Laser peripheral iridotomy induced changes in eyes with primary angle closure disease

Primary angle closure disease (PACD) though less prevalent than primary open angle glaucoma contributes to fifty percent of glaucoma blindness, particularly in the Asian population. Pupillary block is the most common pathology associated with PACD. The definitive treatment to relieve pupillary block and to prevent disease progression is laser peripheral iridotomy (LPI). The most commonly employed laser for performing laser peripheral iridotomy is Neodymium: Yttrium Aluminium Garnet (Nd:YAG). LPI is routinely performed as an outpatient procedure. Though it is often considered as a safe procedure, it is not without limitations. Apart from widening the angle it can influence the intraocular pressure, corneal endothelial cells and can lead to newer visual disturbances/dysphotopsias. Additionally, it can cause or accelerate cataract formation. This narrative review discusses the indications, procedural considerations, structural and functional outcomes, and the changes associated with LPI in eyes with PACD.