a pachymetry test in which the thickness of the cornea was measured which were 494 and 487 microns respectively. I decided to take a second opinion regarding the YAG iridotomy and hence consulted another doctor who is a lady, M.S (Ophthalmology) and a glaucoma specialist in a renowned hospital. She did gonioscopy which showed that my angles were of grade 1&2 (most of them were grade 1). The fundus examination revealed a 0.3 CD ratio and the slit lamp examination of the anterior segment mentioned AC-Shallow. She advised me to undergo a visual field test (Perimetry) and undergo the YAG laser iridotomy. She said that even she does the iridotomy procedure at the hospital, but I somehow wanted to get it done by the previous doctor whom I visited as he was more renowned and of a big stature. I underwent YAG laser iridotomy in both my eyes some 25 days back by the previous male doctor. I was prescribed FML eye drops after the iridotomy which I was told to put for 5 days and then discontinue thereafter. After only two days after the iridotomy, one evening, I started seeing more big halos than before in both my eyes. I immediately rushed to my doctor s clinic while I was seeing the halos to get my eye pressure checked. It was 48 and 37 respectively without any eye pain this time. My doctor was surprised and asked me if I was taking any stress or steroids of any kind. I said stress is only there sometimes and there is no question of taking any steroids by any means. He examined my eyes and said that my openings in the iris from the iridotomy were very much intact and big enough and it seems that I am having some mixed type of Glaucoma,i.e open as well as narrow angle both and hence he told me to undergo trabeculectomy in both eyes, one at a time. This time I was not comfortable and also scared with his idea of undergoing trabeculectomy in both my eyes and hence after two days, I approached the lady doctor again who had examined my eyes before. Here I would like to add that throughout this whole period whenever I had a rise in eye pressure, it was always in the evening only and the seeing of halos accompanied thereafter only. The eye pain would accompany the halos and would be severe at times, but I noticed that it would totally go away immediately after I went to sleep and then when I used to wake up next morning everything would be totally fine till the evening approached. It has been like this throughout.In between these episodes,my vision is perfect. After I approached the Lady Doctor again, she first examined my eyes and said that the iridotomy holes that the previous doctor had made were more than 75% blocked. To confirm it, she clicked the photograph of the iridotomy holes of both eyes and then showed it to me on the computer monitor. I was shocked to see that some white looking fibers had mostly clogged both the holes. I was shocked and angry at the same time because just two days back when I had visited my previous doctor’s clinic with the eye pressure of 48 and 37,he had told me that the holes were quite big and intact, so how could it be that in just a span of two days the holes became 75% blocked? I was highly suspicious regarding his intentions of doing the trabeculectomy surgery on me in both eyes as till now he had only examined my eyes through the slit lamp and had only done the pachymetry test and nothing else. The lady doctor then told me that she will have to re-laser the holes made previously and she asked if my previous doctor had done any eye tests on me apart from the pachymetry test. I answered that only the pachymetry test was performed and nothing else. She was surprised at this and told me that it would be better if I undergo the visual field test (Perimetry) and the OCT (Ocular/Optical coherence tomography test) I gave my approval for both the tests and underwent it. The results of both the tests were encouraging according to the Lady Doctor. She said my visual field test and OCT test both were quite good. The visual field tests showed GHT within normal limits and in the OCT test my RFNL thickness was 107 and 105 respectively, RNFL Symmetry was 84%, Rim Area was 1.46 mm and 1.40 mm respectively, Disc Area was 1.84 mm and 2.05 mm respectively, Average C/D ratio was 0.45 and 0.54 respectively, Vertical C/D Ratio was 0.40 and 0.51 respectively and Cup Volume was 0.052mm and 0.133 mm. In the quadrant section there was only one small yellow colored part while most of them were green colored. She put me on Dorzox drops thrice a day and Alphagan-P drops twice a day and told me to come after two days for re-lasering of the holes. She also advised me to put 2% Pilocar drops one day prior to the laser procedure so that it would be easy to penetrate the Iris. A week back I again underwent the laser procedure, this time by the lady doctor. She performed the procedure and said that everything was fine. She prescribed Zoxan-D eye drops and told me to continue it for 5 days and then discontinue it thereafter and she told me to continue with Dorzox and Alphagan-P as prescribed by her. She has told me to come back for follow up after two weeks to check my eye pressure and condition. It’s been a week now since the re-lasering and I am perfectly Okay till now. Since the re-lasering, I have not experienced any rise in eye pressure and have not seen the halos or experienced any pain. At present I am happy but also worried that for the moment, maybe I have been able to prevent the surgery but am apprehensive about the fact that till how much time will the effect of the re-lasering and the efficacy of the eye drops last? At a later date will I have to undergo a full filtration surgery procedure? My lady doctor had told me that there is no need to worry as millions of people live with glaucoma all over the world happily with proper care and management and I am too young for any eye surgery at the moment. My tests suggest that still my glaucoma (I don’t know whether it is narrow angle or open angle or mixed glaucoma or is it glaucoma at all?) can be controlled without surgery for the moment. I am still very scared about my eye condition and am more scared by the thought of undergoing any filtration surgery as I have heard and read on the internet that there are many complications in filtration surgeries and even if filtration surgeries are successful, it is not guaranteed to work for a life time and that it can fail anytime. There are also long term complications attached with it and sometimes you have to repeat them too. I am very worried about all these things right now. I am also not sure whether I am having glaucoma or not as I am not having any optic nerve damage till now. I don’t know till how much time the good effect of the iridotomy will last? Can it last for 10/15 years and can it be done once again if I have any problems in the future? How many times can the laser iridotomy done in your whole life span? Can I avoid the filtration surgery if the laser iridotomy helps me every time? Please help me. Thank you in advance for your answer and a huge sorry for the big explanation and the questionnaire. Regards.
Asked On : Thu, 16 Jun 2011
Answers:  1 Views:  407
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Ophthalmologist 's  Response
Dear as far as u having glaucoma , one thing is sure that you are a case narrow angle / angle closure glaucoma , the yag PI done in your case is perfectly right , now it is very imp for the PI s to remain patent.usually if done correctly one does not require a repeat PI and also you donot require any medications , if pressures are under control then Yo don't have to worry stall infect just relax and get a yearly Perimetry , and a three monthly IOP check

Dear sir , patency of the PI is dependent upon who has done it, usually if done in good hands it remains patent for life
Answered: Thu, 16 Jun 2011
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