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Home  >  Medical Research Archives  >  Issue 149  > Effects of Laser Peripheral Iridotomy in Primary Angle Closure Suspect in asymptomatic patients (PACS) and complications of Laser Peripheral Iridotmy.
Published in the Medical Research Archives
May 2020 Issue

Effects of Laser Peripheral Iridotomy in Primary Angle Closure Suspect in asymptomatic patients (PACS) and complications of Laser Peripheral Iridotmy.

Published on May 25, 2020




Objective: The Effect of laser peripheral iridotomy in  Primary Angle Closure  suspect in asymptomatic patients and complications of laser peripheral iridotomy. A single institutional study.

This study’s aims to evaluate the  effectiveness of Laser peripheral iridotomy(LPI)  in  eyes with  asymptomatic  primary angle closure suspect  patients. We plan to conduct a retrospective chart review of patients who underwent an LPI , procedure by one glaucoma sub-specialist at Malabar Medical College and Hospital(MMC &H) between January 2017 and December2018. Patients were treated with argon green laser and Nd: Yag   laser applications over  iris at 7 & 4 clock  in one session. Data obtained will include patients’ demographics, sub-type of glaucoma, baseline IOP, Visual Fields, OCT RFNL,  number of anti-glaucoma medications, and post- laser IOP at 1 hour. LPI outcomes at 4, 12  and 24weeks post laser will be evaluated by  slit lamp examination and four mirror gonioscopy  to know the patency of iridotomy. Statistical analyses will be performed comparing  patency of iridotomy. Data on presence and degree of transient IOP rise 1-hour post procedure , complication of iridotomy will also be obtained.

Design and setting: A retrospective study, A single institutional study.

Materials and Methods: In this retrospective study, 67 adult cases of 134 eyes of  Primary  angle closure   suspect(PACS) asypmtomatic patients  were underwent 4-mirror zeiss gonioscopy  before LPI procedure and slit lamp by Van Hericks ,OCT RFNL,HFA 24-2 Sita Standard ,stereioscopic  fundus pictures enrolled into the study from out-patients Department of ophthalmology  MMC &H, Calicut for studies between January 2017 and  December 2018.

Inclusion criteria: All patients who underwent LPI treatment during above mentioned period were included.

Exclusion criteria: Eyes  with corneal scar, very shallow anterior chamber , neovascular glaucoma , Iridocorneal Endothelial syndrome(ICE) ,previous ALT/ SLT patients, unco-operative patients and  Uveitis patients.

Main outcome and Measure: To measure  the patency of iridotomy at 4,  12 and 24weeks of post  LPI treatment, to know the effects on  angle of PACS patients. Statistical analyses will be performed comparing baseline  gonioscopy  with post-laser  gonioscopy  at4,12 and  24 weeks. Successful outcome will be defined as  two  or more  ITC angles are open after LPI with no need for further   medication or   laser.

Results: A total of 134 eyes in 67 patients participated in this study. All 134 glaucoma eyes were treated with LPI. The  134 eyes with Successful opening  of angle more than 2 for at least 24 weeks. Follow-up ranged from 4 to 24 weeks. Gonioscopy was performed  in each  visit to confirm the angle status and patency of iridotomy.Success is defined as opening ofmore than  2 angles ITC for at least 24  weeks, with no need for further   medication  or laser treatment.

The percentage of open angle at 4 weeks was more 2 angles in 36eyes(26.9%), ITC>3 angles in 28eyes, (20.9%) and  ITC>4 angles in 70eyes are  (52.2%) ,at 12weeks  more 2 angles24eyes (17.9%), ITC> 3angles in ,30 eys(20.9%) ITC>4 angles in  80 eyes(59.7%)  and 24 weeks  was more 2 angles14 eyes(10.4%), ITC> 3,30eyes (22.4%) ITC>4 angle in90 eyes (67.2%) .  The success rate  at 24 weeks  ITC  more than2 angle was 10.4%  ,  ITC>3angles 22.4%  and ITC> 4angles in  67.2% respectively.In all cases, IOP was measured within 1 hour and IOP elevation of greater than 8 mm Hg was observed in  eyes21 (15.7%) . Mild-to-moderate anterior chamber reaction is seen in 64eyes  ,hyphema in 6 eyes, ghost images seen in 2 eyes,2 cases of macular edema, cataract  progression  seen in 16eyes,and closureof iridotomy in 26eyes  were noted.

Post laser procedure   combination of steroid and antibiotic  medication was prescribed for 5 days  and IOP pressure more  8 mmHg seen in 21 eyes(15.7%) ,antiglaucoma medications  started  and oral T. Diamox 250mg 2 tablets wre prescribed followed up after 5 days to reasess the IOP.

Conclusions:  LPI  is an effective treatment option for  all patients with in  Primary Angle Closure  suspect to prevent the acute angle closure glaucoma.LPI  is a effective, compliance-free, repeatable,most PACS eyes don’t receive further treatment and safe therapeutic modality having only minor, transient, self-limiting or easily controlled side effects with no sequelae. Progression to PACG is uncommon in PACS and PAC. Despite our methodology, the inherent limitations of studies should be considered, and conclusion drawn from our pooled results should be interpreted with caution. Future large-volume, well-designed with extensive follow-up are awaited to confirm and update the findings of this analysis

Author info

Kashinath Shenoy M., Savitha Shenoy

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