Journal of Current Glaucoma Practice

Register      Login

VOLUME 13 , ISSUE 1 ( January-April, 2019 ) > List of Articles


Comparison of Intraocular Pressure and Anterior Chamber Angle Changes between Pilocarpine and Laser Peripheral Iridotomy

Ardiella Yunard, Virna D Oktariana, Widya Artini, Joedo Prihartono

Keywords : Anterior chamber angle, Clinical trial, Intraocular pressure, Laser peripheral iridotomy, Pilocarpine

Citation Information : Yunard A, Oktariana VD, Artini W, Prihartono J. Comparison of Intraocular Pressure and Anterior Chamber Angle Changes between Pilocarpine and Laser Peripheral Iridotomy. J Curr Glaucoma Pract 2019; 13 (1):32-36.

DOI: 10.5005/jp-journals-10078-1245

License: CC BY-NC 4.0

Published Online: 01-09-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: To compare intraocular pressure and anterior chamber angle changes between pilocarpine and laser peripheral iridotomy in primary angle closure. Materials and methods: In this clinical trial study, 34 eyes of 29 patients with primary angle-closure were prospectively enrolled between November 2015 and February 2016. Intraocular pressure and anterior segment optical coherence tomography were performed at three separate times: on the initial conditions, 3–5 days of administration of topical pilocarpine 2%, and 1 week after laser iridotomy. Anterior chamber angle parameters were the angle opening distance (AOD) and trabecular–iris space area (TISA). Results: The intraocular pressure reduction following pilocarpine administration was significant compared to laser iridotomy: 3.9 mm Hg (−32.5 to 0.20) vs 1.8 mm Hg (−33.5 to 2.30) (p = 0.002). Meanwhile, the increment of angle parameters following laser iridotomy was significant compared to pilocarpine. The AOD750 increment of both nasal and temporal quadrant following laser iridotomy was significant compared to pilocarpine: 0.13 mm (−0.27 to 0.28) vs 0.05 mm (−0.35 to 0.29) (p = 0.003) and 0.12 mm (−0.10 to 0.34) vs 0.04 mm (−0.27 to 0.19) (p = 0.002), respectively. The TISA750 increment of both nasal and temporal quadrant following laser iridotomy was also significant compared to pilocarpine: 0.05 mm2 (−0.06 to 0.20) vs 0.02 mm2 (−0.12 to 0.13) (p = 0.023) and 0.04 mm2 (−0.04 to 0.17) vs 0.01 mm2 (−0.14 to 0.18) (p = 0.012), respectively. Conclusion: Laser peripheral iridotomy widens the angle greater than topical pilocarpine, but topical pilocarpine lowers the intraocular pressure greater than laser iridotomy. These data suggest that pilocarpine has another mechanism to decrease the intraocular pressure in primary angle-closure, besides widening the angle.

