Laser peripheral iridotomy in patients with acute primary angle closure

Abstract

Background/Aim. As glaucoma has very high prevalence worldwide, it is important to examine an additional treatment modalities, and especially the prevention of its progression. The aim of the study was to determine the importance of laser peripheral iridotomy (LPI) in patients with acute primary angle closure (APAC) in preventing primary angle closure glaucoma (PACG) progression and APAC in the fellow eye. Methods. The research included 40 patients and 80 eyes. In all patients, LPI was performed bilaterally on both the APAC-affected eye and the healthy fellow eye. Between 2017 and 2021, which was also the follow-up period in the study, the patients ranging in age from 40 to 79 years who had the pupillary block in an eye were monitored. All patients underwent bilateral laser peripheral iridotomy and the changes in angle width were monitored using gonioscopy. Intraocular pressure measurements were made with an applanation tonometer and Vertical Cup/Disc ratio (Ver C/D rat) performing biomicroscopic examination with indirect ophthalmoscopy and +90 D lens. Results. All 40 patients underwent bilateral laser peripheral iridotomy. The angle width of the APAC-affected eye before treatment was 0.15 ? 0.36, and 1.2 ? 0.41 of the fellow eye. After 12 months, the measurements taken were 0.85 ? 0.36 for the affected eye and 1.9 ? 0.36 for the fellow one (Wilcoxon rank test, p<0.01 statistically significant difference). The mean value of intraocular pressure in the eye without progression of disease before therapy was 53.6 ? 3.73 mmHg, while in the eye with progression it was 60.1 ? 4.37mmHg. After 12 months, it was 14.92 ? 1.22 mmHg in the eye without progression, while in the eye with disease progression it was 23.4 ? 2.53 mmHg (independent samples t-test, p < 0.01). The change in Ver C/D ratio in the eye without progression was 0.4?1, while in the eye with progression, it was 0.45 ? 0.05. After 12 months, it remained unchanged in the eye without progression while in the eye with progression it was 0.65?0.06 (independent samples t-test, p < 0.01). Conclusion. Simultaneous LPI has been proven efficient in patients with APAC in both affected and fellow eyes.