Treatment Of Primary Angle-closure Glaucoma Research Articles

Meta-Analysis of Phacoemulsification and Laser Peripheral Iridotomy in the Treatment of Primary Angle-Closure Glaucoma.

In this meta-analysis, we aimed to systematically compare the efficacy and safety of phacoemulsification and laser peripheral iridotomy (LPI) in the treatment of primary angle-closure glaucoma (PACG). We searched PubMed, MEDLINE, EMBASE, the Cochrane Library, the Chinese Journal Full-text Database (CNKI), the Wanfang database, and the China Science and Technology Journal Database for randomized controlled trials (RCTs) of phacoemulsification and LPI in the treatment of PACG published up to September 30, 2022. Postoperative intraocular pressure (IOP), anterior chamber depth (ACD), complications, corneal endothelial cell count, and best-corrected visual acuity (BCVA) were compared. The effective quantity of measurement data was measured by the mean difference (MD) and 95% confidence interval (CI). The effect of counting data was measured by the odds ratio (OR). A total of 1731 potential studies were identified, and after screening, 8 RCT studies were included. The results of the meta-analysis showed that, compared to the LPI group, the patients in the phacoemulsification group showed lower IOP six and twelve months after operation (MD-3.39, 95% CI -4.15∼-2.63, P < 0.00001; -2.29, -3.52∼-1.06, 0.0003). The ACD in the phacoemulsification group was significantly deeper than that in the LPI group (1.59, 1.10∼2.09, 0.00001). Meanwhile, the incidence of complications in the phacoemulsification group was lower than that in the LPI group (OR = 0.46, 0.29∼0.72, 0.0006). There was no statistically significant difference between the phacoemulsification group and the LPI group in corneal endothelial cell count and BCVA at 6 and 12 months after operation (P=0.38; 0.11; 0.81). Compared with LPI, phacoemulsification is safer and more effective in the treatment of PACG, especially in controlling IOP and minimizing postoperative complications.

Automatic measurement of anterior chamber angle parameters in AS-OCT images using deep learning.

The early assessment of angle closure is of great significance for the timely diagnosis and treatment of primary angle-closure glaucoma (PACG). Anterior segment optical coherence tomography (AS-OCT) provides a fast and non-contact way to evaluate the angle close using the iris root (IR) and scleral spur (SS) information. The objective of this study was to develop a deep learning method to automatically detect IR and SS in AS-OCT for measuring anterior chamber (AC) angle parameters including angle opening distance (AOD), trabecular iris space area (TISA), trabecular iris angle (TIA), and anterior chamber angle (ACA). 3305 AS-OCT images from 362 eyes and 203 patients were collected and analyzed. Based on the recently proposed transformer-based architecture that learns to capture long-range dependencies by leveraging the self-attention mechanism, a hybrid convolutional neural network (CNN) and transformer model to encode both local and global features was developed to automatically detect IR and SS in AS-OCT images. Experiments demonstrated that our algorithm achieved a significantly better performance than state-of-the-art methods for AS-OCT and medical image analysis with a precision of 0.941, a sensitivity of 0.914, an F1 score of 0.927, and a mean absolute error (MAE) of 37.1±25.3 µm for IR, and a precision of 0.805, a sensitivity of 0.847, an F1 score of 0.826, and an MAE of 41.4±29.4 µm for SS, and a high agreement with expert human analysts for AC angle parameter measurement. We further demonstrated the application of the proposed method to evaluate the effect of cataract surgery with IOL implantation in a PACG patient and to assess the outcome of ICL implantation in a patient with high myopia with a potential risk of developing PACG. The proposed method can accurately detect IR and SS in AS-OCT images and effectively facilitate the AC angle parameter measurement for pre- and post-operative management of PACG.

The Treatment of Primary Angle-Closure Glaucoma with Cataract: A Systematic Review and Meta-Analysis of Randomized Controlled Trails.

