YAG Laser Peripheral Iridotomy for the Prevention of Pigment Dispersion Glaucoma

Scott, Andrew; Kotecha, Aachal; Bunce, Catey; Balidis, Miltos; Garway-Heath, David F.; Miller, Michael H.; Wormald, Richard

doi:10.1016/j.ophtha.2010.07.026

Cited by 47 publications

(74 citation statements)

References 18 publications

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“…19 Interestingly, iridotomy did not offer any benefit when performed on PDS eyes showing an already increased IOP or on eyes affected by PG. 17,25 This is not surprising; as already stated, Nd:…”

Section: Discussionmentioning

confidence: 65%

“…However, a tentative summary is shown in Figure 3. 8,11,[16][17][18] Determining which eye affected by PDS will eventually develop PG can be difficult. "Active" pigment dispersion (ie, the detection over time of an increased amount of pigment deposition on anterior segment structures) seems to be a major risk factor for conversion.…”

Section: Discussionmentioning

confidence: 99%

“…This was the case in no more than half of the patient population in the study by Scott et al 17 Meanwhile, no data on iris root configuration were reported in a retrospective study on PG. 25 In the present study, PDS eyes showing both a peak IOP of less than 18 mm Hg and a concave iris root were randomly assigned to Nd:YAG LPI.…”

mentioning

confidence: 90%

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A 10-Year Follow-up to Determine the Effect of YAG Laser Iridotomy on the Natural History of Pigment Dispersion Syndrome

et al. 2014

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Prospective long-term analyses of the role of drug-induced mydriasis and laser peripheral iridotomy (LPI) are needed to identify and manage the eyes of patients with pigment dispersion syndrome (PDS) at risk for progressing to ocular hypertension.OBJECTIVE To assess the 10-year incidence of increased intraocular pressure (IOP) in the 2 eyes of patients with PDS, with 1 eye that underwent LPI and the other that did not. DESIGN, SETTING, AND PARTICIPANTSIn a randomized clinical trial in the glaucoma research unit at the University Hospital of Parma, Italy, 72 patients with PDS underwent phenylephrine testing. Of these 72 patients, 29 (58 eyes) tested positive for succeeding IOP elevation, and 43 (59 eyes) tested negative. For the 29 high-risk patients (all in both eyes), one eye was randomly assigned to LPI, and the fellow eye was left untreated. For the 43 low-risk patients, the affected eyes were left untreated.MAIN OUTCOMES AND MEASURES An IOP elevation of 5 mm Hg or higher vs baseline (daily phasing) was considered to be a significant increase (ie, an event). RESULTSIn the high-risk group, 3 of 21 eyes that underwent LPI (14.3%) and 13 of 21 untreated eyes (61.9%) showed an increase in IOP of 5 mm Hg or higher during the follow-up period; 4 of 35 low-risk eyes (11.4%) showed a similar increase. Event-free mean (SD) time was 7.99 (0.43) years for high-risk treated eyes, 3.89 (0.68) years for high-risk untreated eyes, and 7.16 (0.23) years for low-risk eyes. The log-rank test showed the following: P < .001 for treated high-risk eyes vs untreated high-risk eyes, P = .74 for treated high-risk eyes vs low-risk eyes, and P < .001 for untreated high-risk eyes vs low-risk eyes.CONCLUSIONS AND RELEVANCE At the end of the 10-year follow-up, (1) approximately one-third of the whole PDS patient population showed an IOP increase of 5 mm Hg or higher in at least 1 eye; (2) phenylephrine testing identified eyes at high risk for developing IOP elevation; and (3) LPI, when performed on high-risk eyes, reduced the rate of IOP elevation to the same level as the low-risk eyes.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01053416

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

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A 10-Year Follow-up to Determine the Effect of YAG Laser Iridotomy on the Natural History of Pigment Dispersion Syndrome

et al. 2014

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“…33 Two patients in our series with clinical features of pigment dispersion syndrome had associated glaucoma. 34 This association suggests an increased risk of pigmentary glaucoma in white patients with Knobloch syndrome. Many of the retinal changes noted in this series are consistent with high myopia and are not specific to the syndrome.…”

