Argon Laser Peripheral Iridoplasty Research Articles

Plateau Iris: A Review.

To review the concept of plateau iris and summarize the recent evidence on its diagnosis and management. This is a narrative review on the plateau iris. A literature review was conducted in PubMed, Google Scholar, and Scopus databases using keywords: angle-closure glaucoma, glaucoma, nonpupillary block glaucoma, plateau iris, and plateau iris management. This review defined the current knowledge about plateau iris. First of all, the anatomy and epidemiology were discussed. Then, we outlined the available evidence on the diagnosis of plateau iris and its differential diagnosis. Conclusively, the treatment options were mentioned. Plateau iris is a condition in which nonpupillary block mechanisms are responsible for intraocular pressure elevation and angle closure attack when a patent peripheral iridotomy has removed the relative pupillary block. An anteriorly positioned ciliary body causes mechanical obstruction of trabecular meshwork in these patients. It is usually seen in younger patients with angle closure and is diagnosed by gonioscopic examination and imaging modalities such as Ultrasound biomicroscopy. Despite the known mechanism of plateau iris, there is no consensus over treatment. Low-dose pilocarpine and Argon laser peripheral iridoplasty are nonsurgical treatments for these patients, but their effects are short-term. Cataract extraction with/without endocyclophotocoagulation (ECP), endocycloplasty, excisional goniotomy, and transscleral cyclophotocoagulation are alternative treatments. Patients should be examined periodically for further progression or recurrence of plateau iris. In cases of glaucoma unresponsive to conventional medical treatments, surgical treatments such as trabeculectomy and drainage devices should be considered.

Efficacy of brinzolamide in the initial management of acute primary angle closure: A randomized controlled trial.

WHAT IS KNOWN AND OBJECTIVE?: Since comprehensive medication has an important role in the initial management of patients presenting with acute primary angle closure, it is necessary to analyse the effect of each drug on alleviating the disease. This study aimed to evaluate the intraocular pressure-lowering effect of brinzolamide in the sequential treatment of acute primary angle closure. METHODS: In this randomized double-blind controlled trial, a total of 131 eyes of 125 consecutive patients who presented with their first episode of acute primary angle closure were recruited and received sequential treatment. In this treatment, in the absence of remission, anti-glaucoma drugs, anterior chamber paracentesis and argon laser peripheral iridoplasty are used sequentially. The patients were randomized to receive either brinzolamide or normal saline as a placebo. The primary outcomes were decreased intraocular pressure, success rate and treatment time. RESULTS AND DISCUSSION: There was no statistically significant difference in the decreased level of intraocular pressure between the two groups at 6, 12 or 24h after the start of treatment (p-values were 0.526, 0.206 and 0.130 respectively). The success rate and treatment time were also not significantly different between the groups. No adverse side effects of brinzolamide were observed in the brinzolamide group. WHAT IS NEW AND CONCLUSION?: In patients with a first episode of acute primary angle closure, brinzolamide did not improve the effectiveness of the sequential treatment for reducing the intraocular pressure levels or shortening the treatment time within the first 24h of initiating therapy.

Clinical implication of recent randomized control trial in primary angle-closure disease management.

Blindness due to primary angle-closure glaucoma (PACG) can be reduced significantly if the ongoing angle-closure process is arrested at an early stage. Various treatments such as laser peripheral iridotomy (LPI), iridoplasty, and clear lens extraction (CLE) have been advocated as first-line therapy for primary angle-closure (PAC), PACG, and high-risk cases of primary angle-closure suspect (PACS). EAGLE study, propagated the effectiveness of CLE over LPI for the management of primary angle closure and have sparked controversy regarding the role of LPI as a first line procedure. Randomized controlled trials (RCT), systematic reviews, and meta-analyses of RCTs done on the same question provide us with a solid base for creating guidelines/modules for our day-to-day clinical practice. A systematic review was conducted, searching several databases, including PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov, for the last 16 years (January 2005-December 2021) for RCTs with data published related to primary angle-closure disease (PACD). The search strategy included the following terms: "Primary Angle Closure disease," "Primary Angle Closure Glaucoma," "Primary Angle Closure," "Primary Angle Closure Suspect," "clear lens extraction," "laser iridotomy," "laser peripheral iridotomy," "argon laser peripheral iridoplasty," "selective laser trabeculoplasty," "trabeculectomy," "randomized control trial," and "meta-analysis of randomized control trial." In this review, we will discuss recently published RCTs (within the last 16 years) for the management of PACD and their clinical implications in day-to-day practice.