Currently, there is no generally approved surgical treatment for patients with primary angle-closure glaucoma (PACG) and co-existing cataracts. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of phacoemulsification and phacotrabeculectomy in PACG patients with cataract. Diverse databases were searched, including PubMed, MEDLINE, EMBASE, Cochrane Library, Chinese Journal Full-text Database (CNKI), Wanfang database, and China Science and Technology Journal Database, for randomized controlled trials (RCTs) on phacoemulsification and phacotrabeculectomy for the treatment of PACG published up to 30 June 2021. ReviewManager (RevMan) version 5.4 software was used for the meta-analysis, and the effective quantity of measurement data was measured by the mean difference (MD) and 95% confidence interval (CI). The effect of counting data was measured by odds ratio (OR). Our search of the databases identified 14 RCTs that satisfied the search criteria. Meta-analysis of these 14 RCTs showed that at the 1 month postoperative follow-up, intraocular pressure (IOP) of patients in the phacoemulsification group was higher than that of patients in the phacotrabeculectomy group (MD 2.04, 95% CI 1.42-2.65; P < 0.00001). However, the postoperative IOP was not significantly different between the two groups at the 3, 6, and 12 months postoperative follow-ups (P = 0.52, P = 0.51, and P = 0.05, respectively). More medications for IOP reduction were required by patients in the phacoemulsification group compared with those in the phacotrabeculectomy group at 3 months postoperation (MD 0.76, 95% CI 0.33-1.18; P = 0.0005), 6 months postoperation (MD 0.66, 95% CI 0.15-1.18; P = 0.01), and 12 months postoperation (MD 0.76, 95% CI 0.22-1.30; P = 0.006). Patients in the phacoemulsification group obtained better best corrected visual acuity (BCVA) than those in the phacotrabeculectomy group (MD - 0.17, 95% CI - 0.34 to - 0.01; P = 0.04) at 3 months postoperation, but there was no significant difference in BCVA between the two groups at 6 and 12 months postoperation (P = 0.33 and P = 0.56, respectively). The deepened anterior chamber was more obvious in patients in the phacoemulsification group versus those in the phacotrabeculectomy group (MD 0.61, 95% CI 0.03-1.18; P = 0.04). Patients in the phacoemulsification group experienced fewer postoperative complications than those in the phacotrabeculectomy group (OR 0.27, 95% CI 0.17-0.42; P < 0.00001). Our results provide evidence that phacotrabeculectomy has advantages over phacoemulsification for the treatment of PACG in terms of better IOP and reduced medication need during the early stage post surgery. However, in terms of the complication risk, phacoemulsification is the more secure treatment option.

Recent Trends in Treatment and Associated Costs of Primary Angle-Closure Glaucoma: A Retrospective Cohort Study

To describe recent trends in the treatment for primary angle-closure glaucoma (PACG) and its associated costs in a clinical setting. A retrospective cohort study. We included patients with PACG from 2011 to 2020 using a large-scale administrative claims database in Japan. We calculated the frequencies and costs of antiglaucoma drugs, ophthalmic examinations, and glaucoma-related surgeries, stratified by fiscal years and age groups. Frequencies and costs of antiglaucoma drugs, ophthalmic examinations, and glaucoma-related surgeries. We identified 5654 patients with PACG (15 338 patient-years). Prostanoid FP receptor agonist, nonselective β-blocker, and topical carbonic anhydrase inhibitor use decreased, whereas prostanoid EP2 receptor agonist, α-2 adrenergic agonist, Rho-associated protein kinase inhibitor, and fixed-combination eyedrops use increased. The total amount of drug per patient-year significantly decreased. In recent years, the frequency of cataract surgery increased, whereas that of laser peripheral iridotomy decreased. Visual field testing, slit-lamp examination, intraocular pressure measurement, and funduscopy were performed 0.83, 6.65, 5.15, and 4.61 times/patient-year, respectively. The total cost of drugs, examinations, and surgeries was 60 338 yen per patient-year. Patients with PACG spent more than twice the money on surgeries and examinations than they did on antiglaucoma drugs. The amount of antiglaucoma drugs dispensed decreased, and the proportion of fixed-combination and newly introduced eyedrops increased. Frequency of cataract surgery increased whereas that of laser peripheral iridotomy decreased in recent years. Surgeries and examinations were the major cost drivers for PACG treatment. The current results would be valuable information for future economic analyses and policy making. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Clinical Observation and Analysis of Phacoemulsification Combined with Angle Separation in the Treatment of Primary Angle-closure Glaucoma

Clinical Observation and Analysis of Phacoemulsification Combined with Angle Separation in the Treatment of Primary Angle-closure Glaucoma

Predictors of long-term intraocular pressure control after lens extraction in primary angle closure glaucoma: results from the EAGLE trial

Background/aimsTo assess baseline ocular parameters in the prediction of long-term intraocular pressure (IOP) control after clear lens extraction (CLE) or laser peripheral iridotomy (LPI) in patients with primary angle closure...

