Laser Peripheral Iridotomy With and Without Iridoplasty for Primary Angle-Closure Glaucoma: 1-Year Results of a Randomized Pilot Study

• Published in: American journal of ophthalmology 2010-07, Vol.150 (1), p.68-73
• Main Authors: Sun, Xia, Liang, Yuan Bo, Wang, Ning Li, Fan, Su Jie, Sun, Lan Ping, Li, Si Zhen, Liu, Wen Ru
• Format: Article
• Language: English
• Subjects: Aged; Automation; Biological and medical sciences; Cell Count; Endothelium, Corneal - pathology; Female; Follow-Up Studies; Glaucoma; Glaucoma and intraocular pressure; Glaucoma, Angle-Closure - physiopathology; Glaucoma, Angle-Closure - surgery; Hospitals; Humans; Intraocular Pressure - physiology; Iridectomy; Iris - surgery; Laser Coagulation; Lasers; Lasers, Solid-State - therapeutic use; Male; Medical sciences; Middle Aged; Miscellaneous; Ophthalmology; Pilot Projects; Postoperative Complications; Standard deviation; Tonometry, Ocular; Treatment Outcome; Visual Acuity - physiology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2010.02.004

Purpose To compare the efficacy and safety of laser peripheral iridotomy with or without laser peripheral iridoplasty in the treatment of eyes with synechial primary angle-closure or primary angle-closure glaucoma. Design Randomized, controlled clinical trial. Methods Consecutive patients older than 40 years with synechial primary angle-closure or primary angle closure glaucoma were recruited. Eligible patients were randomized to 1 of 2 treatment options, iridotomy or iridotomy plus iridoplasty, and were followed up for 1 year. Main outcome measures were intraocular pressure (IOP), peripheral anterior synechiae, corneal endothelial cell count, and complications. Results Seventy-seven eyes (77 patients) were randomized to the iridotomy group, and 81 eyes (81 patients) were randomized to the iridotomy plus iridoplasty group. Sixty-one patients (79.2%) in the iridotomy and 65 patients (80.2%) from the iridotomy plus iridoplasty groups completed 1 year of follow-up. There were no significant differences between the groups in the baseline data. IOP was reduced from 24.66 ± 13.76 mm Hg to 19.03 ± 6.21 mm Hg in the iridotomy group ( P < .001) and from 27.96 ± 13.06 mm Hg to 20.45 ± 7.26 mm Hg in the iridotomy plus iridoplasty group ( P < .001). Extent of peripheral anterior synechiae was decreased by 1 more clock-hour after iridoplasty compared with that after iridotomy in the iridotomy plus iridoplasty group ( P < .001). There was no significant difference in IOP, medications, need for surgery, or visual function between groups at the 1-year visit. Conclusions In eyes with synechial primary angle-closure or primary angle-closure glaucoma, both iridotomy alone or combined with iridoplasty provide a significant and equivalent reduction in IOP. There is also a possible reduction in peripheral anterior synechiae, more so in the iridoplasty group.