INFORMED CONSENT FOR LASER IRIDECTOMY

You are under a risk of acute glaucoma by closure of the angle between the iris and cornea. Your ophthalmologist proposes a laser treatment for your condition.

This document contains the information about the reasons, conditions, results, risks and limitations of the proposed medical act.

WHY LASER THERAPY?

The angle between the cornea and iris is the place where the liquid produced in the eye is evacuated. If this angle is closed, this liquid is not drained properly and the pressure inside the eye increases so high that the fibres of the optic nerve are crushed. This incident may occur in some hours of time. Pain and loss of vision, often irreversible and sometimes an anatomical disorganisation of the eye may follow.

The laser iridectomy is the most appropriate way to prevent this situation.

THE LASER TREATMENT

The laser beam uses a light capable of carrying a large amount of energy that will be delivered in a specific location of the iris in order to create the hole that will widen the angle.

The session is performed on an outpatient basis. Anaesthesia of the eye is obtained by the instillation of anaesthetic drops. The patient sits in front of the laser engine. Laser impacts are applied through a lens placed on the eye. The whole procedure time does not exceed 10 minutes per session. It is painless.

The treatment is carried out in 1 or 2 sessions spaced by several days to several weeks.

USUAL COURSE

In the vast majority of cases, treatment is well tolerated and you will leave immediately after treatment and resume your usual activities.

The eye care is reduced to the instillation of drops and / or taking pills as will be indicated by your ophthalmologist.

In most cases, a durable or permanent opening of the angle is achieved. The success rate is very high.

Control will be necessary at a date to be proposed by your ophthalmologist.

COMPLICATIONS OF THE TREATMENT

The non serious complications are:

* Glare, due to the laser session itself, will be felt throughout the examination.
* Conjunctival bleeding due to the contact lens: rare, benign, disappears in few days.
* Arterial hypotension may occur in susceptible individuals. It will quickly disappear when lying down.
* Irritation of the cornea (superficial keratitis): It is a rare hazard, occurring in less than 1% of the cases.
Promptly treated, it cures generally in 24 to 72 hours.
* Moderate elevation of the eye pressure: it is frequent and systematically preventively treated.
* Iris bleeding: It is a very frequent, unpredictable, always transient, hazard. It may cause a visual veil during a few hours.

These incidents are of no concern. If you are prone to arterial hypotension, please report it to your ophthalmologist in writing it at the bottom of this document.

Severe complications of this type of laser photocoagulation are so exceptional that they are not quantifiable.
* Severe elevation of the eye pressure: rare, may cause blurry vision, eye pain, headache. If treated promptly, within the hours of the beginning of the symptoms, it resolves rapidly without sequels.

* Macular oedema: It is a distant reaction to laser impacts that leads to the accumulation of water in the centre of the retina, responsible of a loss of details vision, lasting a few weeks to several months, sometimes permanently.
Although rare, it is systematically preventively treated.

* Retinal detachment. It is a very rare and unpredictable distant reaction to the impacts. It requires delicate surgery of replacement of the retina.

* Misplaced impact, reaching the middle of the centre of the crystalline lens or the retina. This incident can permanently reduce detail vision. It is extremely rare and occurs in restless, undisciplined patients who do not control their eye movements and their bodies. To avoid this, you are asked to keep the most calm and compliance during this examination.

LIMITATIONS OF TREATMENT

This treatment is less effective if the irido-corneal angle is scarred due to previous crises of angle closure that can sometimes go unnoticed.

Like any living tissue, the irido-corneal angle can react in a variable way, immediately, months or years, after the treatment. This treatment can not therefore claim to prevent, neither categorically nor permanently increases intraocular pressure in the longer term, especially if other causes of ocular hypertension (vitreous or lens swelling, trabecular meshwork resistance etc.), are involved

Laser iridectomy does not preclude the use of eye drops nor surgery in the management of glaucoma.

PRECAUTIONS TO BE TAKEN

During pregnancy, no complications due to eye laser treatments have been reported to the mother neither to the child to be born.

YOU SHOULD CONTACT YOUR OPHTHALMOLOGIST IMMEDIATELY IN CASE OF

  • Pain, severe sensitivity to light, redness, tearing, secretions, swelling of the eyes or eyelids
  • Sharp decrease of the vision.
  • Perception of floaters with flashes of lightning, a black rain or a motionless large dark spot.
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