Laser Peripheral Iridotomy

More than 4 decades ago, surgical iridotomy was the best available procedure for eyes with acute angle-closure glaucoma. Since that time, advances in laser technology and laser surgical techniques have allowed laser peripheral iridotomy (LPI) to emerge as the mainstay of treatment for most types of angle-closure glaucoma. Many deserve credit for early work on laser techniques for iridotomy, ^1-5 but 2 major developments have contributed to the current application and efficacy of this method: the development of lasers with good optics, capable of delivering sufficient energy, and the development of a corneal contact lens with a plano-convex button, such as that developed by Robert Abraham (Figure 56-1) or that of James Wise, which improve energy delivery to the iris (Table 56-1).