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Corneal Endothelium Changes 6 Months after Laser Peripheral Iridotomy: Prospective Study
摘要： A decrease in corneal endothelial cell density (ECD) after laser peripheral iridotomy (LPI) has been reported to varying degrees, whereas some investigations have demonstrated no change. Endothelial cell loss after LPI has been hypothesized to result from excessive heat production during the iris photovaporization (Argon) or photodisruption (neodymium:yttriumealuminumegarnet) processes. In our prospective study, we examined the impact of LPI on ECD, comparing ECD before LPI with that 6 months after LPI. Patients 30 years of age or older who were diagnosed as primary angle-closure suspect (PACS) or with primary angle closure (PAC) or primary angle-closure glaucoma (PACG) in at least 1 eye were recruited between September 2012 and December 2013 from glaucoma clinics at Aravind Eye Hospitals in Coimbatore and Pondicherry, South India. The Aravind Eye Hospitals Institutional Review Board approved the study protocol, and written, informed consent was obtained from all participants. The study adhered to the tenents of the Declaration of Helsinki. Exclusion criteria were (1) bilateral pseudophakia, (2) symptoms or signs of acute angle closure attack, or (3) prior iridotomy, iridoplasty, or incisional glaucoma surgery.
关键词： Laser Peripheral Iridotomy,Primary Angle-Closure Glaucoma,Primary Angle-Closure Suspect,Endothelial Cell Density,Corneal Endothelium,Primary Angle Closure
更新于2025-09-19 17:13:59
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Selective Laser Trabeculoplasty Protects Glaucoma Progression in the Initial Primary Open-Angle Glaucoma and Angle-Closure Glaucoma after Laser Peripheral Iridotomy in the Long Term
摘要： Purpose. To compare the ability of SLT in preventing glaucoma progression in the initial primary angle-closure glaucoma (PACG) after laser peripheral iridotomy and primary open-angle glaucoma (POAG) in the long term. Methods. 60 patients with the initial stage of PACG after laser peripheral iridotomy and 64 initial POAG patients were recruited in a prospective study. Complete success of selective laser trabeculoplasty (SLT) was de?ned as a 20% intraocular pressure (IOP) reduction with topical hypotensive medications without any hypotensive intervention. Pre-SLT rate of progression and post-SLT rate of progression (ROP) was detected in the both groups by means of the trend and the event analysis of perimetry, the Guided Progression Analysis, and the optical coherence tomography- (OCT-) based negative trend for either the thickness of the peripapillary retinal nerve ?ber layer (RNFL) or ganglion cell complex (GCC). Results. IOP decreased signi?cantly after SLT in both the groups. 30% in PACG and 19% in POAG had the progression according to perimetry and 49% in PACG and 40% in POAG had the progression, respectively, according to OCT. After SLT, ROP was reduced from ? 0.14 ± 0.39 dB/year to ? 0.08 ± 0.48 dB/year, p ? 0.034, in PACG and from ? 0.09 ± 0.36 dB/year to ? 0.04 ± 0.43 dB/year, p ? 0.021, in POAG. According to RNFL trend analysis, ROP was reduced from ? 1.86 ± 2.9 μm/year to ? 1.38 ± 2.2 μm/year, p ? 0.039, and from ? 1.24 ± 2.23 μm/year to ? 0.76 ± 1.73 μm/year, p ? 0.037, in PACG and POAG, and according to GCC, ROP was reduced from ? 1.88 ± 2.9 μm/year to ? 1.34 ± 2.0 μm/year, p ? 0.040, and from ? 1.35 ± 2.16 μm/year to ? 0.91 ± 1.86 μm/year, p ? 0.040, in PACG and POAG, respectively. ROP was signi?cantly faster in PACD than in POAG between 2 and 6 years after SLT: ? 0.15 ± 0.46 dB/year and 0.02 ± 0.38 dB/year (p ? 0.042). However, it did not di?er signi?cantly according to OCT. Conclusion. SLT is an e?ective treatment for initial PACG after LPI and POAG that can prevent functional and structural deterioration in the long term.
