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Related Experiment Video

Updated: Mar 25, 2026

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Peripheral iridotomy for pigmentary glaucoma.

Manuele Michelessi1, Kristina Lindsley

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Peripheral laser iridotomy shows uncertain effectiveness for pigment dispersion syndrome and pigmentary glaucoma. More research is needed on long-term visual function and patient-important outcomes.

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Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Ocular Surgery

Background:

  • Pigmentary glaucoma is a form of open-angle glaucoma linked to pigment dispersion syndrome, where iris pigment disperses and deposits within the eye.
  • Peripheral laser iridotomy aims to equalize intraocular pressure by creating an opening in the iris, potentially reducing pigment dispersion and visual field loss.
  • The efficacy of peripheral laser iridotomy for pigmentary glaucoma and pigment dispersion syndrome remains unclear.

Purpose of the Study:

  • To systematically review the effects of peripheral laser iridotomy compared to other treatments or no treatment for pigment dispersion syndrome and pigmentary glaucoma.

Main Methods:

  • Searched multiple electronic databases (CENTRAL, MEDLINE, EMBASE) and clinical trial registries for randomized controlled trials (RCTs).
  • Included RCTs comparing peripheral laser iridotomy with no treatment or other interventions for pigment dispersion syndrome and pigmentary glaucoma.
  • Assessed trials for risk of bias and extracted data; meta-analysis was not performed due to data variability.

Main Results:

  • Five RCTs (260 eyes) were included, with trials assessed as having high or unclear risk of bias.
  • Evidence regarding the effect of laser iridotomy on visual field progression was uncertain (very low-quality evidence).
  • Intraocular pressure (IOP) reduction was uncertain, and one trial showed increased need for additional IOP-lowering treatment post-iridotomy (very low-quality evidence).
  • Adverse events were generally mild, but some participants required cataract surgery or repeat iridotomy.

Conclusions:

  • There is insufficient high-quality evidence to confirm the effectiveness of peripheral laser iridotomy for pigmentary glaucoma or pigment dispersion syndrome.
  • Long-term effects on visual function and patient-important outcomes are not established.
  • Future research should prioritize patient-centered outcomes and optimal treatment timing across disease stages.