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

Zhekov, Ivailo; Pardhan, Shahina; Bourne, Rupert

doi:10.1111/ceo.13303

Cited by 12 publications

(4 citation statements)

References 22 publications

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“…At 6 years, there was a significant difference in the rate of loss; however, it was small (0.74%), and the authors concluded that it was not clinically significant [266]. In another RCT involving primarily Chinese participants, the follow-up period was 3 years, which was shorter than the RCT; however, there was no significant difference in the rate of endothelial cell loss between the treated and untreated groups [268]. Based on these results, we concluded that although LPI treatment did not result in a clinically clear decrease in corneal endothelial cells, it may have affected the long-term course of the disease.…”

Section: Summary Of Sr Reportmentioning

confidence: 93%

“…The literature related to an RCT from China called the ZAP trial, which compared PACS eyes with and without unilateral LPI treatment, included East Asians as in Japan, and had a long-term observation period of 6 years [265][266][267]. An RCT that followed corneal endothelial cell density for 3 years was also selected [268]. Another RCT, called the IMPACT study, was also selected; however, it was excluded from this CQ as it included both PACS and primary angle-closure, had a short observation period of 6 months, and included a Caucasian population [84].…”

Section: Process Of Recommendation Creationmentioning

confidence: 99%

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The Japan Glaucoma Society guidelines for glaucoma 5th edition

et al. 2023

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We are pleased to bring you the 5th edition of the Glaucoma Clinical Practice Guidelines. Clinical practice guidelines are based on evidence (scientific grounds). It is a document that presents the treatment that is the most appropriate for the patient. "Glaucoma Clinical Guidelines" was first published in 2003. This was the first guideline for glaucoma treatment in Japan. The principle of glaucoma treatment is to lower intraocular pressure. Means for lowering intraocular pressure includes drugs, lasers, and surgery; Glaucoma is a disease that should be considered as a complex syndrome rather than a single condition. Therefore, the actual medical treatment is not as simple as one word. This time we set the Clinical Questionnaire with a focus on glaucoma treatment. We hope that you will take advantage of the 5th edition.

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Section: Summary Of Sr Reportmentioning

confidence: 93%

Section: Process Of Recommendation Creationmentioning

confidence: 99%

The Japan Glaucoma Society guidelines for glaucoma 5th edition

et al. 2023

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“…Laser peripheral iridectomy (LPI) is one of the treatment options for angle closure because it can establish an outflow channel of aqueous humor and alleviate pupillary block [5][6] . After LPI, the iris becomes flat, and the angle of the chamber widens [7][8][9][10] . LPI is indispensable for glaucoma treatment [11][12] .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the learning curve of laser peripheral iridectomy: the 20th case reaches the turning point

Liu¹,

Chen²,

Liao³

et al. 2022

Int J Ophthalmol

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AIM: To explore the learning curve for ophthalmologists at the start of laser peripheral iridectomy (LPI) training. METHODS: The learning curve of 4 doctor groups without previous LPI experience was studied. Three main parameters of LPI were reviewed: total energy, argon energy and neodymium-doped yttrium aluminum garnet (Nd:YAG) energy. Procedures were evaluated in cohorts of 20 cases to identify the turning points of the three variables. RESULTS: There was no significant difference in terms of age or eye among the 4 doctor groups. There were stable trends on the learning curve for the Doctor A and C groups regarding total energy and argon energy. In addition, the turning points on the learning curve were determined after the 20th procedure for the Doctor B and D groups regarding total energy and argon energy. Moreover, the Nd:YAG energy was relatively stable since the first procedure. CONCLUSION: It requires approximately 20 procedures for a beginner to reach a turning point on the learning curve regarding LPI. It can serve as a point of reference or guideline for training beginners to perform LPI.

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“…The conventional method of treatment is the laser peripheral iridotomy (LPI) leading to an improvement in the topography of the anterior chamber angle (ACA)3,4 and to a decrease in intraocular pressure (IOP) fluctuations,5 which are considered a risk factor of glaucoma progression 6. Nevertheless, some authors do not note any improvement in hydrodynamics after LPI 7.…”

mentioning

confidence: 99%

Comparison of Lens Extraction Versus Laser Iridotomy on Anterior Segment, Choroid, and Intraocular Pressure in Primary Angle Closure Using Machine Learning

Курышева

Pomerantsev²,

Rodionova³

et al. 2022

Journal of Glaucoma

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Précis: Treatment strategy of primary angle closure (PAC) is not clear due to the large number of clinical and anatomic-topographic parameters in PAC, influencing the treatment algorithm. Using the machine learning method DD-SIMCA, we justify the expediency of early lens extraction (LE) in PAC. Purpose: To compare the anatomic and functional efficacy of LE and laser peripheral iridotomy (LPI) in patients with PAC using Machine Learning. Materials and Methods: This prospective study included 120 patients aged 41–80 years: 60 eyes with PAC, 30 with PAC suspects, and 30 with healthy eyes (control). Thirty PAC eyes with intraocular pressure (IOP) up to 30 mm Hg were treated using LE with intraocular lens implantation and 30 eyes with LPI. All subjects underwent Swept Source optical coherence tomography. We analyzed 35 parameters of each eye including the lens vault, the choroidal thickness, the anterior chamber angle, and iris specifications such as iris curvature. Considering the correlations between them, the machine learning method DD-SIMCA 1-class classification was applied: the proximity of each sample to the target class (control) was characterized by the total distance to it. Results: After LE, IOP was significantly lower than after LPI (P=0). Every third eye with PAC after LE reached the target class: specificity according to DD-SIMCA equals 0.67. This was not observed for the eyes after LPI: specificity equals 1.0. After LE, all parameters of the anterior chamber angle did not differ from the control (all P>0.05). After LPI, there was an increase in anterior chamber depth (P=0) and a decrease in lens vault (P=0), but results comparable to the control were achieved only for iris curvature (P=1.000). Conclusion: The efficacy of LE in PAC is higher than LPI due to the better postoperative anterior chamber topography and lower IOP. This study lends further clinical and anatomic support to the emerging notion of LE as an effective treatment for PAC.

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

Abstract: LPI widened all angle sections with maximum effect observed in the site opposite the iridotomy. Angle changes were maintained up to 6 months after LPI treatment without any statistically significant change in DIOP fluctuation.

Cited by 12 publications

References 22 publications

The Japan Glaucoma Society guidelines for glaucoma 5th edition

The Japan Glaucoma Society guidelines for glaucoma 5th edition

Evaluation of the learning curve of laser peripheral iridectomy: the 20th case reaches the turning point

Comparison of Lens Extraction Versus Laser Iridotomy on Anterior Segment, Choroid, and Intraocular Pressure in Primary Angle Closure Using Machine Learning

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