A novel iridoplasty suture technique to repair iris defects and traumatic mydriasis

A new iridoplasty method is described, which uses the U-suture technique to repair traumatic mydriasis and large iris defects. Two 0.9 mm opposing corneal incisions were made. The needle was inserted through the first incision, passed through the iris leaflets, and removed through the second incision. The needle was reinserted through the second incision and removed through the first incision by re-passing the needle through the iris leaflets to form a U-shaped suture. The modified Siepser technique was applied to fix the suture. Thus, with a single knot, the iris leaflets were brought closer (shrinking like a pack), fewer sutures were used and fewer gaps were left. Satisfactory aesthetic and functional results were obtained in all cases in which the technique was applied. There was no suture erosion, hypotonia, iris atrophy, or chronic inflammation during the follow-up.

Glaucoma de ângulo fechado devido a síndrome de íris em platô / Primary angle closure glaucoma due to plateau íris syndrome

Resumo Objetivo: Descrever um caso de glaucoma de ângulo fechado devido a síndrome de íris em platô. Descrição do caso: Paciente do sexo feminino, de 50 anos de idade, que há 13 meses foi tratada de fechamento angular primário a esquerda com sucesso com iridotomia periféria com Nd:YAG laser, compareceu ao serviço com queixa de embaçamento visual e dor intermitentes no olho esquerdo. Ao exame, observou-se fechamento angular à esquerda que se desfazia à gonioscopia de identação e pressão intraocular (PIO) de 16 e 42mmHg. O exame do ângulo da câmara anterior pela tomografia de coerência óptica evidenciou iridotomia patente em ambos os olhos e à esquerda o fechamento aposicional. Pelo estudo das imagens do ângulo foi possível identificar a configuração íris em platô, caracterizando a síndrome de íris em platô à esquerda. Foi procedida a goniosplastia com laser de argônio em ambos os olhos, o que permitiu a correção da configuração da íris e controle da PIO. Após o tratamento, foi realizado exame de campo visual que foi normal à direita e à esquerda identificou escotoma arqueado superior. O fundo de olho mostrou disco óptico normal a direita (0,2),e glaucomatoso à esquerda (0,6). Um ano após a gonioplastia, a acuidade visual foi de 20/30 sem correção por ambos os olhos, PIO de 12 e 13mmHg, sem medicações, com fundo de olho e campos visuais inalterados. Conclusão: A configuração íris em platô deve sempre ser considerada frente a casos de fechamento angular primário, sendo a tomografia de coerência óptica valiosa ferramenta para corroborar no seu diagnóstico.

Abstract Objective: To present a case of closed-angle glaucoma due to Plateau iris syndrome. Case Description: Female Patient, 50 years old, that 13 months ago was treated for primary angular closure to the left successfully with iridotomy with Nd: YAG Laser. She attended the service complaining of visual haze and intermittent pain in the left eye. On examination, it was observed angle closure in the left that could be openned with identation. Intraocular pressure (IOP) of 16 and 42mmHg respectively. The examination of the anterior chamber angle by optical coherence tomography showed patent iridotomy in both eyes and on the left the apositional angle closure. By studying the angle images it was possible to identify plaeau iris configuration, characterizing the iris syndrome of plateau iris. Gonioplasty with argon laser was performed in both eyes, which allowed the correction of iris configuration and control of IOP. After treatment, visual field examination was performed, which was normal to the right and to the left identified superior arcuate scotoma. The Fundus showed a normal right optical disc (0.2), and glaucomatous left (0.6). One year after gonioplasty, visual acuity was 20/30 without correction by both eyes, PIO of 12 and 13mmHg, without medications, with unaltered visual fields and optic discs. Conclusion: The Iris configuration in Plateau should always be considered in front of cases of primary angle closure, being the optical coherence tomography valuable tool to corroborate in its diagnosis.

Lasers in glaucoma

While lasers have been used for many years for the treatment of glaucoma, proper indications and use of the procedures need to be considered before their application. This review summarizes the important laser procedures in Glaucoma.

