The rarity of clinically significant rise in intraocular pressure after laser peripheral iridotomy with apraclonidine

Abstract

ObjectiveTo determine the incidence of intraocular pressure (IOP) rise of varying degrees after laser peripheral iridotomy (LPI) in patients with and without glaucoma treated perioperatively with pilocarpine and apraclonidine. DesignA retrospective chart review. ParticipantsA total of 289 eyes in 179 patients with narrow occludable angles (NOA) (N = 148), open-angle glaucoma or ocular hypertension (OAG) (N = 115), or chronic-angle closure glaucoma (CACG) (N = 26) were reviewed. Main outcome measuresThe difference between preoperative and postoperative IOP, absolute postop- erative IOP, and the need for acute IOP-lowering treatment was noted. ResultsOnly 1.1% (95% confidence interval [CI], 0.03%–5.8%; 1 of 94) of patients and 0.7% (95% CI, 0.02%–3.7%; 1 of 148) of eyes with NOA experienced a rise of more than 10 mmHg 1 to 2 hours after LPI. The incidence of postoperative IOP greater than 25 mmHg and acute postoperative IOP-lowering management was 0% (95% CI, 0%–3.8%). Intraocular pressure in 1 of 115 eyes (0.9%, 95% CI, 0.02%–4.7%) with OAG rose more than 10 mmHg, requiring acute treatment. None of the 26 CACG eyes experienced a rise of more than 10 mmHg (95% CI, 0%–13.2%). ConclusionThe IOP rise that requires further intervention after LPI with the perioperative use of pilocarpine and apraclonidine is very uncommon. In patients with NOA, routine postiridotomy IOP monitoring may not be required.