Advances of minimally invasive glaucoma surgery in the combined treatment of primary angle-closure glaucoma

Glaucoma is the leading irreversible blinding eye disease worldwide, and China has the largest amount of primary angle-closure glaucoma (PACG). To reduce blindness, the therapeutic evolution can play a role. With the technical development of minimally invasive glaucoma surgery (MIGS), the treatment of angle-closure glaucoma has been in a transformation. This article reviews the literatures related to the advances of MIGS in the combined treatment of PACG. The research findings show that MIGS may become one of the preferred surgical treatments for PACG in the future clinical management of glaucoma.

Combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation in the treatment of PACG with cataract.

To investigate the efficacy and safety of combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation (PGE group and PG group) for the treatment of patients with coexisting primary angle-closure glaucoma (PACG) and cataracts. The clinical data of patients with PACG and cataract were retrospectively reviewed. There was a total of 88 eyes in the study and were divided into two groups, 42 eyes in PGE group and 46 eyes in PG group. Surgery success cumulative survival, preoperative and postoperative intraocular pressure (IOP), number of IOP-lowering medications, best corrected visual acuity (BCVA) in the two groups were observed for more than 12mo and compared within each group and between two groups. The mean IOP in PGE group declined from 24.9 mm Hg preoperatively to 14.1 mm Hg at the first month after operation (P<0.001) and at the last visit 16.2 mm Hg (P<0.001). Meanwhile PG group also showed significant decrease, from 24.1 mm Hg preoperatively to 13.0 mm Hg at 1mo after operation (P<0.001) and 15.3 mm Hg at the last visit (P=0.004). The mean medications reliance reduced in both groups, in PGE group was reduced from 1.62 preoperatively to 0.13 at the last visit (P<0.001), in PG group from 0.87 to 0.10 (P<0.001). At the last visit, BCVA increased from 0.21 to 0.60 in PGE group (P<0.001) and from 0.24 to 0.67 in PG group (P<0.001). The success rate of PGE group at 1mo was 95.2%, then decreased to 70.7% at the last visit, whereas in PG group, the success rate at 1mo was 100%, at the last visit was 73.4%. PGE shows promise for PACG patients with cataracts to reduce IOP, lighten the medication burden and improve visual acuity, and PG still has its value in specific patients.

Development of lens surgery in the treatment of primary angle-closure glaucoma

Development of lens surgery in the treatment of primary angle-closure glaucoma

Automatic Classification of Anterior Chamber Angle Based on Ultrasound Biomicroscopy Images

Introduction: Evaluating the anterior chamber angle (ACA) is important for the early diagnosis and treatment of primary angle-closure glaucoma. The assessment of ultrasound biomicroscopy (UBM) images usually requires well-trained ophthalmologists and screening for patients with narrow ACA is usually time- and labor-intensive. Therefore, the automatic assessment of UBM could be cost-effective and valuable in daily practice. Objective: The objective of this study is to develop an automatic method for localizing and classifying ACA based on UBM images. Methods: UBM images were collected and a coarse-to-fine method was used to localize the apex of the angle recess. By analyzing the grayscale features around the angle recess, closed angles were identified, and the rest were then classified as open or narrow angles, based on the degree of ACA. Using manual classification as the reference standard, the overall accuracy (OAcc), sensitivity (Sen), specificity (Spe), and balanced accuracy of the automatic classification method were evaluated. Results: A total of 540 UBM images from 290 participants were analyzed. Using these UBM images and the proposed method, the ACA was classified as open, narrow, or closed. During processing, the method localized the angle recess with 95% accuracy. The OAcc of the ACA classification was 77.8%, and the Spe and Sen of our method were 85.8 and 81.7% for angle closure; 88.9 and 75.6% for open angles; 91.9 and 76.1% for narrow angles, respectively. Conclusions: Our method of automatic angle localization and classification based on UBM images is feasible and reliable. The automatic classification of ACA provides a basis and reference for future studies.

