Complications from iridotomy include bleeding, persistent postoperative inflammation, accelerated cataract formation, and lens damage. Retinal tear, postoperative IOP spike, and corneal endothelial damage can also occur. Visual dysphotopsias (glare, streaks, lines, halos) may be present and are thought to result from proximity of the iridotomy to the tear meniscus, which acts as a strong prism. Thus, some clinicians advocate temporal placement of the iridotomy, taking precautions to perform the iridotomy at a distance from the tear film. However, it is unclear whether the location of the iridotomy affects the likelihood of dysphotopsias, and a large prospective study suggests that it does not.
Srinivasan K, Zebardast N, Krishnamurthy P, et al. Comparison of new visual disturbances after superior versus nasal/temporal laser peripheral iridotomy. Ophthalmology. 2018;125(3):345–351.
Vera V, Naqi A, Belovay GW, Varma DK, Ahmed II. Dysphotopsia after temporal versus superior laser peripheral iridotomy: a prospective randomized paired eye trial. Am J Ophthalmol. 2014;157(5):929–935.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.