  1. Esmaeili A, Barazandeh B, et al. Assessment of the anterior chamber parameters after laser iridotomy in primary angle close suspect using pentacam and gonioscopy. Int J Ophthalmol 2013;6:680–684. DOI: 10.3980/j.issn.2222-3959.2013.05.25.
  2. Friedman DS, Foster PJ, et al. Angle closure and angle-closure glaucoma: what we are doing now and what we will be doing in the future. Clin Exp Ophthalmol 2012;40:381–387. DOI: 10.1111/j.1442- 9071.2012.02774.x.
  3. Tham CC, Leung DY, et al. Effects of phacoemulsification vs combined phaco-trabeculectomy on drainage angle status in primary angle closure glaucoma (PACG). J Glaucoma 2010;19:119–123. DOI: 10.1097/IJG.0b013e31819d5d0c.
  4. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006;90:262–267. DOI: 10.1136/bjo.2005.081224.
  5. Razeghinejad MR, Kamali-Sarvestani E. The plateau iris component of primary angle closure glaucoma: developmental or acquired. Med Hypotheses 2007;69:95–98. DOI: 10.1016/j.mehy.2006.11. 025.
  6. Weinreb RN, Aung T, et al. The pathophysiology and treatment of glaucoma: a review. JAMA 2014;311:1901–1911. DOI: 10.1001/jama.2014.3192.
  7. Kumar RS, Baskaran M, et al. Prevalence of plateau iris in primary angle closure suspects an ultrasound biomicroscopy study. Ophthalmology 2008;115:430–434. DOI: 10.1016/j.ophtha.2007.07.026.
  8. Lee KS, Sung KR, et al. Longitudinal changes in anterior segment parameters after laser peripheral iridotomy assessed by anterior segment optical coherence tomography. Invest Ophthalmol Vis Sci 2013;54:3166–3170. DOI: 10.1167/iovs.13-11630.
  9. Talajic JC, Lesk MR, et al. Anterior segment changes after pilocarpine and laser iridotomy for primary angle-closure suspects with Scheimpflug photography. J Glaucoma 2013;22:776–779. DOI: 10.1097/IJG.0b013e318259505a.
  10. Ang GS, Wells AP. Changes in Caucasian eyes after laser peripheral iridotomy: an anterior segment optical coherence tomography study. Clin Exp Ophthalmol 2010;38:778–785. DOI: 10.1111/j.1442- 9071.2010.02360.x.
  11. Grewal SPS, Jain R, et al. Evaluation of anterior segment changes following laser peripheral iridotomy using pentacam scheimpflug imaging system in eyes with primary angle closure. Highlights of Ophthalmology 2010;36:13–14.
  12. Thomas R. Glaucoma in developing countries. Indian J Ophthalmol 2012;60:446–450. DOI: 10.4103/0301-4738.100546.
  13. Harasymowycz P, Wang J, et al. Angle closure glaucoma. In. Gault J, Vander J. ed. Ophthalmology secrets in color, 4th ed. Philadelphia: Elsevier; 2015. pp. 154–171.
  14. Edwards RS. Behaviour of the fellow eye in acute angle-closure glaucoma. Br J Ophthalmol 1982;66:576–579. DOI: 10.1136/bjo.66.9.576.
  15. Kobayashi H, Kobayashi K, et al. Pilocarpine induces an increase in the anterior chamber angular width in eyes with narrow angles. Br J Ophthalmol 1999;83:553–558. DOI: 10.1136/bjo.83.5.553.
  16. Abe H, Kitazawa Y, et al. Guidelines for Glaucoma, 2nd ed. Tokyo: Japan Glaucoma Society; 2006. pp. 25–33.
  17. Johnstone MA. Aqueous humor outflow system overview. In. Stamper RL, Lieberman MF, et al. ed. Becker-Shaffer's Diagnosis and Therapy of the Glaucomas, 8th ed., Elsevier; 2009. pp. 25–42.
  18. Bartlett JD, Fiscella RG, et al. Ocular hypotensive drugs. In. Bartlett JD, Jaanus SD. ed. Clinical ocular pharmacology, 2nd ed. United States: Elsevier; 2008. pp. 139–170.
  19. Shiroma LO, Costa VP. Parasympatomimetic. In. Shaarawy TM, Sherwood MB, et al. ed. Glaucoma, 2nd ed. London: Elsevier; 2015. pp. 577–582.
  20. Han S, Sung KR, et al. Outcomes of laser peripheral iridotomy in angle closure subgroups according to anterior segment optical coherence tomography parameters. Invest Ophthalmol Vis Sci 2014;55:6795–6801. DOI: 10.1167/iovs.14-14714.
  21. Nolan W, Foster P, et al. YAG laser iridotomy treatment for primary angle closure in east Asian eyes. Br J Ophthalmol 2000;84:1255–1259. DOI: 10.1136/bjo.84.11.1255.
  22. Yang CC, Chou SC, et al. Anterior chamber angles shallowing and intraocular pressure after topical pilocarpine. J Ocul Pharmacol Ther 1997;13:219–224. DOI: 10.1089/jop.1997.13.219.
  23. Zimmerman TJ, Wheeler TM. Miotics: side effects and ways to avoid them. Ophthalmology 1982;89:76–80. DOI: 10.1016/s0161- 6420(82)34866-6.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.