Clinical Outcomes of Peripheral Iridotomy in Patients with the Spectrum of Chronic Primary Angle Closure

Abstract

Purpose. To evaluate outcomes of peripheral iridotomy (PI) for initial management of primary angle closure suspects (PACS), chronic primary angle closure (CPAC), and chronic primary angle closure glaucoma (CPACG). Patients and Methods. Seventy-nine eyes with PACS, CPAC, or CPACG and better than 20/50 visual acuity that underwent PI as initial management were included. Eyes with previous acute angle closure attacks, laser trabeculoplasties, surgeries, or intraocular injections were excluded. Additional treatments, glaucomatous progression, intraocular pressure, visual acuity, and the number of medications were evaluated. Results. The mean followup was 57.1 ± 29.0 months (range 13.8–150.6 months). Sixty-eight eyes (86.1%) underwent additional medical, laser, or surgical treatment. Forty eyes (50.6%) underwent lens extraction due to reduced visual acuity. The mean 10× logMAR visual acuity score for all patients significantly declined from 0.94 ± 1.12 at baseline to 1.83 ± 3.49 (N = 79, P = 0.0261) at the last followup. Conclusions. Most patients who undergo PI for CPAC spectrum will require additional intervention for either IOP lowering or improvement of visual acuity. This suggests that a procedure that not only deepens the angle but also lowers IOP and improves visual acuity would be desirable as further intervention could be avoided. Evaluation of techniques that achieve all 3 goals is warranted.

Ocular coherence tomography‐measured changes over time in anterior chamber angle and diurnal intraocular pressure after laser iridotomy: IMPACT study

“…It is possible that in both studies, the initial IOP may not have been sufficiently high enough to observe statistically or clinically significant drop in IOP measurements following LPI. However, Cumba et al . report similar findings in their patients (baseline IOP 19.6 ±5.5 mmHg), where no change in IOP was observed at 6 months.…”

Effect of Laser Peripheral Iridotomy on Anterior Chamber Angle Anatomy in Primary Angle Closure Spectrum Eyes

“…However, many studies have agreed that a majority of eyes with LPI will go on to further treatment, and it is unclear how long the effect of LPI will last. 27-29 …”

Management of Primary Angle-Closure Glaucoma

“…Laser peripheral iridotomy (LPI) may be able to open an appositionally closed angle and results in reduction of IOP. [1][2][3][4] However, it may not be effective in opening angles with PAS closure. Laser peripheral iridotomy is in general minimally invasive.…”