Efficiency of glaucoma treated by laser iridoplasty combined with YAG laser or by traditional trabeculectomy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To discuss the clinical effects of laser iridoplasty combined with YAG laser or traditional trabeculectomy in the treatment of glaucoma. <p>METHODS: The clinical data of 60 cases(60 eyes)of patients with glaucoma were retrospectively analyzed. The patients who underwent laser iridoplasty combined with YAG laser iridotomy were included in observation group(<i>n</i>=38, 38 eyes), and those who underwent traditional trabeculectomy were included in control group(<i>n</i>=22, 22 eyes). The changes of intraocular pressure(IOP), angle opening distance(AOD500), central anterior chamber depth(ACD), corneal endothelial cell density(ECD)were compared between the two groups before operation and at 1mo, 3mo and 12mo after operation, and the occurrence of complications within 12mo after operation were analyzed in the two groups. <p>RESULTS: At 1mo, 3mo and 12mo after operation, the IOP level in the two groups was decreased significantly compared with that before operation, and the level in observation group was significantly lower than that in control group(<i>P</i><0.05). The levels of AOD500 and ACD in observation group were significantly higher than those before treatment and than those in control group(<i>P</i><0.05). There was no statistically significant difference in the ECD level of observation group compared with that before operation(<i>P</i>>0.05), but the level was significantly higher than that in control group(<i>P</i><0.05). Within 12mo after operation, the total incidence rate of complications in observation group was significantly lower than that in control group(<i>P</i><0.05). <p>CONCLUSION: Laser iridoplasty combined with YAG laser for glaucoma can obtain an ideal treatment effect, and its safety is better than traditional trabeculectomy and it is beneficial to the recovery of ocular function.

Effect comparison of laser peripheral iridoplasty at different sites of iris in pigment rabbit glaucoma / 中华实验眼科杂志

Background Laser peripheral iridoplasty (LPI) is widely used in the treatment of glaucoma by flattening the iris and widening angle of anterior chamber (AA).However,no evidence suggests the optimal site of LPI in iris.Objective This study was to compare the therapeutic effects of LPI at different sites of iris for glaucoma.Methods Glaucoma models were established in the right eyes of 40 healthy adult male pigment rabbits by intrachamber injection of 0.1 ml compound carbomer solution with 0.3％ carbomer and 0.025％ dexamethasone.The models were randomly divided into model control group,corneoscleral limbus group,one spot from corneoscleral limbus group and two spots from corneoscleral limbus group.LPI was performed at corresponding site of iris by 532 nm argon laser with the spot diameter 500 μm,energy 300 mW,exposure time 0.3 seconds and laser number 24 spots,and the rabbits in the model control group did not receive LPI.Intraocular pressure (IOP),coefficient of outflow facility (C value) were measured and calculated with Schi(o)tz tonometer before LPI and 2,4,7,14 and 30 days after LPI,and anterior chamber depth (ACD),AA,anterior chamber angle opening distance within 500 μm radius from scleral spur (AOD500) were measured with ultrasound biomicroscope (UBM).The eyeballs were extracted 30 days after LPI,and the chamber angle were observed under the optical microscope after hematoxylin and eosin staining.The use and care of the animals complied with the Guide for the Care and Use of Laboratory Animals of the National Institutes of Health.Results UBM showed that compared with the model control group,the anterior chamber angle was evidently widened in all the LPI groups,with the best effectiveness in the one spot from corneoscleral limbus group and the worst one in the two spots from corneoscleral limbus group.Compared with the model control group,the IOP was evidently reduced,and C values,AA and AOD500 were significantly increased in the corneoscleral limbus group,one spot from corneoscleral limbus group and two spots from corneoscleral limbus group after LPI,showing significant differences among the four groups (IOP:Fgroup =16.848,P ＜ 0.01;C value:Fgroup =9.629,P ＜ 0.01;AA:Fgroup =62.336,P＜0.01;AOD500:Fgroup =77.779,P ＜ 0.01).IOP was reduced and C value,AA and AOD500 were increased in 2,4,7,14 and 30 days after LPI as compared with before LPI,with significant differences over time (IOP:Ftime =3.041,P =0.011;C value:Ftime =4.311,P＜0.01;AA:Ftime =14.627,P＜0.01;AOD500:Ftime =20.378,P＜0.01).Compared with the model control group,the ACD was significantly increased in the corneoscleral limbus group and one spot from corneoscleral limbus group,and that in the two spots from corneoscleral limbus group was significantly reduced,and the ACD was insignificantly increased over time after LPI (Fgroup =18.017,P＜0.01;Ftime =0.022,P =1.000).Hematoxylin and eosin staining showed that the trabecular meshwork and adhesion of tissure were reopened and the anterior chamber angle was widened after LPI.Conclusions LPI can widen anterior chamber angle and lower the IOP.The best therapeutic outcome for glaucoma is displayed when LPI is performed at the iris site corresponding to one spot from the corneoscleral limbus.

