Sequential use of argon and ND:YAG lasers to produce an iridotomy--a pilot study

A two-step technique for laser iridotomy in difficult irides is described. The method utilizes the argon and ND:YAG lasers sequentially. Sixteen eyes were treated by two argon stretch burns and up to 35 penetrating burns that produced an iridotomy that was either imperforate or inadequate. The ND:YAG laser was then used to complete the iridotomy. In all 16 eyes an iridotomy was achieved in one session. Only two eyes had a moderate increase in pressure that was easily controlled. There were no other significant complications. Total energy levels for each laser modality were significantly lower than those previously reported using either laser alone. The sequential technique is safe and effective and is recommended for iridotomy in difficult iris types.