Effectiveness of Argon Laser Peripheral Iridoplasty in Plateau Iris Syndrome Patients after Laser Peripheral Iridotomy

Objective: There is controversy surrounding the next best step in treating plateau iris syndrome (PIS) patients with persistent angle dysfunction despite a patent laser peripheral iridotomy (LPI). The aim of this study was to examine the effectiveness of argon laser peripheral iridoplasty (ALPI) in PIS patients with a patent LPI. Methods: Retrospective review of medical records in consecutive patients that underwent ALPI to treat persistently narrow angles due to underlying PIS after a patent LPI. Patients in whom angle configuration could not be ascertained by review of medical records, those with less than 12 months follow-up at our institution, or those younger than 18 years of age were excluded. Kaplan-Meier survival analysis was used to determine treatment survival time. Paired t-tests were used to compare intraocular pressure (IOP), number of glaucoma medications, and bestcorrected visual acuity (BCVA) 12 months post-ALPI and at the last follow-up visit. Results: Fifty-one eyes of 51 patients were included in the analysis. The median survival time for a successful ALPI procedure was 1023 days (34.1 months). The majority of failure events were attributed to cataract extraction to open a persistently narrow angle, performed at approximately 934 (± 694) days (31.1 months) after ALPI. No changes in IOP, number of glaucoma medications, or BCVA from baseline were observed after 12 months or at last follow-up. Conclusion: ALPI is a potentially effective treatment for PIS following LPI. While angle dysfunction may re-emerge over time, ALPI can potentially delay the need for lensectomy in patients without visually significant cataracts.

Argon Laser Iridoplasty For Plateau Iris Syndrome: Long-Term Outcomes of 48 Eyes.

Argon laser peripheral iridoplasty (ALPI) was performed on 48 eyes with plateau iris syndrome (PIS). Indentation gonioscopy was used to monitor the opening of the iridocorneal angle. Mean intraocular pressure (IOP) at 5 years decreased from 15.9 to 14.4 mm Hg. None of the eyes required trabeculectomy. The purpose of this article was to report the long-term outcomes of ALPI for PIS. A retrospective chart review was performed on all patients with PIS treated with ALPI from 2001 to 2012. The study included 48 eyes from 28 patients with PIS after peripheral iridotomy, with a follow-up of at least 5 years. Patients with advanced glaucoma requiring initial surgical treatment (pathologic discs and IOP above the target IOP despite medical treatment) were excluded. The primary outcomes were the effect on the number of IOP medications, and the need for complementary selective laser trabeculoplasty (SLT) or surgery (trabeculectomy and/or phacoemulsification). Secondary outcomes were optic nerve head changes and adverse events. The mean IOP statistically decreased after ALPI (15.91±2.62 vs. 14.35±2.18 mm Hg, P>0.001). The mean number of IOP-lowering medications statistically increased after ALPI (0.81±0.94 vs. 1.2±1.04, P>0.001). Mean follow-up was 92.4±26.5 months. At the end of the follow-up, 12 (25%) eyes had no medications, 20 (42%) had 1 medication, 11 (23%) had 2 medications, 3 (6%) had 3 medications, and 2 (4%) had 4. Ten (21%) eyes underwent SLT, 6 (10%) underwent phacoemulsification, and no trabeculectomy was necessary during follow-up. The change in cup to disc ratio from pre-ALPI to latest follow-up was not statistically significant, and no adverse events were reported. ALPI is relatively effective and safe to prevent angle-closure glaucoma and avoid trabeculectomy in patients with PIS. This procedure often helps to control IOP, although SLT and additional medical treatments are frequently necessary to maintain the target IOP.