Application of phacoemulsification with laser peripheral iridoplasty for acute angle-closure glaucoma with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM: To observe the application of phacoemulsification combined with laser peripheral iridoplasty ( LPIP ) for acute angle-closure glaucoma with cataract which could not be controlled well by drugs.?METHODS:From January 2011 to June 2015, 49 eyes in 47 patients with acute angle - closure glaucoma and cataract were recruited while their intraocular pressure remained higher than 40mmHg 12h after drug treatment. LPIP were performed and phacoemulsification and intraocular lens implantation were carried out 3d after. Their clinical data and follow-up results were reviewed.?RESULTS: The intraocular pressure before treatment, 1d after LPIP, 1d after phacoemulsification, 1mo after phacoemulsification and 3mo after phacoemulsification were 62. 35+10. 31mmHg, 17. 96 ± 4. 64 mmHg, 16. 58 ± 3. 19mmHg, 13. 50 ± 2. 74 mmHg and 13. 46 ± 2. 48 mmHg respectively (F=10. 02,P<0. 05); the intraocular pressure of 1d (t=4. 35), 1mo (t=6. 43) and 3mo (t=6. 97) after phacoemulsification were all lower than the initial pressure (P<0. 05). The visual acuity showed the same trendy, while the visual acuity before treatment, 1d after LPIP, 1d, 1 and 3mo after phacoemulsification were 0. 06± 0. 02, 0. 20 ± 0. 18, 0. 45 ± 0. 19, 0. 60 ± 0. 11 , 0. 65 ± 0. 09 respectively (F=8. 36,P<0. 05). The best corrected visual acuity at 1d, 1 and 3mo after phacoemulsification were better than that before laser treatment ( t= 3. 97, 5. 12, 5. 89,P<0. 05). At 1d and 3mo after phacoemulsification, the anterior chamber depth, angle opening distance, trabecular/iris angle were all better than the initial ones (P<0. 05). At 1 and 3mo after phacoemulsification, the goniosynechia got better as well (P<0. 05).?CONCLUSION:Phacoemulsification combined with LPIP can reduce intraocular pressure, improve the visual acuity and make the anterior chamber depth, angle opening distance, trabecular/ iris angle, goniosynechia better for patients with acute angle-closure glaucoma and cataract when drug cannot control intraocular pressure well.

