After the LPI

This module reviews terminology and indications for peripheral iridotomy (PI) briefly, and then focuses on management of the patient whose angles remain narrow despite a successful PI. The mechanisms that cause this are explored, following by treatments for each. Particular attention is paid to lens-based surgery and ancillary techniques including phacoemulsification, goniosynechialysis, iridoplasty and endocycloplasty. Management of specific challenges encountered during lens removal for angle closure are discussed, including low endothelial cell counts, zonulopathy and intraoperative malignant glaucoma. Illustrative cases and discussion are used to elucidate and reinforce the clinical approach to treatment decisions in angle closure after successful PI.

Learning objectives

At the end of this session, participants will be able to:

  • Review mechanisms that cause angles to remain narrow despite a PI
  • Discuss modifications to their pace technique to allow safe lens removal as a treatment for angle closure related to lens rise
  • Recognize comorbidities that can complicate lens removal including endothelial decompensation and zonulopathy
  • Review and discuss the role of iridoplasty and endocycloplasty as a treatment for angle closure related to plateau iris syndrome
  • Discuss the role of goniosynechialysis to address synechial angle closure
  • Review the presentation and management of malignant glaucoma, both intraoperative and postoperative

CPD credits

This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification program of the Royal College of Physicians and Surgeons of Canada, and approved by the Canadian Ophthalmological Society. Physicians may claim a maximum of 1.5 Section 1 credits.

Through an agreement between the Royal College of Physicians and Surgeons of Canada and the American Medical Association, physicians may convert Royal College MOC credits to AMA PRA Category 1 credits. Information on the process to convert Royal College MOC credit to AMA credit.

Physicians should only claim credit commensurate with the extent of their participation in the learning activity.

INSIGHT was co-developed with Allergan and was planned to achieve scientific integrity, objectivity, and balance. The use of the partner logo is ethically permissible.