Argon Laser Peripheral Iridoplasty and Argon Laser Pupilloplasty: Alternative Management for Medically Unresponsive Acute Primary Angle Closure.

Objective To introduce the combined laser technique, argon laser peripheral iridoplasty (ALPI) and argon laser pupilloplasty (ALPP), in the management of medically unresponsive acute primary angle closure (APAC). Design Retrospective study. Methods We retrospectively reviewed the records of 23 patients (27 eyes) with APAC, who were applied ALPI and ALPP when traditional treatment failed. The visual acuity and intraocular pressure (IOP) were monitored before surgery and at 1, 2, 12, 24, and 48 h after surgery. Additionally, the angle-opening status was monitored before surgery and 48 h after the treatment by using an ultrasonic biological microscope (UBM), and the presurgical and postsurgical cornea edema statuses were observed by using a slit lamp. We also documented the complications of laser treatment. Results For the ALPI + ALPP laser-effective group, the presurgical IOP was 52.1 ± 9.3 mmHg and the postsurgical IOP was 37.6 ± 10.9 mmHg (1 h), 28.4 ± 12.4 mmHg (2 h), 19.9 ± 9.0 mmHg (6 h), 16.8 ± 7.3 mmHg (12 h), 15.9 ± 5.9 mmHg (24 h), and 14.9 ± 5.0 mmHg (48 h), with statistically significant differences (p < 0.05) in each time point. It was observed in all the patients that the corneal edema alleviated, the angles opened, and visual acuity recovered with varying degrees at 48 h after applying combined laser treatment. For the ALPI + ALPP laser-ineffective group, further interventions were taken. Definite treatment was given in both groups to maintain the long-term IOP control. Conclusions Although the combination of ALPI and ALPP is a temporizing therapeutic strategy for APAC, it is effective in relieving pupillary block which is unresponsive to miotic agents, opening the closed angle to a certain extent, restoring the transparency of cornea, and reducing IOP to a safe level for further definitive treatment.

Efficacy and Safety of Argon Laser Peripheral Iridoplasty and Systemic Medical Therapy in Asian Patients with Acute Primary Angle Closure: A Meta-Analysis of Randomized Controlled Trials.

Purpose The purpose of this meta-analysis was to assess the percent reduction in the intraocular pressure (IOP) after argon laser peripheral iridoplasty (ALPI) and systemic medical therapy in patients with acute primary angle closure (APAC). Methods We searched a number of electronic databases, including MEDLINE, EMBASE, PubMed, and Cochrane Library. We searched the electronic databases from the inception of the databases to August 2018. The primary outcomes included the IOP reduction (IOPR), percent reduction in IOP (IOPR%) from baseline to the endpoint and peripheral anterior synechiae (PAS). The secondary outcomes included the cup-to-disc ratio (CDR), mean endothelial count, and percent of patients requiring topical glaucoma medication. Summary weighted mean difference (WMD), odds ratio (OR), and 95% confidence intervals (CIs) were calculated. Results Four eligible studies including 183 eyes (92 in the ALPI group and 91 in the medical therapy group) were identified. When comparing ALPI to medical therapy, the WMDs of the IOPR% were 30.03 (95% CI: 21.33 to 38.72, p < 0.00001) at 15 minutes, 27.39 (95% CI: 18.89 to 35.89, p < 0.00001) at 30 minutes, 18.15 (95% CI: 10.63 to 25.68, p < 0.00001) at 1 hour, and 12.91 (95% CI: 4.50 to 21.32, p=0.003) at 2 hours. There was no statistically significant difference between the two groups at 24 hours and at more than 6 months after therapy. Meanwhile, no significant difference was observed in the degree of PAS, CDR, mean endothelial count, and percent of patients requiring topical glaucoma medication after treatment between the two groups. Conclusions Both ALPI and systemic medications were effective with regard to decreasing the IOP. ALPI was more effective in lowering the IOP within the first two hours. Therefore, ALPI may be a better choice for rapidly lowering the IOP in patients with APAC within a short period.