Efficacy of treating the early-stage chronic angle closure glaucoma with laser peripheral iridoplasty / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the safety of the laser peripheral iridoplasty ( LPIP ) for the early-stage chronic primary angle-closure glaucoma ( ECPACG) . METHODS:Sixty-five eyes of 36 patients with ECPACG received LPIP. At preoperative and postoperative, patients were examined with intraocular pressure ( IOP ) , anterior chamber, optical coherence tomography ( OCT) , visual acuity, visual field, fundus and complications. The mean follow-up was 18. 2±6. 7mo (ranged 12~24mo). RESULTS: The preoperative average IOP were 23. 8±5.6mmHg, postoperative 1wk, 1, 3, 6, 12mo and in the last follow-up time the average IOP were 18. 7±3. 8, 17. 9±3. 2, 17. 6±3. 5, 18. 4±3. 7, 18. 6±3. 7, and 18. 6±7. 8mmHg. There was statistical difference comparing with preoperative (P0. 05). The postoperative visual acuity, visual field, fundus had not changed. There were no complications found. CONCLUSION:LPIP is safe, and has the short time effect in the treatment of ECPACG. With elapse of time, the effect of LPIP is weakened. We can repeat the treatment.

Laser peripheral iridoplasty combined with iridectomy for the unmanageable acute angle-closure glaucoma by medication / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect and safety of laser peripheral iridoplasty combined with iridectomy in the unmanageable acute angle - closure glaucoma by medication. METHODS:Totally 19 cases (21 eyes) with acute angle-closure glaucoma, including 15 cases ( 17 eyes ) with primary glaucoma and 4 cases (4 eyes) with intumescent cataract - induced glaucoma, were recruited into the study. The intraocular pressure ( IOP ) of all cases were still >21mmHg after 24h drug treatment, and then were treated by laser peripheral iridoplasty combined with iridectomy. The visual accurity, IOP, cornea, peripheral anterior chamber depth, anterior chamber angle and complications were observed at 24h after the surgery. RESULTS:The mean IOP of all cases was reduced from 53. 09±11. 01mmHg before the surgery to 14. 98±4. 21mmHg at 24h after the treatment, with significant statistical difference ( P CONCLUSION: Laser peripheral iridoplasty combined with iridectomy is an effective and safe method for the treatment of the unmanageable acute angle - closure glaucoma by medication.

Estudio de la efectividad de la iridoplastia periférica con Nd YAG láser doblado mediante imágenes de Scheimpflug y gonioscopia / Study of the effectiveness of double-frequency Nd YAG laser peripheral iridoplasty using Scheimpflug images and gonioscopy

Objetivo: evaluar la efectividad de la iridoplastia periférica con Nd YAG láser doblado mediante imágenes de Scheimpflug y gonioscopia.Métodos: estudio longitudinal descriptivo prospectivo en 40 ojos (23 pacientes) con cierre angular residual (grado 0-2 según Shaffer) por bloqueo pupilar (n=30) o por síndrome de iris plateau (n=10). La presión intraocular, gonioscopia e imágenes de Scheimpflug (Oculus Pentacam) fueron obtenidas antes de la cirugía y 1 semana después, y luego comparadas.Resultados: 70 porciento de los ojos con bloqueo pupilar (p=0,00) y 100 porciento con iris plateau mostraron gonioscópicamente ángulos grado 2-3 (según Shaffer) en el posoperatorio. Las imágenes de Scheimpflug no evidenciaron modificación de la abertura angular posquirúrgica (p=0,696, p=0,572, bloqueo pupilar; p=0,053, p=0,113, iris plateau). El volumen medio de la cámara anterior (p=0,001 y p=0,008) y el diámetro pupilar (p=0,002, bloqueo pupilar) se incrementaron significativamente. Se obtuvo una reducción posoperatoria de la presión intraocular de 2,4 mmHg (p=0,004, bloqueo pupilar) y 3,6 mmHg (p=0,011, iris plateau). Las complicaciones fueron mínimas y fueron resueltas con tratamiento tópico.Conclusiones: la iridoplastia con Nd YAG láser es efectiva y segura. Las imágenes de Scheimpflug no son útiles para adquirir mensuraciones precisas de la amplitud del ángulo camerular

