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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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Predictors of Short-Term Intraocular Pressure Change after Laser Peripheral Iridotomy
摘要： To describe short-term intraocular pressure (IOP) changes after laser peripheral iridotomy (LPI) and identify factors predicting IOP lowering. Design: Multicenter, prospective randomized study. Participants: Four hundred fifty-five South Indian eyes of 455 participants 30 years of age or older with a diagnosis of primary angle-closure suspect (PACS), primary angle closure (PAC), or PAC glaucoma (PACG). Methods: Participants were randomized to superior or nasal/temporal LPI. Multivariate regression models were used to determine preoperative features and LPI parameters associated with change in IOP from baseline to the 2-week postoperative examination. Main Outcome Measures: Change in IOP at 2 weeks after LPI compared with baseline. Results: Among all treated eyes, 11.0% of eyes demonstrated a 20% or more decrease in IOP after LPI, whereas 19.6% demonstrated at least a 20% increase in IOP. Intraocular pressure changes occurring after LPI did not differ by LPI location (P > 0.5 for all comparisons). Although the anterior chamber angle widened after LPI (P < 0.001) and was classified as open after laser in most eyes (64% in all 4 quadrants), there was no significant association between gonioscopic angle opening and LPI-induced IOP change (P ? 0.7). Linear regression analysis demonstrated more IOP lowering with higher baseline IOP (3.2 mmHg more lowering per 10-mmHg higher baseline IOP; 95% confidence interval [CI], 2.3e4.1 mmHg) and PAC/PACG diagnosis (1.4 mmHg more IOP lowering vs. PACS diagnosis; 95% CI, 0.2e2.6 mmHg) predicted a lower IOP after LPI. After multivariate adjustment, only higher baseline IOP predicted lower IOP after LPI (P < 0.001). Features not associated with IOP lowering included demographic, visual, and A-scan measures; baseline gonioscopic angle width; total laser energy; LPI area; and LPI location (P > 0.08 for all). Eyes with PAC/PACG, as compared with PACS, demonstrated more IOP lowering after LPI (1.2(cid:2)1.7 mmHg vs. e0.4(cid:2)1.0 mmHg; P < 0.001) after adjusting for baseline IOP. Conclusions: Neither LPI location nor degree of gonioscopic angle opening was associated with statistically significant change in IOP after LPI. Although significant IOP lowering after LPI was uncommon in the overall cohort, higher baseline IOP and PAC/PACG diagnosis predicted lower postoperative IOP.
关键词： primary angle-closure suspect,primary angle closure,laser peripheral iridotomy,intraocular pressure,PAC glaucoma
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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To Study the Efficacy of Laser Peripheral Iridoplasty in the Treatment of Eyes With Primary Angle Closure and Plateau Iris Syndrome, Unresponsive to Laser Peripheral Iridotomy, Using Anterior-Segment OCT as a Tool
摘要： The article discusses the efficacy of laser peripheral iridoplasty (LIP) in treating eyes with primary angle closure and plateau iris syndrome, unresponsive to laser peripheral iridotomy (LPI), using anterior-segment OCT as a tool. It highlights the importance of angle anatomy in the pathomechanism of primary angle closure glaucoma and the role of ASOCT in providing an objective picture of angle structures over time and after interventions. The study was conducted on 100 eyes of primary angle closure randomized to undergo either LPI or LPI plus LIP, with results showing significant IOP lowering in the LIP group, especially in eyes with appositional closure and synechiae <180 degrees.