Long term follow‐up of patients with plateau iris syndrome after treatment with argon laser peripheral iridoplasty

Long term follow‐up of patients with plateau iris syndrome after treatment with argon laser peripheral iridoplasty

Acute primary angle closure-treatment strategies, evidences and economical considerations.

Acute primary angle closure requires emergency management that involves a rapid lowering of the intraocular pressure and resolution of relative pupil block - the most common mechanism of angle closure. Emergency strategies for lowering intraocular pressure include medical treatment and argon laser peripheral iridoplasty. Anterior chamber paracentesis and diode laser transcleral cyclophotocoagulation may be considered in special situations. Relative pupil block can be relieved by peripheral laser iridotomy and primary lens extraction; the latter is a more effective treatment according to the results of clinical trials. However, primary lens extraction can be technically demanding in the acute setting. Peripheral laser iridotomy has a role in relieving pupil block and should also be considered in most cases. Lens extraction may be combined with procedures such as goniosynechialysis, trabeculectomy or endoscopic cyclophotocoagulation. In this review, we aim to discuss the available evidence regarding the different treatment modalities. We also discuss the economic consideration, including cost-effectiveness and life expectancy, in the management of acute primary angle closure.

Argon laser peripheral iridoplasty for chronic primary angle-closure and angle-closure glaucoma in caucasians.

To investigate whether the peripheral thinning and shrinking of the iris as induced with Argon laser peripheral iridoplasty (ALPI) has an effect on intraocular pressure (IOP), angle structure and 3-D anterior segment (AS) morphology in Caucasians with chronic primary angle-closure (PAC) and primary angle-closure glaucoma (PACG). Twenty-four eyes of 24 patients (age 67.7±8.9years; seven males; 17 females) diagnosed with PAC (n=10) or PACG (n=14) were assigned for ALPI prior to laser peripheral iridotomy (LPI) and consecutively enrolled in this prospective interventional study. Intraocular pressure (IOP) was measured with Goldmann applanation tonometry, angle structure with gonioscopy using the Shaffer grading system and AS morphology with the Pentacam rotating Scheimpflug camera prior to and 3months after ALPI. Intraocular pressure (IOP)-lowering medication was not changed during follow-up. Intraocular pressure (IOP) changed statistically significantly from 18.8±3.6 to 14.7±3.1mmHg (p<0.001). Gonioscopy showed a statistically significant angle widening in all four quadrants: nasally from Shaffer 1.04±0.98 to 2.54±1.1 (p<0.001), superiorly from 0.39±0.66 to 1.58±1.21 (p<0.001), temporally from 0.87±1.01 to 2.17±1.24 (p=0.001) and inferiorly from 1.22±0.74 to 2.75±0.9 (p<0.001). Pentacam parameters like anterior chamber depth, volume and angle did not increase statistically significantly. Argon laser peripheral iridoplasty (ALPI) is a safe and effective procedure for reducing appositional angle-closure and thus IOP in nonacute PAC and PACG patients.

Quantitative assessment of changes in anterior segment morphology after argon laser peripheral iridoplasty: findings from the EARL study group.

