Laser iridotomy in dark irides

Background: Laser iridotomy is the established treatment for angle-closure glaucoma. Nd:YAG (neodymium: yttrium–aluminium–garnet) laser iridotomy is challenging in the heavily pigmented irides of African and Asian patients, Aim: To present a modified laser iridotomy technique for use in dark irides. Methods: The argon laser was applied in two stages: firstly, low-power argon was applied, which created a circular area of pitted iris stroma in the superior iris. High-power argon was then applied in the same area to form a punched-out crater at the level of the radial muscle fibres. The iridotomy was then completed with low-energy YAG laser. Results: 15 eyes of 8 consecutive patients who underwent successful combined argon–YAG laser iridotomy using low levels of YAG energy in dark irides is presented. The combined technique avoids common issues associated with the use of pure YAG laser, including high energy levels and a high risk of iris haemorrhage. Conclusions: Combined two-stage argon and YAG laser is an effective technique in the treatment of angle-closure glaucoma of dark irides of African and Asian patients. The technique is more effective and has reduced complications in comparison to pure argon or YAG laser techniques.