Study of power use and complication frequency of Nd:YAG laser iridotomy in the management of primary angle closure glaucoma

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Background: The aim of the study was to assess the power use and efficacy of Nd:YAG laser iridotomy in the management of primary angle closure (PAC). Material and methods: A prospective cross-sectional analysis was done in 146 eyes of 81 cases who underwent neodymium: yttrium-aluminum-garnet laser iridotomy. There were 42 patients with chronic primary angle closure glaucoma (PACG), 46 with acute and subacute PAC, and 11 with PACS (suspects). After initial intraocular pressure (IOP) controlling, all patients were treated with Nd:YAG laser iridotomy. Before and after the laser therapy, IOP, laser parameters, mean power use, and complications, if any, were noted. Results: The average total power used was 78.56 ± 8.1 mJ per eye. The anatomy of angle structures improved by one or two of Shaffer’s grades. Controlled IOP was noted in 71% (17) of patients with PACG (chronic) and 93% (43) of patients with PAC (acute and subacute). The average total power used was 78.568.1 mJ per eye. Junior residents used more power than senior residents (88.5 62.5 mJ vs. 63.55 ± 5.8 mJ, p = 0.011). Complications included elevated IOP in 38.27% (31/81), aqueous flare/debris in 34.56% (24/81), iris bleeding in 18.51% (15/81), corneal burns in 4.93% (4/81), and lens damage in 3.71% (3/81). Laser peripheral iridotomy (LPI) was repeated in 48.14% of cases (39/81), with junior residents having a higher rate of repeat LPI than senior residents (p = 0.02). Complication rates differed between residents who performed the procedure (p = 0.16). In PACS subjects, 63.6% had a history of repeated LPI, followed by 58.33% in PACG and 39.1% in PAC cases. At follow-up, 3% of PAC eyes had glaucomatous optic neuropathy. Conclusion: Laser iridotomy in managing early PACG reduces IOP and improves patient acuity. Nd:YAG laser iridotomy is effective in widening the drainage angle and lowering elevated IOP in patients with PAC.