Phacoemulsification combined with goniosynechialysis in treatment of primary angle-closure glaucoma with intraocular pressure out of control after trabeculectomy

Phacoemulsification combined with goniosynechialysis in treatment of primary angle-closure glaucoma with intraocular pressure out of control after trabeculectomy

Pentacam changes in primary angle-closure glaucoma after different lines of treatment.

To assess the changes in the anterior chamber parameters using Pentacam following four different lines of treatment of primary angle-closure glaucoma (PACG). A retrospective comparative study included 126 patients (126 eye) presented within 24-48h after acute angle-closure glaucoma (AACG). Patients were divided into 2 groups: group A (68 eyes) with controlled intraocular pressure (IOP) ≤21 mm Hg, which included subgroup A1 (34 eyes) with clear lens underwent Nd:YAG laser peripheral iridotomy (LPI) and subgroup A2 (34 eyes) with cataract underwent standard phacoemulsification; and group B (58 eyes) with uncontrolled IOP, which included subgroup B1 (30 eyes) with clear lens underwent trabeculectomy and subgroup B2 (28 eyes) with cataract underwent combined phacoemulsification and trabeculectomy. Patients were followed up for at least 3mo. Primary outcomes were Pentacam anterior segment measurements [anterior chamber angle (ACA) and depth (ACD)]. Secondary outcomes were changes in IOP, visual acuity (VA) and recorded complications. At the 3rd month, there was significant increase in the ACA values in all studied groups compared to preoperative values (P<0.001). The highest percent of increase in ACA was recorded in phacotrabeculectomy group B2 (128.40%). There was significant increase in ACD values at 3rd month compared with baseline values (P<0.001) for groups A1, A2, and B2; without change in B1 trabeculectomy group. The maximum deepening of ACD was noticed in group B2 with 94.27% increase. Significant decrease in postoperative IOP in groups A2, B1 and B2 (P<0.001, P=0.014, and P<0.001 respectively). In group A1 there was significant increase in 3rd month postoperative IOP from baseline values (P<0.001). The maximum decrease in IOP was noticed in group B2 with 59.54% decrease. VA improvement in 3rd month postoperative was recorded in all studied groups, maximum VA improvement was observed in group B2 up to 0.2 logMAR. Pentacam can be a helpful tool in studying and comparing the effect of the different lines of management of PACG on the anterior chamber measures. Phacotrabeculectomy was proved to be an effective line for managing PACG with resultant significant increase in the anterior chamber parameters, IOP reduction as well as maximum VA improvement. LPI has only temporary effect on IOP with significant changes in ACA and ACD. Phacoemuslification alone can be an option in treating PACG. Trabeculectomy resulted in temporary increase in the anterior chamber parameter which subsequently returned to baseline values.

Preliminary efficacy of penetrating canaloplasty in primary angle-closure glaucoma

Objective: To evaluate the preliminary efficacy and safety of penetrating canaloplasty for treating primary angle-closure glaucoma (PACG). Methods: It is a prospective interventional case series study. Twenty-two patients (24 eyes) with PACG were treated with penetrating canaloplasty (video attached) at the Eye Hospital of Wenzhou Medical University from June 2015 to August 2018. This modified canaloplasty was performed by making a window at the corneal-scleral bed. Aqueous was redirected to the opening of Schlemm's canal after the canaloplasty with intension sutures. Postoperative follow-up was made at 1 day, 7 days, 1 month, 3 months, and 6 months. Surgical success was defined as intraocular pressure (IOP) ≤ 21 mmHg (1 mmHg=0.133 kPa) with glaucoma medication (quantified success) and without any glaucoma medication (complete success). Main outcome measures included IOP, number of medication, surgical success rate, complications, and filtering bleb status. One-way repeated measure ANOVA and rank sum test were used in statistical analysis. Results: Due to the failure of circumferential catheterization of the canal, 4 eyes converted to trabeculectomy. A total of 19 PACG patients (20 eyes) achieved the successful 360-degree catheterization of the canal, including 11 males and 8 females. The mean age was (54±7) years old (range: 41-65 years old), and the mean angle-closure range was (326.3±46.6) degrees. The mean preoperative IOP was (38.0±11.9) mmHg with the median medication number of 3 (range: 2-5). The mean postoperative IOP was (14.5±11.1), (16.1±6.0), (17.7±5.5), (15.7±5.0), and (15.4±3.7) mmHg at 1 day, 7 days, 1 month, 3 months, and 6 months, respectively. There was significant difference in IOP between postoperative and preoperative (all P<0.01). The median medication number (range) was 0 (0-3), 0 (0-2), 0(0-3), 0(0-2), and 0 (0-2) at the 5 time points, respectively. There was significant difference in medication number between postoperative and preoperative (all P<0.01). The quantified success rate was 95%(19/20), and the complete success rate was 90%(18/20) at 6 months. Postoperative complications were observed in 7 eyes (35%) of 20 PACG eyes, including 3 eyes (15%) with hyphema, 2 eyes (10%) with shallow anterior chamber, 1 eye (5%) with Descemet membrane detachment, and 1 eye (5%) with filtration obstruction at the trabeculum ostium. According to the results of slit lamp and ultrasound biomicroscopy examinations, 70% of the eyes (14/20) had no filtering bleb. Eight eyes (40%) with IOP spike were observed. Conclusion: Preliminary study shows penetrating canaloplasty is safe and effective in the treatment of PACG, but needs a longer follow-up. (Chin J Ophthalmol, 2019, 55: 448-453).