Objective: to assess the effectiveness of double-frequency Nd YAG laser peripheral iridoplasty using Scheimpflug images and gonioscopy.Methods: longitudinal prospective and descriptive study of 40 eyes (23 patients) with residual angle-closure (Shaffer´s grade 0-2) due to pupillary block (n=30) or plateau iris syndrome (n=10). The gonioscopy, Scheimpflug images (Oculus Pentacam) and intraocular pressure were obtained preoperatively and one week postoperatively and then compared.Results: of the surgical eyes, 70 per cent with pupillary block (p=0,000) and the 100 per cent with plateau iris were Shaffer´s grade 2-3 postoperatively. The Scheimpflug images did not show changes on angle openness after surgery (p=0,696, p=0,572, pupillary block; p=0,053, p=0,113, plateau iris). The mean volume of anterior chamber (p=0,001 and p=0,008) and the pupil diameter (p=0,002 in pupillary block) significantly increased The intraocular pressure reduction of 2,4 mmHg (p=0,004, pupillary block) and 3,6 mmHg (p=0,011, plateau iris) was obtained. Complications were minimal and responded well to topical treatment.Conclusion: the Nd YAG laser peripheral iridoplasty is effective and safe. Scheimpflug images are not useful for precise measurements of angle openness

Management of angle closure glaucoma.

Primary angle closure glaucoma (PACG) is equally prevalent in Indian in Asian population as the primary open angle glaucoma. Eighty-six percent of people with PACG are in Asia, with approximately 48.0% in China, 23.9% in India and 14.1% in southeast Asia. To understand PACG, it is mandatory to understand its classification and type of presentation with the underlying pathophysiology. The treatment options are medical, laser and/or surgical. The present article provides an overview of PACG.

Laser Peripheral Iridotomy with Iridoplasty in Primary Angle Closure Suspect: Anterior Chamber Analysis by Pentacam

PURPOSE: To compare conventional laser peripheral iridotomy (LPI) and LPI combined with laser peripheral iridoplasty in eyes with primary angle closure suspect (PACS) by assessment of anterior chamber dimensional changes using a Pentacam. METHODS: Forty-eight eyes of 24 subjects with bilateral PACS were recruited consecutively. Each eye was randomly allocated to treatment with conventional LPI, argon LPI only, or LPI plus iridoplasty, which consisted of simultaneous argon LPI and peripheral iridoplasty. Anterior chamber measurements were performed on each eye using a Pentacam, both before and after treatment. Mean anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle were measured, and topographic ACD analysis was performed. Results were compared between the two treatment groups. RESULTS: After treatment with either conventional LPI or LPI plus iridoplasty, the mean ACD and ACV increased significantly. Topographic ACD analysis revealed that the mid-to-peripheral ACD increase was significantly greater in the LPI plus iridoplasty group than in eyes treated with conventional LPI. Intraocular pressure changes and post-LPI complications did not differ between the groups. CONCLUSIONS: Compared with conventional LPI, our study showed that LPI plus iridoplasty improved the mid-to-peripheral ACD increase. This procedure may have a role as an adjunct for reducing angle closure by simultaneously eliminating pupillary and non-pupillary block components.

Change in Angle Parameters Measured by Anterior Segment Optical Coherence Tomography after Laser Peripheral Iridotomy Alone versus Laser Peripheral Iridotomy and Argon Laser Peripheral Iridoplasty

