Laser peripheral iridoplasty: procedures and pitfalls

Introduction: Argon laser peripheral iridoplasty (ALPI) is an effective and safe procedure for relieving appositional angle closure. While commonly performed, accurate diagnosis for the indications, and attention to procedural details, would be essential for successful outcome. Areas covered: The article reviewed the indications and contraindications to ALPI and discussed the details and common pitfalls regarding the procedure. Expert opinion: Argon laser peripheral iridoplasty is efficacious in acute primary appositional angle closure, and secondary causes of appositional angle closure such as plateau iris syndrome (PIS), and phacomorphic glaucoma. Its efficacy in chronic angle closure is variable. Contraindications, e.g. flat anterior chamber and synechial angle closure, should be identified. The proper technique, including longer duration, lower laser power settings, larger spot size, and placement of burns over the extreme periphery of the iris, are crucial to the success of the procedure.