Argon laser peripheral iridoplasty (ALPI) could be effective in widening residual angle closure following laser peripheral iridotomy (LPI). We investigated changes in angle parameters following ALPI and its safety profile in this study. Retrospective, observational case series. The records from a single centre, of 36 patients (60 eyes) who underwent ALPI, for residual angle closure following LPI, were reviewed. We analysed anterior chamber parameters in anterior segment optical coherence tomography (ASOCT) images using customized software pre- and post-ALPI. Paired t-test was used to compare changes. ASOCT parameters analysed included angle opening distance (AOD 500 and 750), trabecular iris surface area (TISA 500 and 750), anterior chamber width (ACW), anterior chamber volume (ACV), angle recess area (ARA), anterior chamber area (ACA), anterior chamber depth (ACD) and lens vault (LV). There was a mean increase in AOD 500 (0.05 vs. 0.16 mm, P < 0.001), AOD 750 (0.15 vs. 0.27 mm, P < 0.001), TISA 500 (0.010 vs. 0.038 mm2 , P < 0.001), TISA 750 (0.039 vs. 0.102 mm2 , P < 0.001), ACV (89.76 vs. 102.25 mm3 , P = 0.01), ARA 500 (0.015 vs. 0.033 mm2 , P < 0.001) and ARA 750 (0.044 vs. 0.088 mm2 , P < 0.001). There was no significant change in ACW, ACD, ACA and LV. Mean intraocular pressure (IOP) decreased post-ALPI (17.2 vs. 15.7 mmHg, P = 0.002). The mean follow-up duration was 2.1 years (range 0.5-5 years). ALPI results in changes to the angle morphology and lowered IOP in eyes with residual angle closure. Our findings suggest a possible role for ALPI in eyes with residual angle closure following peripheral iridotomy.

Pattern Scanning Laser (PASCAL) for Peripheral Iridoplasty in Eyes With Plateau Iris Syndrome: A Novel Application.

The purpose of this study was to evaluate safety and efficacy of pattern scanning laser (PASCAL) for peripheral iridoplasty in eyes with plateau iris syndrome. This study was a retrospective review of cases that underwent PASCAL laser peripheral iridoplasty. Eyes with plateau iris syndrome confirmed on gonioscopy and ultrasound biomicroscopy were included in the study. Primary and secondary outcome measures were angle widening on gonioscopy and magnitude of intraocular pressure (IOP) reduction, respectively. Twelve eyes of 8 patients that completed 1-year follow-up were analyzed. Angle widening was noted in 46% of treated quadrants by at least 1 grade (Shaffer classification) at 1-month follow-up. A statistically significant IOP reduction was noted at 1 year from 20.6±4.8 to 17.8±3.8 mm Hg (P=0.01). At 1 month, 8 of 12 eyes (66.6%) achieved gonioscopic success (widening of the angle by at least 1 grade in 2 of 4 quadrants). At 1 year, 6 of 12 eyes (50%) achieved tonometric success (20% reduction or 3 mm Hg IOP reduction from the baseline without addition of new antiglaucoma medications). No adverse effects associated with PASCAL laser peripheral iridoplasty were observed. PASCAL laser iridoplasty can be a safe and effective alternative to argon laser peripheral iridoplasty in the management of eyes with plateau iris syndrome. Our findings need to be further validated on larger sample size and in different ethnicities.

Pilocarpine test may predict success of argon laser peripheral iridoplasty

Pilocarpine test may predict success of argon laser peripheral iridoplasty

Changing patterns in treatment of angle closure glaucoma.

Angle closure glaucoma is a leading cause of blindness globally and trends of how best to treat this disease are evolving. The advent of anterior segment imaging aids our understanding of pathogenesis and allows more robust and objective measurement of treatment modalities. We will also review recent literature regarding the role of laser and surgical interventions for the treatment of primary angle closure disease. Recent studies evaluating the efficacy of laser peripheral iridotomy (LPI) in primary angle closure suspects (PACs) show that while it is a safe intervention and initially anterior chamber angle widens following the laser treatment, the effect is lost with time. Only a small minority of PACs patients develop primary angle closure (PAC) or primary angle closure glaucoma (PACG). Trials evaluating argon laser peripheral iridoplasty (ALPI) have failed to show a substantial clinical benefit. In patients with early or moderate PACG and those with PAC with IOP over 30 mmHg, clear lens extraction is associated with better clinical and quality of life outcomes than LPI. Recent evidence supports initial clear lens extraction in the context of PACG or primary angle closure with IOP more than 30 mmHg.

