Laser Peripheral Iridoplasty

Argon Laser Peripheral Iridoplasty (ALPI) opens up appositionally-closed portions of the anterior chamber drainage angle with low-power, larger-spot-size, longer-duration laser contraction applications on the far periphery of the iris. The laser applications induce contraction and thinning of the iris stroma, and thereby open up the space between the iris and the trabecular meshwork. ALPI is indicated in primary angle closure disease (PACD), in particular primary angle closure (PAC) and primary angle closure glaucoma (PACG). ALPI is effective and safe in aborting acute angle closure, both primary and certain forms of secondary types. It is also useful in other situations when ocular hypertension is caused by more extensive appositional angle closure. In this chapter, the techniques of ALPI are described. The complications of ALPI, their avoidance and management, are discussed. Surgical tips and pearls in performing ALPI, and how to make ALPI a safe and effective option in the management of angle closure, are presented.