Immediate Changes in Intraocular Pressure after Laser Peripheral Iridotomy in Primary Angle-Closure Suspects

Jiang, Yuzhen; Chang, Dolly S.; Foster, Paul J.; He, Mingguang; Huang, Shengsong; Aung, Tin; Friedman, David S.

doi:10.1016/j.ophtha.2011.08.014

Cited by 47 publications

(40 citation statements)

References 28 publications

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“…Known complications of LPI include immediate IOP rise, 15 bleeding, 16 marked inflammation, 17 visual shadows, ghost images, crescents, lines, 18 cataract progression, 19 lens dislocation, 20 and other lens-related and cornea-related pathologies, including corneal decompensation. [21][22][23][24][25][26] Performing LPIs on 2 separate visits could possibly reduce the rate of complications occurring in both eyes simultaneously.…”

Section: Discussionmentioning

confidence: 99%

“…The rate of complications is comparable with, or lower than, the rate reported in other prospective studies. 15,16,28 A screening program for angle closure in Mongolia offered bilateral LPIs to patients with confirmed diagnosis. Treatment outcomes were excellent, with 98% of treated eyes showing angle deepening 29 ; however, the reports do not specify how many patients were actually treated using this strategy and what was the complication rate associated with this treatment.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project

Waisbourd

Delvadia

Sembhi

et al. 2016

Journal of Glaucoma

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project

Waisbourd

Delvadia

Sembhi

et al. 2016

Journal of Glaucoma

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“…A frequent complication of LPI is the spike that occurs about 10% to 20% in PACS 47 and up to 30% in PAC or PACG. 48 This rise is usually transient and has not been associated with documented damage.…”

Section: Complications Of Initial Lpi and Trabeculectomymentioning

confidence: 99%

Initial Treatment for Primary Angle-Closure Glaucoma in China

Liang

Wang

Rong

et al. 2015

Journal of Glaucoma

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China has a large burden of primary angle-closure glaucoma (PACG) and the approach to treatment is different from that in most parts of the world. In China, trabeculectomy is a mainstay of initial treatment for PACG and laser peripheral iridotomy is reserved for PAC and PACG with peripheral angle synechiae ≤180 degrees. The greater reduction of and more stable IOP, lower frequency of acute angle closure, decreased progression of peripheral anterior synechia and glaucoma, and the reduction of ocular complications associated with long-term use of glaucoma medications support the use of initial trabeculectomy in PACG without significant lens opacities. Further study is required to determine the indications and effectiveness of initial trabeculectomy for PACG in a developing country setting.

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“…Fortunately, it is often self-limiting and stops with gentle pressure on the eye applied with the contact lens. 17,18 The most common complication after an LPI is postlaser IOP elevation, the incidence of which varies from 5.7 % to 40 % depending on the definition of an IOP spike. A pressure spike usually occurs within the first 1 hour after LPI.…”

Section: Complicationsmentioning

confidence: 99%

“…Of the 734 eyes, 9.8 % had an IOP spike of >8 mmHg, and only 0.54 % had an IOP >30 mmHg after 1 hour; 0.82 % continued to have raised IOP at 2 weeks. 18 Pre-and/or posttreatment with brimonidine 0.2 % or apraclonidine 0.5 % is helpful in preventing IOP spikes. 19 Care must be provided for patients with advanced PACG as pressure spikes may be severe and prolonged, causing further vision loss in a compromised nerve.…”

Section: Complicationsmentioning

confidence: 99%

Lasers in Primary Angle Closure

Chee¹,

Srinivasan²,

Cheng³

2015

US Ophthalmic Review

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Glaucoma Touch MEdical MEdia 99 Glaucoma is a leading cause of blindness worldwide. 1 Broadly speaking, there are two types of glaucoma: open angle and angle closure. Unlike open angle where the angle between the iris and cornea is open, angleclosure glaucoma is an optic neuropathy secondary to raised intraocular pressure (IOP) due to the closure of the drainage angle. Worldwide, the mean prevalence of angle closure glaucoma is 0.69 %, and 86 % of those affected were from Asia. 1 Although angle closure is less common, it is potentially more blinding, though early intervention could prevent progression of disease. Patients with acute angle closure often present with acute red painful eye but symptoms of chronic angle closure are often silent. Angle closure is classified according to gonioscopy findings, IOP, and optic nerve damage (see Table 1). Laser in angle closure has been used since the 1970s, and its application had expanded and evolved over the years. 2 This article reviews the type of lasers used in primary angle closure glaucoma (PACG), their efficacy, and complications. Laser Peripheral Iridotomy Indications and EfficacyLaser peripheral iridotomy (LPI) is a treatment that creates an opening in the peripheral iris to allow an alternative pathway for aqueous to flow between the anterior and posterior chamber, bypassing the pupil. This eliminates the element of pupil block, which is the most common contributing factor to angle closure in PACG. 3 There are many other factors that contribute to the narrowing of the drainage angle, which includes lens vault, cataract, axial length, iris root thickness, and plateau iris configuration. 4 LPI is indicated in acute ACG (AACG), in the fellow eye of AACG, PAC suspects (PACS), PAC, and PACG (see Table 1). There is some evidence that LPI can be helpful in phacomorphic glaucoma and pigment dispersion syndrome. 3The effectiveness of LPI in preventing glaucoma, controlling IOP, and improving angle width, varies according to severity of disease at presentation as well as mechanism underlying angle closure. LPI is successful in preventing acute PAC (APAC) in the fellow eye of patients who had APAC. When followed up over 4 years, none of the fellow eyes treated with LPI developed APAC while only 11.2 % of cases had an increase in IOP during follow-up, which required additional medical or surgical intervention. 5 LPI can also be useful in controlling IOP and angle width. 5,6 The Liwan Eye study in China reported a mean IOP reduction of 3 mmHg and increase in anterior chamber angle width of 2 units in Shaffer angle grade, 2 weeks post-LPI. 6 By contrast, a Vietnamese study with a longer mean follow-up time of 12 years reported 22.2 % of patients with PACS progressed to PAC despite LPI. 7 The need for additional intervention to control IOP after LPI for PAC, especially in PACG, has been a relatively consistent finding in various studies. Peng et al. reported 42.2 % of PAC and all PACG required additional interventions to control IOP. 7 Cumba et al. also reported a significant ...

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Immediate Changes in Intraocular Pressure after Laser Peripheral Iridotomy in Primary Angle-Closure Suspects

Cited by 47 publications

References 28 publications

Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project

Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project

Initial Treatment for Primary Angle-Closure Glaucoma in China

Lasers in Primary Angle Closure

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