Progression rate to primary angle closure following laser peripheral iridotomy in primary angle-closure suspects: a randomised study

AIM: To report the progression rate (PR) to primary angle closure (PAC) following laser peripheral iridotomy (LPI) in PAC suspects (PACS). METHODS: Prospective, randomized controlled interventional clinical trial conducted at the Handan Eye Hospital, China. Totally 134 bilateral PACS, defined as non-visibility of the posterior trabecular meshwork for ≥180 degrees on gonioscopy were randomly assigned to undergo LPI in one eye. Gonioscopy and Goldmann applanation tonometry were performed prior to, on day 7 and 12mo post LPI. RESULTS: Eighty of 134 patients (59.7%) could be followed up at one year. The mean intraocular pressure (IOP) in treated eyes was 15.9±2.6 mm Hg at baseline, 15.4±3.0 mm Hg on day 7; 16.5±2.9 mm Hg at one month, and 15.5±2.9 mm Hg at 12mo; the IOP in untreated eyes was similar (P=0.834). One or more quadrants of the angle opened in 93.7% of the LPI treated eyes, but 67.0% (53/79) remained closed in two or more quadrants. The PR to PAC in untreated eyes was 3.75% and one developed acute angle-closure glaucoma (AACG); the PR to PAC in treated eyes was 2.5% and none had developed peripheral anterior synechia (PAS) or AACG. CONCLUSION: LPI can open some of the occludable angle in the majority of eyes with PACS, but 67% continue to have non-visibility of the trabecular meshwork for over 180 degrees.

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Change in Angle of Eyes with Primary Angle Closure Suspects One Year after Laser Peripheral Iridotomy : a randomised study

10.21203/rs.2.12953/v2 ◽

2020 ◽

Author(s):

dapeng mou ◽

Yuan Bo Liang ◽

Su Jie Fan ◽

Yi Peng ◽

Ning Li Wang ◽

...

Keyword(s):

Clinical Trial ◽

Trabecular Meshwork ◽

Applanation Tonometry ◽

Angle Closure ◽

Progression Rate ◽

Clinical Trial Registry ◽

Laser Peripheral Iridotomy ◽

Primary Angle Closure ◽

One Year ◽

Peripheral Iridotomy

Abstract Background: To report the changes in anterior chamber angle and progression rate to PAC(primary angle closure) following laser peripheral iridotomy (LPI) in primary angle closure suspects(PACS).Methods: Prospective, randomized controlled interventional clinical trial conducted at the Handan Eye Hospital, China. 134 bilateral PACS, defined as non-visibility of the posterior trabecular meshwork for ≥ 180 degrees on gonioscopy were randomly assigned to undergo LPI in one eye. Gonioscopy and Goldmann applanation tonometry were performed prior to, on day 7 and 12 months’ post LPI.Results: 80 of 134 patients (59.7%) could be followed up at one year. The mean IOPin treated eyes was 15.9±2.7 mmHg at baseline, 15.4±3.0 mmHg on day 7; 16.5±2.9 mmHg at one month and 15.5±2.9 mmHg at 12 months; the IOP in untreated eyes was similar (p=0.834). One or more quadrants of the angle opened in 93.7% of the LPI treated eyes, but 67.0% (53/79) remained closed in two or more quadrants. The progression rate to PAC in untreated eyes was 3.75% and one developed acute angle closure glaucoma(AACG), the progression rate to PAC(primary angle closure) in treated eyes 2.5% in treated eyes, none had developed PAS or AACG. Conclusion: LPI can open some of the occludable angle in the majority of eyes with PACS, but 67% continue to have non-visibility of the trabecular meshwork for over 180 degrees. IOP remained similar in treated and untreated eyes. Further research is needed to determine the full implications of residual closure as well as the need for follow up and treatment in PACS. The cumulative incidence for PAC/AACG in treated eyes were not significantly different from untreated eyes.Trial registration: Chinese Clinical Trial Registry ChiCTR-TCH-10000820. Registered on 08 April 2010(retrospectively registered).

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Change in Angle of Eyes with Primary Angle Closure Suspects One Year after Laser Peripheral Iridotomy : a randomised study

10.21203/rs.2.12953/v1 ◽

2019 ◽

Author(s):

Dapeng Mou ◽

Yuan Bo Liang ◽

Su Jie Fan ◽

Yi Peng ◽

Ning Li Wang ◽

...

