| Nature of Enquiry | Laser iridotomy for angle-closure gcuolama may close in the early period after the laser is performed, but can easily be opened up. In a few patients, late closure occurs, and is also easily opened. In ALT for open-angle gcuolama, about 90% of patients get an initial response and 80% have a response at the end of one year. The procedure wears off at a rate of approximately 10% per year, so that somewhat less than half of patients treated are still under control at the end of five years. However, this certainly is a long enough period of time to make it worthwhile undergoing the procedure.The trabecular meshwork runs circumferentially around the eye for 360 degrees. Many ophthalmologists treat 180 degrees, using 50 spots, and if the pressure comes under control, stop at that point. Then, if and when the initial treatment wears off, the second 180 degrees can be similarly treated. Some ophthalmologists believe in treating the entire 360 degrees initially. Repeat ALT, in which an additional treatment superimposed upon the first area of treatment is applied, has been advocated. I very rarely do this. Many patients can get a rise in IOP instead of a lowering. If the initial treatment of 360 degrees (whether performed in one session or two sessions) is insufficient or the effect wears off, I feel that the next step should be surgical intervention. |