J.ophthalmol.(Ukraine).2022;6:10-13.
http://doi.org/10.31288/oftalmolzh202261013
Received: 07.09.2022; Accepted: 04.11.2022; Published on-line: 21.12.2022
Our experience of laser iridotomy in patients with chronic angle closure glaucoma
R. M. Lopadchak, I. Ia. Novytskyy, Ya. Z. Fedus
Danylo Halytsky Lviv National Medical University
Lviv (Ukraine)
TO CITE THIS ARTICLE: Lopadchak RM, Novytskyy IIa, Fedus YaZ. Our experience of laser iridotomy in patients with chronic angle closure glaucoma. J.ophthalmol.(Ukraine).2022;6:10-13. http://doi.org/10.31288/oftalmolzh202261013
Background: Determining the strategy of surgical treatment for chronic angle closure glaucoma (CACG) is still important.
Purpose: To assess the efficacy, rates of successful intraocular pressure (IOP) lowering and the increase in anterior chamber angle for laser peripheral iridotomy (LPI) in patients with CACG.
Material and Methods: We examined 31 patients (31 eyes; 18 women and 13 men) who had undergone LPI for CACG. Patient age ranged from 49 to 77 years (mean age, 64.8 ± 5.3 years). The indication for LPI was an anterior chamber angle of Shaffer grade 2 to 3 and the presence of optic neuropathy. Mean Maklakoff intraocular pressure (IOP) was 23.4 ± 1.2 mmHg.
Results: Thirteen patients required surgery during the follow-up after LPI. Particularly, 10 eyes required phacoemulsification (PHACO) only, and 3 eyes, PHACO plus goniosynechialysis (GSL), because of decompensated IOP and an anterior chamber angle narrower than Shaffer grade 2 by gonioscopy. Kaplan-Meier survival analysis showed that the rates of successful IOP lowering for laser peripheral iridotomy (without the need for surgery, PHACO alone or PHACO plus GSL) at 12 months, 24 months and 36 months were 87.1%, 71.0% and 58.06%, respectively.
Conclusion: The LPI is effective for opening the anterior chamber angle and reducing IOP over 6 months, but is less effective and does not allow opening the anterior chamber angle over a period exceeding 6 months. The LPI may be considered as a preparatory procedure in CACG, particularly in the presence of an acute angle-closure glaucoma attack in the fellow eye.
Keywords: chronic angle closure glaucoma, laser peripheral iridotomy, gonioscopy, phacoemulification, goniosynechialysis, anterior chamber angle optical coherence tomography
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Disclosures
Corresponding Author: Lopadchak R.M., e-mail: rlopadchak@yahoo.com
Author Contributions: IN - concept, design, data analysis, drafting the manuscript. RL: concept, design, data collection and interpretation, research, drafting the manuscript. YaF: concept, design, research, data interpretation. All authors analyzed the results and agreed on the final version of the manuscript.
Disclaimer: The authors declare that the opinions expressed in this article are their own and not the official positions of the institution.
Conflict of interest: The authors have no conflicts of interest, including financial interests, activities, relationships, or affiliations.
Sources of support: none.
Ethical Statement: This research was conducted with the participation of people. All study participants signed informed consent. The permission of the local Bioethics Committee was obtained. The study was conducted in accordance with the Declaration of Helsinki. The study does not include experiments on animals.
Abbreviations: CACG, chronic angle closure glaucoma; ACA, anterior chamber angle; IOP, intraocular pressure; LPI, laser peripheral iridotomy; PHACO, cataract phacoemulsification; GSL, goniosynechialysis; OCT, optical coherence tomography; PACG, primary angle-closure glaucoma; IOL, intraocular lens.