Keyword(s):

Clinical Trial ◽

Trabecular Meshwork ◽

Applanation Tonometry ◽

Angle Closure ◽

Progression Rate ◽

Clinical Trial Registry ◽

Laser Peripheral Iridotomy ◽

Primary Angle Closure ◽

One Year ◽

Peripheral Iridotomy

Abstract Background: To report the changes in anterior chamber angle and progression rate to PAC(primary angle closure) following laser peripheral iridotomy (LPI) in primary angle closure suspects(PACS). Methods: Prospective, randomized controlled interventional clinical trial conducted at the Handan Eye Hospital, China. 134 bilateral PACS, defined as non-visibility of the posterior trabecular meshwork for ≥ 180 degrees on gonioscopy were randomly assigned to undergo LPI in one eye. Gonioscopy and Goldmann applanation tonometry were performed prior to, on day 7 and 12 months’ post LPI. Results: 80 of 134 patients (59.7%) could be followed up at one year. The mean IOP in treated eyes was 15.9±2.7 mmHg at baseline, 15.4±3.0 mmHg on day 7; 16.5±2.9 mmHg at one month and 15.5±2.9 mmHg at 12 months; the IOP in untreated eyes was similar (p=0.834). One or more quadrants of the angle opened in 93.7% of the LPI treated eyes, but 67.0% (53/79) remained closed in two or more quadrants. The progression rate to PAC in untreated eyes was 3.75% and one developed acute angle closure glaucoma(AACG), the progression rate to PAC(primary angle closure) in treated eyes 2.5% in treated eyes, none had developed PAS or AACG. Conclusion: LPI can open some of the occludable angle in the majority of eyes with PACS, but 67% continue to have non-visibility of the trabecular meshwork for over 180 degrees. IOP remained similar in treated and untreated eyes. Further research is needed to determine the full implications of residual closure as well as the need for follow up and treatment in PACS. The cumulative incidence for PAC/AACG in treated eyes were not significantly different from untreated eyes. Trial registration: Current Controlled Trials Chinese Clinical Trial Registry ChiCTR-TCH-10000820, as well as the date of registration(retrospectively registered).

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Laser Peripheral Iridotomy versus Trabeculectomy as an Initial Treatment for Primary Angle-Closure Glaucoma

Journal of Ophthalmology ◽

10.1155/2017/2761301 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Yan Yun Chen ◽

Su Jie Fan ◽

Yuan Bo Liang ◽

Shi Song Rong ◽

Hai Lin Meng ◽

...

Keyword(s):

Initial Treatment ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Laser Peripheral Iridotomy ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma ◽

Group 2 ◽

One Year ◽

Peripheral Iridotomy ◽

Group 1

Purpose. To compare laser peripheral iridotomy (LPI) with trabeculectomy as an initial treatment for primary angle-closure glaucoma (PACG) with peripheral anterior synechiae (PAS) ≥ 6 clock hours. Methods. Patients were drawn from two randomized controlled trials. 38 eyes of 38 patients (PAS ≥ 6 clock hours) were treated with LPI (group 1) while 111 eyes of 111 PACG patients (PAS ≥ 6 clock hours) underwent primary trabeculectomy (group 2). All patients underwent a comprehensive ophthalmic examination at baseline and at postoperative visits and were followed up for a minimum of one year. Results. Group 2 had higher baseline IOP (45.7 ± 14.8 mmHg versus 34.3 ± 14.3 mmHg) than group 1 and more clock hours of PAS (10.4 ± 1.9 versus 9.0 ± 2.2). IOPs at all postoperative visits were significantly lower in group 2 than in group 1 (p=0.000). Five eyes in group 1 required trabeculectomy. 17 of the 38 eyes in group 1 (44.7%) required IOP-lowering medications as compared to seven of the 111 eyes in group 2 (6.3%). Cataract progression was documented in 2 eyes (5.3%) in group 1 and 16 eyes (14.4%) in group 2. Conclusions. Primary trabeculectomy for PACG (PAS ≥ 6 clock hours) is more effective than LPI in lowering IOP.

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