Long-term Outcome of Argon Laser Peripheral Iridoplasty in the Management of Plateau Iris Syndrome Eyes.

To report long-term (>5 y) outcomes of plateau iris syndrome patients treated with argon laser peripheral iridoplasty (ALPI). A retrospective chart review was performed on all patients with plateau iris syndrome treated with ALPI from 1996 to 2007. The study included 22 eyes from 22 patients with plateau iris after peripheral iridotomy that were followed for at least 1 year after ALPI. The primary outcome was incidence of needing any intraocular pressure (IOP)-lowering medications or surgery (either a filtering procedure or phacoemulsification). Demographic and baseline clinical data were summarized by mean (±SD) or frequency (percentage). Snellen best-corrected visual acuity was converted to logMAR. The paired t test was used to compare IOP changes, number of IOP-lowering medications, and best-corrected visual acuity from baseline to annual follow-up. Mean follow-up was 76 months. Only 2 (9%) eyes maintained an IOP<21 mm Hg without requiring medication or surgery. Seventeen (77%) eyes underwent surgery at an average of 49.1±7.9 months after ALPI. Eight (36%) eyes underwent filtering surgery, and 9 (41%) eyes underwent phacoemulsification. Three months after cataract extraction, no eyes required IOP-lowering medication. The beneficial effects of ALPI last for <4 years, with the majority of patients (77%) requiring surgery. Phacoemulsification alone was a successful treatment for plateau iris in our patient population.

Plateau Iris - Therapeutic options and functional results after treatment.

We present the therapeutic options and functional results in patients with plateau iris (syndrome or configuration) in consecutive case series. Material and method: Our study included newly diagnosed patients with acute angle closure by "plateau iris" (configuration or syndrome), between June 2016 and April 2017. Series of 8 consecutive patients met the inclusion criteria, all being females. All the patients underwent an individualized treatment according to the underlying mechanism and evolution. Functional results (visual acuity, IOP, topical medication) were reported in the current paper. Results: For 10 months, we diagnosed 14 eyes, from 9 patients with acute angle closure by Plateau Iris, distributed as it follows: 6 eyes with closed angle glaucoma (optic disk and visual field changes), 8 eyes with plateau iris syndrome and 2 eyes with plateau iris configuration. 7/ 8 patients were misdiagnosed with primary open angle glaucoma, whereas only one patient had the correct diagnosis of closed angle glaucoma and underwent peripheral laser iridotomy. As treatment options in our study, we recommended and performed argon laser peripheral iridoplasty + iridotomy in 10/ 14 eyes, cataract lens was extracted in 4 eyes and then replaced with PC-IOL, whereas 2 eyes required a filtering anti-glaucoma surgery (trabeculectomy + PI). 2 eyes from the same patient could not be treated as intended as the patient refused the treatment. In this unique case, Pilocarpine (4%) was temporarily indicated. Conclusion: Plateau iris represents a diagnostic trap, but based on a thorough gonioscopic examination and a good patient history, the right diagnosis can be made, all along with a correct therapeutic approach.

Temporal ocular coherence tomography-measured changes in anterior chamber angle and diurnal intraocular pressure after laser iridoplasty: IMPACT study

AimsTo evaluate temporal change in anterior chamber angle anatomy following argon laser peripheral iridoplasty (ALPI) in eyes with occludable angles postlaser peripheral iridotomy (LPI) compared with control eyes. Additionally, the...

Management of Primary Angle-Closure Glaucoma.

