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Iridotomy
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Iridotomy

I had an iridotomy done to my right eye eight months ago.

About one hour after the procedure I noticed that my vision was no longer blurred as before, but was gradually fading. After two hours I had the impression a dark curtain was falling down. As the doctor's office was closed, I went to the hospital, where an eye doctor examined my eye. I then was rushed into the operation room and had surgery on my eye. It was only afterwards that I got to know that I had had a complete retinal detachment. Some vision has come back, but not much. I lost my job.
I later learned that in farsighted eyes, which are smaller than eyes with normal vision, an iridotomy shoudn't be done, because the shock waves of the laser can easily cause a retinal detachment because of the smallness of the eye.
Why didn't my doctor know of that risk?
Can I hold him responsible?
There are so many severe risks of iridotomy that it should never be done as a precautious measure.

Maud
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233488_tn?1310696703
You facts are completely wrong. Iridotomies for angle closure glaucoma or in eyes that are at risk for angle closure are almost always farsighted. Probably 99% of laser iridotomies are done on farsighted eyes.

The Yag laser doesn't set up shock waves that spread out like waves. The yag creates a plasma that stops the energy from spreading out.

Retinal detachment is not a recognized risk for laser iridotomy.

It is standard of care to do laser iridotomy for prevention reasons in farsighted eyes at risk.

Since you had occludiable angles you doctors would not have dilated you prior to the iridotomy for fear of causing an attack of  angle closure. Thus you could well have had a retinal detachment in the far periphery that they couldn't see and that progressed after the LPI.

I'm not a lawyer but I think you're going to have a hard time proving you have had anything other than some real bad luck.

JCH III MD
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Thank you very much for your answer.

I went to the eye doctor because I thought I needed glasses for reading.
It was found out that I was farsighted, and I got glasses.
I then had a complete eye examination. The doctor found out that I had a high pressure in my eyes (23/24). He also said that my angles were rather narrow. He then dilated my pupils and examined the retina. He said everything was fine.
He proposed I should have an iridotomy. As I was the last patient that day, the doctor did the iridotomy straight away.
It was done with an Argon laser.

So am I right in assuming that the doctor shouldn't have dilated my pupils?

Anyhow, ten minutes before the iridotomy the doctor said when examining the retina: 'Everything is fine.'
Is it possible that the retina detached during those 10 minutes?

I think it is rather more probable that it detached because of the iridotomy.
I have found quite a lot of studies on the net saying that the waves can cause retinal detachment.
Are they all wrong?
Is the risk smaller with an Yag laser?

Thanks for an anwer
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233488_tn?1310696703
There is a difference between angles being narrow and occludable. It's okay to dilate non-occludable narrow angles. Generally in patients with occludable narrow angles i would not dilate the eye and advise the patient they needed a laser peripheral iridotomy (LPI).

While there may be isolated cases of retinal detachment flollowing LPI I think it far more likely that the RD is already there but not seen because the pupil isn't dilated, then a LPI is done the pupil dilated and then the pre-existing RD is seen.

Also its very difficult to do a LPI with the pupil dilated as the iris is folded and not on stretch. While LPIs can be done with an argon laser most physicians use the yag laser.

This is an important thing for you to understand. If you had argon laser that is a hot laser. It does not set up shock waves the way a yag laser does. It burns holes not blows holes with the localized plasma shock wave.

For LPIs I do not believe that RD is such a well recognized complication that it needs to be part of the informed consent. For Yag laser capsulotomies where the patient has already had cataract surgery it is a well recognized fact that the Yag capsulotomy may increase the risk of RD by .5 to 1% in some (myopic long eyes, young patients).

So to summarize RD is not a common risk for LPI but is for Yag capsulotomy.

In any case You are probably seeing a retina physician now. You may need to see a glaucoma specialist to sort all of this out.

Were you advised to have a LPI on the other eye? In almost all cases occludable angles are bilateral and if one eye needs LPI so does the other. Has the retina doctor commented or dilated the other eye?

JCH III MD

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Avatar_n_tn
Thank you very much indeed for your detailed answer and for taking so much time to write to me.

As I said, the pupil was dilated about 15  minutes before the LPI and the retina was 'fine', as the doctor said. So the RD definitely was not there before the LPI.
So I still see a connection between the LPI and the RD.

As to shock waves, you write:
The Yag laser doesn't set up shock waves that spread out like waves. The yag creates a plasma that stops the energy from spreading out.
On the other hand you write:
It (the Argon laser) does not set up shock waves the way a yag laser does.
So the Yag laser does set up shock waves, whilst the argon laser doesn't, is that right?

Well, having an RD after an LPI is certainly not so very common, but still common enough  to need to be part of the informed consent.
The informed consent I signed didn't mention any complications at all, and that's where my lawyer sees a chance for me to hold the doctor responsible.

Of course I have seen a retinal physician, but he can't help me. The retina was so completely detached that it could only be fixed partially and is not stretching smoothly but is wavery and full of scars. There are some holes that can't be repaired as the retina has become very thin. My vision in that eye is only 9%, it was 100% before the LPI.

Of course I was told I needed a LPI on the other eye, but even the glaucoma specialist to whom I went says he can understand I will never ever have anything done to my eyes again.

With vision in practically only one eye, I will certainly have enormous difficulties in finding a new job, because I am no longer allowed to drive a car nor to work on a computer for more than three hours a day.
So this LPI has literally destroyed my life.
I am 26.

Every doctor should tell his patients that a LPI has many risks, among others RD.
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233488_tn?1310696703
I disagree with you and your lawyer, Since this is in litigation I shall not comment further.

JCH III MD
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