Abstract
Objective To quantitatively study the intraocular pressure (IOP) control and chamber angle opening degree of patients with acute angle-closure glaucoma (stage of attack) treated by laser peripheral iridoplasty (LPIP) with different numbers of laser shots, and to evaluate the efficacy and safety of different numbers of laser shots. Methods Fifty-five patients (60 eyes) with acute angle-closure glaucoma treated in our hospital from May 2019 to December 2020 were selected as the research subjects. All patients had poor intraocular pressure control (≥40 mmHg) after IOP-lowering drug therapy. The patients were randomly divided into three groups, 20 eyes in each group, and underwent laser peripheral iridoplasty (LPIP) with different numbers of laser shots (group I: 35 laser shots, group II: 45 laser shots, and group III: 60 laser shots). The best-corrected visual acuity, IOP, corneal condition, and opening degree of anterior chamber angle (ACA), namely, the trabecular-iris angle (TIA), angle opening distance at 500 μm (AOD500), and complications of patients before LPIP, 2 hours after LPIP, and 24 hours after LPIP were observed, and the opening degree of ACA were quantitatively measured. Results The corrected visual acuity of the three groups after LPIP was improved to varying degrees, and the IOP decreased, TIA and AOD500 were increased compared with those before operation, and the differences were statistically significant (P < 0.05). There were statistically significant differences between group II and group I (P < 0.05). Four eyes in group I underwent LPIP again due to increased IOP. In group III, iris hemorrhage occurred in one eye and iris depigmentation occurred in one eye, and there was no statistical difference compared with group II (P > 0.05). Conclusions LPIP can effectively reduce preoperative IOP and increase ACA width in patients with persistent high IOP that failed to respond to drug therapy, and moderate numbers of laser shots can achieve satisfactory results and highest safety.
Highlights
Glaucoma is a progressive optic neuropathy having specific pattern of visual field defects and characteristic appearances of the optic discs
From May 2019 to December 2020, 55 patients (60 eyes) with acute primary acute angleclosure glaucoma who were admitted to our department and emergency department for outpatient, emergency, and inpatient treatment and whose intraocular pressure (IOP) still could not be controlled after IOP-lowering drugs were selected. ere were 21 males (22 eyes) and 34 females (38 eyes), aged from 55 to 72 years, with an average of 63.4 years
Trabeculectomy under high IOP is a risky operation, which is prone to serious complications such as malignant glaucoma and explosive suprachoroidal hemorrhage during and after operation. erefore, it is necessary to seek an effective and safe treatment to reduce IOP before glaucoma filtration surgery
Summary
Glaucoma is a progressive optic neuropathy having specific pattern of visual field defects and characteristic appearances of the optic discs. It is classified into open-angle or closedangle glaucoma based on appearance of anterior chamber angle. Many individuals with appositional anterior chamber angle closure have normal IOP and no glaucoma symptoms. Primary angle-closure glaucoma (PACG) is defined as angle closure with glaucomatous optic disc injury and/or visual field loss. Angle closure refers to patients with narrow angles, PAC, or PACG [1]. PACG causes 91 percent of the 1.7 million bilaterally blinded Chinese glaucoma patients. PACG may be the main cause of glaucoma blindness today, according to Foster and Johnson [8]
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