Eye massage combined with laser treatment for acute attack of primary angle-closure glaucoma

Objective To observe the efficacy of eye massage combined with laser treatment for the acute attack of primary angle-closure glaucoma. Methods The data of 102 eyes of 102 patients with acute attack of primary angle-closure glaucoma from Aug. 2016 to May 2018 were analyzed retrospectively. Eye massage was performed on the basis of systemic and topical medication to reduce intraocular pressure.All cases received the combined surgery of multi-wavelength laser peripheral iridoplasty and YAG laser iridotomy. Results After treatment, the intraocular pressure decreased in 100 patients, with average (28.59±6.84) mmHg(1 mmHg=0.133 kPa). No serious complication occurred. Two cases of ineffective underwent traditional trabeculectomy. Conclusion Eye massage combined with laser treatment for the treatment of primary angle-closure glaucoma on the basis of drug treatment in acute attack is effective. Key words: Eye massage; Laser; Glaucoma, angle-closure, primary

Prophylactic laser iridotomy in primary angle-closure suspects

Primary angle-closure suspects are individuals with 180° or more contact between the iris and trabecular meshwork, normal intraocular pressure, no evidence of peripheral anterior synechiae (iris adhering to the trabecular meshwork), and a healthy optic nerve. These individuals might develop peripheral anterior synechiae and increased intraocular pressure that damages their optic nerve, a condition known as primary angle-closure glaucoma. Although less common than primary open-angle glaucoma, primary angle-closure glaucoma is more visually destructive. There is good clinical evidence to guide the management of primary angle closure and primary angle-closure glaucoma, either with cataract extraction or laser peripheral iridotomy, but our knowledge regarding the management of primary-angle closure suspects is inadequate. 1 Azuara-Blanco A Burr J Ramsay C et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet. 2016; 388: 1389-1397 Summary Full Text Full Text PDF PubMed Scopus (273) Google Scholar Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomised controlled trialIncidence of angle-closure disease was very low among individuals classified as primary angle closure suspects identified through community-based screening. Laser peripheral iridotomy had a modest, albeit significant, prophylactic effect. In view of the low incidence rate of outcomes that have no immediate threat to vision, the benefit of prophylactic laser peripheral iridotomy is limited; therefore, widespread prophylactic laser peripheral iridotomy for primary angle-closure suspects is not recommended. Full-Text PDF

Evidence-based surgical treatment of primary angle-closure glaucoma

Evidence-based surgical treatment of primary angle-closure glaucoma

Commentary on effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE)

Relative pupil block is the most common mechanism of intraocular pressure (IOP) elevation in primary angle-closure glaucoma (PACG) and primary angle closure (PAC). The standard approach of treating PACG and PAC is laser peripheral iridotomy (LPI) with or without additional IOP-lowering agents. If IOP remains poorly controlled, lens removal could be considered, especially if the patient has co-existing symptomatic cataract. The efficacy of lowering IOP by lens extraction for patients with co-existing cataract and PACG or PAC is known (1-4). Some authors had suggested an early lens extraction approach as the treatment of choice for PACG (5,6). However, the justification of performing clear-lens extraction as first-line treatment instead of LPI for this group of patients, who have satisfactory visual acuity, is often obviated by the concern of potentially serious complications, such as malignant glaucoma. There has been no randomised control trial to justify clear-lens extraction as the first-line treatment in clinical practice.

