Journal of Current Glaucoma Practice

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VOLUME 8 , ISSUE 2 ( May-August, 2014 ) > List of Articles

BRIEF REPORT

Role of Laser Iridoplasty in the Management of Angle Closure Mechanisms other than Pupillary Block

Vitor Gomes Prado, Syril Dorairaj, Luis Gustavo Biteli, Aline KS Sousa, Pilar AM Moreno, Flavio Siqueira Lopes, Tiago Santos Prata

Keywords : Angle closure, Nonpupillary block mechanisms, Plateau iris, Laser peripheral iridoplasty

Citation Information : Gomes Prado V, Dorairaj S, Gustavo Biteli L, KS Sousa A, Moreno PA, Siqueira Lopes F, Santos Prata T. Role of Laser Iridoplasty in the Management of Angle Closure Mechanisms other than Pupillary Block. J Curr Glaucoma Pract 2014; 8 (2):82-84.

DOI: 10.5005/jp-journals-10008-1166

License: CC BY-NC 4.0

Published Online: 01-08-2014

Copyright Statement:  Copyright © 2014; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Purpose: To investigate the treatment outcomes of argon laser peripheral iridoplasty (ALPI) in angle closure mechanisms other than pupillary block. Methods: We conducted a comprehensive chart review to evaluate consecutive patients who underwent ALPI due to unsuccessful laser iridotomy (whenever the angles remained occludable) between July 2009 and April-2012. An occludable angle was defined as the posterior trabecular meshwork not visible for ≤180° without indentation on dark room gonioscopy. Eyes with previous incisional surgery or more than 90° of peripheral anterior synechiae were excluded. Main data collected were age, presence of glaucoma, pre- and postlaser intraocular pressure (IOP), angle-status, and underlying angle closure mechanism. Main outcomes were post ALPI angle widening on gonioscopy and magnitude of IOP reduction. Results: A total of 41 eyes (27 patients) with persistent occlu-dable angles were initially included in the analysis, comprising approximately 14% of the 196 patients (321 eyes) that had under gone laser iridotomy during the predefined period. Among these cases, most common angle closure mechanisms were plateauiris (56%) and lens-induced component (34%). Patients with plateau iris were mostly women and younger than those with lens-induced component (p ≤ 0.03). A total of 35 eyes (23 patients) underwent ALPI (63% had glaucoma). Mean IOP was significantly reduced from 18. 2 ± 4.7 to 14.6 ± 3.8 (p < 0.01), with no significant difference between patients with plateau iris and lens-induced components (p = 0.22). Over 91% of these eyes showed nonoccludable angles following ALPI (follow-up of 11.8 ± 3.3 months). Conclusion: In this series of middle-aged patients with occlu-dable angles, despite a patent iridotomy, ALPI was a useful procedure independent of the underlying mechanism, leading to angle widening and moderate IOP reduction in most cases.


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