关键词： intraocular pressure,plateau iris syndrome,primary angle closure,anterior-segment OCT,laser peripheral iridoplasty
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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Corneal topography and angle parameters after laser iridotomy combined with iridoplasty assessed by dual Scheimpflug analyzer
摘要： Purpose To investigate the changes in corneal topography including parameters such as corneal curvature and corneal aberrations, along with anterior chamber angle (ACA) after laser iridotomy (LI) combined with peripheral iridoplasty (PI) using dual Scheimpflug analyzer. Methods In this prospective observational study, dual Scheimpflug analyzer images were acquired before and 1 week after LI plus PI. Corneal curvature of both axial and instantaneous maps from anterior and posterior surface, respectively, and total corneal power (TCP) were acquired. These corneal parameters from three zones (central, middle, and peripheral) and total corneal wavefront aberration, trefoil, and coma were obtained. The ACA from four quadrants, anterior chamber depth (ACD), anterior chamber volume (ACV), and intraocular pressure (IOP) were also inspected. Results ACD increased from 2.15 ± 0.25 to 2.18 ± 0.24 mm (P = 0.002). ACV and ACA from all four quadrants increased significantly after the laser treatment (all P < 0.05). IOP decreased from 16.9 ± 3.1 to 14.7 ± 2.9 mmHg following LI plus PI (P = 0.000). No significant changes were detected in corneal axial and instantaneous curvature from three zones on the anterior and posterior corneal surface after LI plus PI (all P > 0.05). The TCP, total corneal wavefront aberration, trefoil, and coma also revealed no significant changes after the laser procedure (all P > 0.05). Conclusions Treatment with LI combined with PI did not affect the corneal topographic parameters from both anterior and posterior surfaces. However, LI plus PI significantly and effectively improved ACA parameters.
关键词： Anterior chamber angle,Laser iridoplasty,Dual Scheimpflug analyzer,Laser iridotomy,Primary angle closure
更新于2025-09-12 10:27:22
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Argon Laser Peripheral Iridoplasty and Argon Laser Pupilloplasty: Alternative Management for Medically Unresponsive Acute Primary Angle Closure
摘要： 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 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. Definitive 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.
关键词： acute primary angle closure,argon laser peripheral iridoplasty,argon laser pupilloplasty,corneal edema,intraocular pressure
更新于2025-09-11 14:15:04
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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
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Assessment of Schlemm’s canal in acute primary angle closure: an anterior segment optical coherence tomography study
摘要： Purpose To image and quantitatively evaluate the Schlemm’s canal (SC) dimensions in the eyes with acute primary angle closure (APAC) with anterior segment optical coherence tomography (AS-OCT), and compare it with the SC measurements taken after the control of intraocular pressure (IOP) and in the normal age-matched controls. Materials and methods Seventeen eyes of 14 patients with the newly diagnosed APAC and 59 age-matched normal subjects underwent AS-OCT to image SC. SC cross-sectional area, SC meridional and coronal diameters were measured in the temporal and nasal regions at 3 and 9 o’clock position. After laser iridotomy and control of the IOP, all SC parameters were measured again at a week later, in APAC eyes. the SC Intrasession intraobserver reliability of measurements was assessed with intraclass correlation coef?cient. Results Mean SC-SCA (10,600 ± 2691 lm2), SC meridional (682 ± 125 lm) and coronal diameters (21.2 ± 8.2 lm) showed a signi?cant increase in the APAC eyes at presentation, when compared to the SC parameters measured at a week later (6499 ± 1754 lm2, 450 ± 169 lm and 15.75 ± 8.6 lm, p = \ 0.0001, \ 0.0001 and 0.01, respectively) and in the normal controls (7192 ± 1022 lm2, 499.2 ± 179.8 lm, p = 0.02, \ 0.0001, 0.01, respectively). There was no difference in the measured SC parameters between the normal controls and APAC eyes, when the parameters were measured at a week, after resolution of the acute attack (all p [ 0.05). Conclusion A signi?cant expansion of SC was observed in the APAC eyes at presentation, when compared to the normal controls and after the acute attack resolved. SC parameters may provide a useful research tool for evaluating morphological changes in the SC in APAC eyes, during an acute attack.
关键词： Schlemm’s canal,Anterior segment optical coherence tomography,Acute primary angle closure
更新于2025-09-09 09:28:46