How do you decide where to place the LPI for angle-closure glaucoma?  

For narrow angles, I place it somewhere in the inferotemporal iris in a crypt. I do not use an Argon laser. With the YAG laser at 7 mJ (though different lasers may be more or less). Offset at +250 and only one burst, I can typically get through with 2-4 shots in most irides unless there is absolutel...

After having done hundreds of LPIs, I find that placing them into a thin spot in the iris (an iris crypt) is best. I avoid most bleeding and use the fewest number of laser bursts. The discussion over placing the LPI above the superior tear margin is OK, but to avoid using 10-20 bursts just to get a ...

If the patient is in true angle closure and not able to be broken with medical management, the LPI should be placed wherever it can be reasonably placed. I have found angle closure LPIs to be very challenging since there is such little anterior chamber depth and the pigment and bleeding that occurs ...

To determine where to place a routine (not emergent) LPI, I consider the upper lid position while also trying to utilize the nearest crypt. With the patient’s eye topically anesthetized, I ask them to look down briefly before I have them look straight ahead. At that point, I estimate MRD1. If ...

I avoid superior as this has been associated with glare, and used to do them in a crypt slightly inferotemporal, however I have found that some LPIs result in zonular weakness. Temporal zonular weakness is less preferable during cataract surgery, so I have switched to doing LPIs slightly inferonasal...

In acute ACG, where the cornea can have edema and the AC is extremely shallow, trying to make an LPI with the YAG laser is very difficult and can cause some endothelial damage. In this scenario, I perform peripheral Argon (or Diode) laser iridoplasty to contract and pull the peripheral iris out of t...

LPIs are always placed supratemporal in the affected eye when I do them. They are consistently placed and thus easy to see and find. Also, you avoid any optical effect from the exposed LPI. I do avoid the 12 o’clock position, as sometimes the gas bubble (CO2) can obstruct the newly formed hole...

In an angle closure attack, on rare occasions, I cannot break through due to corneal edema. Sometimes the central cornea is still clear, and so I take an argon laser, or the diode equivalent, with moderate energy and a 200 µm spot and make two or three thermal burns to the Iris near the sphinc...