关键词： Ganglion Cell Complex,Laser Peripheral Iridotomy,Optical Coherence Tomography,Primary Angle-Closure Glaucoma,Selective Laser Trabeculoplasty,Intraocular Pressure,Retinal Nerve Fiber Layer,Primary Open-Angle Glaucoma,Glaucoma Progression
更新于2025-09-16 10:30:52
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Factors Associated with Interventions after Laser Peripheral Iridotomy for Primary Angle-Closure Spectrum Diagnoses
摘要： To assess factors associated with receipt of subsequent medical, laser, or surgical interventions after laser peripheral iridotomy (LPI). Design: Retrospective review. Participants: A total of 1271 eyes in 692 subjects with narrow angles (NAs) that were treated with LPI. Methods: Demographic and clinical factors associated with primary angle-closure (PAC) or PAC glaucoma (PACG) versus PAC suspect (PACS) diagnosis and use of glaucoma medications at the time of LPI, as well as factors predictive of subsequent addition of glaucoma medications, and receipt of selective laser trabeculoplasty (SLT), cataract surgery, and glaucoma surgery were assessed using logistic regression with generalized estimating equations. Kaplan-Meier curves and Cox proportional-hazards regression analysis were used to assess baseline factors affecting the time to SLT, cataract surgery, or glaucoma surgery. Main Outcome Measures: Diagnosis of PAC/PACG and medical, laser, or surgical interventions after LPI. Results: African Americans (odds ratio [OR], 2.12; P < 0.001) were significantly more likely than whites to have PAC/PACG than PACS and to already be taking glaucoma medications (OR, 2.25, P < 0.001) at the time of LPI. In multivariable logistic regression analysis, African Americans were significantly more likely to be prescribed additional glaucoma medications after LPI (OR, 1.73; P = 0.025) and receive glaucoma surgery (OR, 2.7; P = 0.007), but were less likely to receive SLT (OR, 0.37; P = 0.009). In multivariate Cox proportional-hazards regression analysis, African Americans had longer time to SLT than whites (hazard ratio [HR], 0.41; P = 0.022), but a shorter time to glaucoma surgery (HR, 2.57; P = 0.004). There was no significant association between race and the likelihood of cataract surgery or time to cataract surgery (P > 0.10). Conclusions: African Americans were more likely than whites to carry a diagnosis of PAC or PACG at the time of LPI and were significantly more likely to be prescribed additional glaucoma medications and require glaucoma surgery after LPI. Improved screening methods that target African Americans with NAs are needed so that preventive interventions such as LPI can be performed earlier to decrease the risk of progression.
关键词： selective laser trabeculoplasty,primary angle-closure glaucoma,laser peripheral iridotomy,African Americans,glaucoma surgery
更新于2025-09-16 10:30:52
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Effects of Cataract Extraction on the Outcomes of Automated Perimetry and Retinal Nerve Fiber Layer Thickness Measurements by Optical Coherence Tomography in Primary Angle Closure Glaucoma
摘要： Objective: To evaluate the effect of cataract extraction on both visual field and retinal nerve fiber layer thickness measurements in primary angle closure glaucoma (PACG) eyes. Methods: Retrospective cohort study on 30 PACG eyes underwent cataract extraction. Changes in RNFL thickness and visual field parameters including mean deviation (MD), visual field index (VFI) and pattern standard deviation (PSD) were analyzed within 6 months before and after cataract extraction. Results: Overall, MD (p=0.003) and VFI (p=0.004) improved significantly after cataract extraction, whereas PSD showed no significant change (p=0.6). In the 10 eyes with MD worse than -20 dB, mean MD improved by 3.4 ± 3.56 dB (from -24.36 ± 3.06 dB to -20.96 ± 5.06 dB, p=0.01) and mean VFI improved by 16.25 ± 15.66% (from 23.38 ± 9.65% to 39.63 ± 20.83%, p=0.02). PSD showed no significant change after cataract extraction (p=0.07). In the 20 eyes with MD better than -20 dB, MD and VFI also improved postoperatively, but the changes did not reach statistical significance: mean MD improved by 1.64 ± 3.65 dB (from -11.57 ± 5.57 dB to -9.92 ± 5.36 dB, p=0.05) whilst mean VFI improved by 4.57 ± 12.29% (from 74.95 ± 17.95% to 79.52 ± 17.26%, p=0.07). RNFL thickness did not show any significant changes after cataract extraction (p=0.13). Conclusions: Both MD and VFI improved after cataract extraction, especially in eyes with pre-operative MD worse than -20 dB. PSD and RNFL thickness showed no significant change after cataract extraction.
关键词： Perimetry,Visual field,Extraction,Retinal nerve fiber layer thickness,Optical coherence tomography,Primary angle closure glaucoma,Cataract
更新于2025-09-10 09:29:36