Section: Discussionmentioning

confidence: 98%

Molecular and Clinical Findings in Patients With Knobloch Syndrome

Hull

Arno

et al. 2016

JAMA Ophthalmol

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IMPORTANCE Knobloch syndrome is a rare, recessively inherited disorder classically characterized by high myopia, retinal detachment, and occipital encephalocele, but it is now known to have an increasingly variable phenotype. There is a lack of reported electrophysiologic data, and some key clinical features have yet to be described.OBJECTIVE To expand on current clinical, electrophysiologic, and molecular genetic findings in Knobloch syndrome. DESIGN, SETTING, AND PARTICIPANTSTwelve patients from 7 families underwent full ophthalmic examination and retinal imaging. Further investigations included electroretinography and neuroradiologic imaging. Bidirectional Sanger sequencing of COL18A1 was performed with segregation on available relatives. The study was conducted from July 4, 2013, to October 5, 2015. Data analysis was performed from May 20, 2014, to November 3, 2015. MAIN OUTCOMES AND MEASURESResults of ophthalmic and neuroradiologic assessment and sequence analysis of COL18A1. RESULTSOf the 12 patients (6 males; mean age at last review, 16 years [range, 2-38 years]), all had high myopia in at least 1 eye and severely reduced vision. A sibling pair had unilateral high myopia in their right eyes and near emmetropia in their left eyes from infancy. Anterior segment abnormalities included absent iris crypts, iris transillumination, lens subluxation, and cataract. Two patients with iris transillumination had glaucoma. Fundus characteristics included abnormal collapsed vitreous, macular atrophy, and a tesselated fundus. Five patients had previous retinal detachment. Electroretinography revealed a cone-rod pattern of dysfunction in 8 patients, was severely reduced or undetectable in 2 patients, and demonstrated cone-rod dysfunction in 1 eye with undetectable responses in the other eye in 2 patients. Radiologic imaging demonstrated occipital encephalocele or meningocele in 3 patients, occipital skull defects in 4 patients, minor occipital changes in 2 patients, and no abnormalities in 2 patients. Cutaneous scalp changes were present in 5 patients. Systemic associations were identified in 8 patients, including learning difficulties, epilepsy, and congenital renal abnormalities. Biallelic mutations including 2 likely novel mutations in COL18A1, were identified in 6 families that were consistent with autosomal recessive inheritance with a single mutation identified in a family with 2 affected children. CONCLUSIONS AND RELEVANCEThis report describes new features in patients with Knobloch syndrome, including pigment dispersion syndrome and glaucoma as well as cone-rod dysfunction on electroretinography. Two patients had normal neuroradiologic findings, emphasizing that some affected individuals have isolated ocular disease. Awareness of the ocular phenotype may aid early diagnosis, appropriate genetic counseling, and monitoring for potential complications.

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“…There is no universal consensus on whether YAG laser peripheral iridotomy may prevent progression of PDS in pigmentary glaucoma [10,11]. However, we decided not to perform YAG laser peripheral iridotomy, considering the possible adverse effects that could occur in a patient of such a young age, so we continued o monitor the patient.…”

Section: Resultsmentioning

confidence: 99%

A Rare Case of Pigment Dispersion Syndrome in an 8-Year-Old Boy

Rafiq¹

2017

AOVS

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YAG Laser Peripheral Iridotomy for the Prevention of Pigment Dispersion Glaucoma

Cited by 47 publications

References 18 publications

A 10-Year Follow-up to Determine the Effect of YAG Laser Iridotomy on the Natural History of Pigment Dispersion Syndrome

A 10-Year Follow-up to Determine the Effect of YAG Laser Iridotomy on the Natural History of Pigment Dispersion Syndrome

Molecular and Clinical Findings in Patients With Knobloch Syndrome

A Rare Case of Pigment Dispersion Syndrome in an 8-Year-Old Boy

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