Primäres Engwinkelglaukom: Linsenextraktion überzeugt als alternative Therapieoption

Azuara-Blanco A et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet 2016; 388: 1389–1397

The questionnaire survey on glaucoma diagnosis and treatment in China (2016)

Objective: To investigate the present situation of diagnosis and treatment for primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) and awareness of the relevant progress among Chinese ophthalmologists. Methods: This study was a cross-sectional, non-randomized sampling survey. Participants were ophthalmologists who attended the 11st Chinese Glaucoma Society Congress during November 11 to 12, 2016. They were invited to fill out a questionnaire. The questionnaire included participants' basic information and their knowledge about glaucoma diagnosis and treatment. The data collected through questionnaire were analyzed with SAS9.4. Results: A total of 450 questionnaires were distributed and 372 valid questionnaires were retrieved, with a response rate of 82. 7%(372/450). ISGEO classification system was adopted by 58.9% (219/372) of the participants as the diagnostic criteria for PACG. Of the respondents, 48.1% (179/372) of the participants believed that "anterior chamber angle closure mechanism-based PACG classification system" was more instructive for treatment, the percentage was higher than ISGEO classification system (42.2%, 157/372). Most (72.3%, 269/372) of the participants knew the 3-minute dark room prone test, but only 27.7%(103/372) of them applied it in clinical practice. A total of 83.4%(310/372) of the participants believed that low cerebrospinal fluid pressure is a risk factor for POAG. In all, 71.8% (267/372) of the participants reported that their institutes had applied compound trabeculectomy with adjustable suture, with 76.9%(286/372) of the participants agreeing that the adjustable suture reduced the rate of complications after trabeculectomy. Conclusions: Currently, both ISGEO classification system and anterior chamber angle closure mechanism-based PACG classification system were adopted in the diagnosis and treatment of glaucoma. Low cerebrospinal fluid pressure as new risk factors for POAG has been widely acknowledged and given attentions by Chinese ophthalmologists. The 3-minute darkroom prone test and compound trabeculectomy with adjustable suture still need to be promoted. (Chin J Ophthalmol, 2017, 53: 115-120).

Efficacy of neodymium-doped yttrium aluminum garnet laser iridotomies in primary angle-closure diseases: superior peripheral iridotomy versus inferior peripheral iridotomy

Purpose: To evaluate the efficacy and safety of superior peripheral iridotomy versus inferior peripheral iridotomy in the treatment of primary angle-closure glaucoma (PACG) in phakic patients.Methods: In this randomized, prospective, paired-eye comparative study, patients with primary angle closure or primary angle-closure suspects were recruited and randomized to receive neodymium-doped yttrium aluminum garnet (Nd:YAG) laser peripheral iridotomy (LPI) superiorly in one eye and inferiorly in the other eye. Patients were masked to the location of treatment in each eye. The main outcome measures were patency of iridotomy, intraocular pressure (IOP), complications and visual symptoms at each postoperative visit during a 1 year follow-up.Results: A total of 164 patients were recruited, of whom 150 (91.46%) completed the study. The mean age was 58.85 ± 6.4 years. Average IOP measurements before LPI was 22.85 ± 7.53 and 23.62 ± 8.32 in superior LPI and inferior LPI eyes respectively. After LPI, average IOP was 25.14 ± 2.73 and 20.97 ± 2.72 in superior LPI and inferior LPI eyes respectively. Inferior LPIs required less use of mean total laser energy to perforate the tissue (p = .05) and resulted in a significantly lower incidence of iris bleeding at the time of treatment (p = .004), lower IOP elevation following treatment (p = .002), lower incidence of focal corneal damage (p = .002) and a lower post-laser iritis (p = .04). All the 300 iridotomies were patent at 12 month follow up.Conclusion: The inferior LPI appeared to be an efficient method of preventing pupil block with fewer complications. Visual symptoms following inferior LPI are similar to superior LPI.