Abstract
ABSTRACTAimTo compare intraocular pressure and anterior chamber angle changes between pilocarpine and laser peripheral iridotomy in primary angle closure.Materials and methodsIn 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).ResultsThe 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.ConclusionLaser 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.How to cite this articleYunard A, Oktariana VD, et al. Comparison of Intraocular Pressure and Anterior Chamber Angle Changes between Pilocarpine and Laser Peripheral Iridotomy. J Curr Glaucoma Pract 2019;13(1):32–36.
Highlights
Visual impairment in primary angle closure glaucoma is 2–3 times more common compared to primary open angle glaucoma despite the less prevalence of primary angle-closure glaucoma compared to primary open angle glaucoma.[1,2]Acute attack of angle closure glaucoma causes blindness in 10% of the total cases.[2,3] Quigley et al.[4]predicted the number of patients with bilateral blindness due to angle closure glaucoma in 2020 would reach 5.3 million
Primary angle-closure included in this study were patients diagnosed as primary angle closure suspect (PACS), primary angle closure (PAC), and primary angle-closure glaucoma (PACG)
The diagnosis of PACS was made in eyes with iris and trabecular meshwork contact ≥180° on gonioscopy, IOP ≤ 21 mm Hg, and without presence of peripheral anterior synechiae (PAS)
Summary
Relative pupillary block is the main mechanism of aqueous flow obstruction in angle closure glaucoma patients. There is an aqueous flow obstruction from posterior to anterior chamber through pupil, causing higher pressure in posterior chamber than the anterior chamber. This pressure gradient pushes peripheral iris to anterior, closing the anterior chamber angle.[5,6]. The advantages of ASOCT are faster and easier procedure, more comfortable for the patients with no contact involved, less anatomical distortion caused by contact pressure, as well as quantitative and more objective results.2,8,10.
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