Use of laser iridoplasty in iris incarceration of a glaucoma drainage device

PURPOSETo describe the use of laser iridoplasty to release iris incarceration occluding a glaucoma drainage device. OBSERVATIONSA 46-year-old male with uncontrolled type 1 diabetes mellitus presented with neovascular glaucoma and subsequently had a glaucoma drainage device implanted for control of intraocular pressure. One month post-operatively, he presented with a significantly elevated intraocular pressure, thought to be due to poor drainage from iris incarceration in the device. He had recently developed a vitreous hemorrhage and hyphema, and he had florid neovascularization of the iris, thus raising concern that traditional neodymium:yttrium-aluminum-garnet (Nd:YAG) iridotomy would promote re-formation of the hyphema. Thus, a diode solid-state laser iridoplasty was performed around the site of incarceration, resulting in successful release of the iris from the device without hyphema formation. CONCLUSIONS AND IMPORTANCEGlaucoma drainage devices are effective tools to help control intraocular pressure. However, they risk post-operative complications, such as iris incarceration within the device, that prevents them from functioning properly. In such cases, Nd:YAG laser iridotomy is often used around the site of incarceration, thus releasing it from the device. In this case report, we describe how diode solid-state laser can be used to release the iris incarceration via iridoplasty. Such iridoplasty may result in a decreased likelihood of hyphema formation as compared to Nd:YAG iridotomy, so this provides a superior alternative in patients with a propensity for developing a hyphema, such as in patients with iris neovascularization.