Primary angle-closure glaucoma (PACG) is a progressive optic nerve degeneration and is defined as a glaucomatous optic neuropathy with associated characteristic enlargement of optic disc cupping and visual field loss that is secondary to ocular hypertension caused by closure of the drainage angle. Angle closure is caused by appositional approximation or adhesion between the iris and the trabecular meshwork. The main treatment strategy for PACG lies in the reduction of intraocular pressure, reopening of the closed angle, and possible prevention of further angle closure. There is no universally agreed best surgical treatment for PACG. Trabeculectomy, goniosynechialysis (GSL), glaucoma implant, and cyclodestructive procedures are effective surgical options. Each of them plays an important role in the management of PACG with its own pros and cons. Accumulating evidence is available to show the effectiveness of visually significant and visually nonsignificant cataract extraction in the treatment of PACG. Trabeculectomy and GSL are often combined with cataract extraction, which may offer additional pressure control benefits to patients with PACG. This review article will discuss laser peripheral iridotomy, argon laser peripheral iridoplasty, and surgeries such as GSL, phacoemulsification, and phaco plus glaucoma surgeries that lower intraocular pressure and also alter the anterior segment and/or drainage angle anatomy. Currently, glaucoma implants and cyclodestruction are mainly reserved for PACG patients who have failed previous filtering operations. Their role as initial surgical treatment for PACG will not be discussed.

Argon Laser Peripheral Iridoplasty for Primary Angle-Closure Glaucoma: A Randomized Controlled Trial

To determine the effectiveness of argon laser peripheral iridoplasty (ALPI) in primary angle closure (PAC) and primary angle-closure glaucoma (PACG). Randomized controlled trial. Eighty PAC or PACG subjects who underwent laser iridotomy (LI) and had at least 180° of persistent appositional angle closure and intraocular pressure (IOP) of more than 21 mmHg were enrolled. Subjects were randomized to receive either 360° ALPI (Visulas 532s; Carl Zeiss Meditec, Jena, Germany) or medical therapy (Travoprost 0.004%; Alcon-Couvreur, Puurs, Antwerp, Belgium). Repeat ALPI was performed if the IOP reduction was less than 20% from baseline along with inadequate angle widening at the month 1 or month 3 visit. Intraocular pressure was controlled with systematic addition of medications when required. The primary outcome measure was success rates after ALPI at 1 year. Complete success was defined as an IOP of 21 mmHg or less without medication, and qualified success was defined as an IOP of 21 mmHg or less with medication. Failure was defined as an IOP more than 21 mmHg despite additional medications or requiring glaucoma surgery. Forty subjects (51 eyes) were randomized to ALPI and 40 subjects (55 eyes) were randomized to medical therapy. Complete success (IOP ≤21 mmHg without medication) was achieved in 35.0% eyes of the ALPI group compared with 85.0% of eyes in the prostaglandin analog (PGA) group (P < 0.001), and qualified success (IOP ≤21 mmHg with medication) was achieved in 35.0% and 7.5%, respectively (P = 0.003). The IOP decreased by 4.9 mmHg (95% confidence interval [CI], 3.5-6.3 mmHg) in the ALPI group (P < 0.001) and by 6.1 mmHg (95% CI, 5.1-7.1 mmHg) in the medication group (P < 0.001). A failure rate of 30.0% was noted in the ALPI group compared with 7.5% in the medication group (P = 0.01). No treatment-related complications were recorded in either group. After 1 year, ALPI was associated with higher failure rates and lower IOP reduction compared with PGA therapy in eyes with persistent appositional angle closure and raised IOP after LI.

Anterior segment morphology after acute primary angle closure treatment: a randomised study comparing iridoplasty and medical therapy

PurposeTo compare the effect of argon laser peripheral iridoplasty (ALPI) and conventional medical therapy in the immediate treatment of acute primary angle closure (APAC) using anterior segment optical coherence tomography...