Intérêt de l’iridotomie périphérique au laser dans le glaucome pigmentaire et le syndrome de dispersion pigmentaire : une revue de la littérature

Abstract

Pigment dispersion syndrome (PSD) is characterized by a structural abnormality of the posterior surface of the iris causing contact with the zonular fibers. It can lead to an open-angle glaucoma secondary to pigment dispersion into the trabecular meshwork. Laser peripheral iridotomy (PI) has been proposed as a treatment for pigmentary glaucoma (PG) and pigment dispersion syndrome (PDS) by reducing the dispersion of pigment. The goal of this review was to assess the effects of PI for PSD and PG. We included six randomized controlled trials and two cohort studies (286eyes of 218participants). Four trials included participants with PG, and 4trials enrolled participants with PSD with or without elevated intraocular pressure (IOP). Among patients with PG, at an average of 9months of follow-up, the mean difference in IOP between groups was 2.69mmHg less in the PI group (95% CI: -6.05to 0.67; 14eyes). In patients with PDS, the average IOP was statistically lower after PI as compared to baseline (Student test, t=11.49, P<0.01). With regard to visual field progression in participants with GP, after an average follow-up of 28months, the risk of progression was not influenced by PI (RR 1.00 95%: CI 0.16to 6.25; 32eyes). No trials that enrolled patients with PSD showed a diminution of the risk of glaucoma conversion at mid- and long-term. PI decreases the biomechanical factor causing contact between the iris and zonular fibers and may lower IOP over the long-term. Nevertheless, the effects of PI on visual field changes or progression have not been established in PG and PDS. There is no scientific evidence as of yet to advocate PI as a treatment for PDS or PG.