Abstract
ABSTRACTPurpose: 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.How to cite this article: Prado VG, Dorairaj S, Biteli LG, Sousa AKS, Moreno PAM, Lopes FS, Prata TS. Role of Laser Iridoplasty in the Management of Angle Closure Mechanisms other than Pupillary Block. J Curr Glaucoma Pract 2014;8(2):82-84.
Highlights
Laser peripheral irido tomy (LPI) remains the cornerstone of angle closure manage ment, it does not widen the angle in all cases, as approximately 20 to 30% of these patients continue to have appositional angle closure in the presence of a patent iridotomy.[1,2,3]
Argon laser peripheral iridoplasty (ALPI) and lens extraction have been suggested as effective procedures to manage eyes with persistent occludable angle.[8,9,10]
We aimed to investigate the efficacy of ALPI in consecutive eyes with occludable angles despite a patent iridotomy, independent of the underlying angle closure mechanism
Summary
Relative pupillary block is considered the primary mecha nism for angle-closure.[1,2,3] laser peripheral irido tomy (LPI) remains the cornerstone of angle closure manage ment, it does not widen the angle in all cases, as approximately 20 to 30% of these patients continue to have appositional angle closure in the presence of a patent iridotomy.[1,2,3] In these cases, nonpupillary block mechanisms, such as lensinduced, plateau iris and peripheral angle crowding, may be involved.[4,5,6,7] Argon laser peripheral iridoplasty (ALPI) and lens extraction have been suggested as effective procedures to manage eyes with persistent occludable angle.[8,9,10]. Looking carefully at previously published data, most studies have focused on ALPI effects exclusively in eyes with plateau iris component[9] or have not defined the underlying angle closure mechanism. We aimed to investigate the efficacy of ALPI in consecutive eyes with occludable angles despite a patent iridotomy, independent of the underlying angle closure mechanism
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