We were suitably impressed to read the article entitled “Argon laser iridotomy-induced bullous keratopathy—a growing problem in Japan” by Ang et al,1 advocating a change in management of primary angle-closure glaucoma (PACG). A case of ours follows, illustrating the point that a large dosage of argon laser may be required to create an iridotomy.

In 1993, a 46-year-old woman of East Asian descent presented to another hospital in Sydney, Australia with bilateral acute angle-closure glaucoma. After initial topical and systemic treatment, she underwent bilateral argon laser iridotomies (ALI). Because of her dark irides, this procedure took almost an hour to perform in each eye and was unsuccessful. She then underwent bilateral trabeculectomies, with minimal effect. …