PURPOSE: To compare the changes in angle parameters after laser peripheral iridotomy (LPI) alone versus LPI and ALPI (argon laser peripheral iridoplasty) in primary angle closure patients by using anterior segment optical coherence tomography (AS-OCT). METHODS: A total of 25 eyes from 17 patients with narrow angles were enrolled in this present study. Eleven eyes in the LPI treatment group and 14 eyes in the LPI and ALPI combined treatment group were evaluated using AS-OCT. The anterior chamber depth (ACD), angle opening distance at 500 microm (AOD 500) and 750 microm (AOD 750), angle recess area at 500 microm (ARA 500) and 750 microm (ARA 750), trabecular-iris space area at 500 microm (TISA 500) and 750 microm (TISA 750), trabecular-iris angle (TIA) were measured. The pre- and post-treatment parameters were compared in each group. The parameter changes after laser treatment were also compared. RESULTS: AOD 500, AOD 750, ARA 500, ARA 750, TISA 500 and TISA 750 except ACD significantly increased following LPI treatment (p = 0.013, p = 0.010, p = 0.008, p = 0.003, p = 0.006, p = 0.003, p = 0.013, respectively, Wilcoxon signed rank test) and LPI and ALPI combined therapy (p = 0.001, p = 0.001, p = 0.001, p = 0.001, p = 0.001, p = 0.001, p = 0.001, respectively, Wilcoxon signed rank test). The AOD 500 difference, TISA 500 difference, and TISA 750 difference were significantly greater after LPI and ALPI combined therapy than after LPI treatment alone (p = 0.112, p = 0.147, p = 0.049, p = 0.037, respectively, Mann-Whitney U-test). CONCLUSIONS: The results from the present study showed LPI alone or LPI and ALPI combined therapy significantly widened the anterior chamber angle and combined therapy showed greater effect than LPI alone.

Effect of selective laser trabecularplasty on early chronic primary angle-closure glaucoma / 上海第二医科大学学报

21 mmHg.The side effects,IOP and application of anti-glaucoma drugs were examined 1 h,1 d,1 week,1 month,3 months and 6 months after SLT. Results The IOP was significantly decreased 1 week,1 month,3 months and 6 months after SLT compared with that before treatment(P21 mmHg using two anti-glaucoma drugs,respectively. Conclusion SLT is a safe and effective method for IOP control in early CPACG after treatment with laser peripheral iridoplasty and laser iridectomy.

Effect of Combined Argon Laser Peripheral Iridoplasty and Laser Iridotomy in Primary Angle-Closure Glaucoma

PURPOSE: To assess the effect of argon laser peripheral iridoplasty in patients with primary angle-closure glaucoma. METHODS: Eyes of 63 patients with primary angle-closure glaucoma who needed laser therapy were evaluated. We divided the patients randomly into two groups and studied prospectively. Thirty eyes (30 patients) were treated with both laser iridotomy and argon laser peripheral iridoplasty. Thirty-three eyes (33 patients) were treated with only laser iridotomy. Anti-glaucoma drugs were not used after laser therapy, and intraocualr pressure (IOP) over 21 mmHg during follow-up period were considered as failure. RESULTS: No differences were found between the two groups in age, sex, initial IOP, clinical forms of angle closure, degrees of peripheral antirior synechiae, and follow-up period. Patients treated with argon laser peripheral iridoplasty and laser iridotomy had successfully controlled IOPs (<21 mmHg) than those with only laser iridotomy through 8 months after laser therapy (p<0.05, log-rank test). However, there was no difference in the two groups at the final follow-up months (12 months) (p=0.180, log-rank test). CONCLUSIONS: Argon laser pheripheral iridoplasty decreased IOP in the early post-laser period. However, in the long term follow-up, the effect of argon laser pheripheral iridoplasty did not last when compared with laser iridotomy.

Effectiveness of Argon Laser Peripheral Iridoplasty in the Treatment of Severe Acute Angle-Closure Glaucoma

We used argon laser peripheral iridoplasty to reduce intraocular pressure[IOP] in acute angle-closure glaucoma[ACG] which is unrelieved by medical and physical treatments and could not be treated by peripheral iridotomy due to edematous cornea and turbid aqueous. Eight of 16 eyes [16 patients] were successfully treated. These successfully treated eyes had a mean duration of angle closure of 4.1 days and 8 unsuccessfully treated eyes 9.2 days. The 6 eyes of 8 eyes with successful reduction of IOP after argon laser peripheral iridoplasty were treated peripheral iridotomy at average 1.7 day later and had deep anterior chamber. After a mean follow-up period of 2 months, 7 of these 8 successfully treated eyes had an IOP less than or equal to 21mmHg. Argon laser pripheral iridoplasty may be successful in treating ACG which is unrelieved by medical and physical treatments and could not be treated by pripheral iridotomy, especially in cases that are recognized and treated soon after onset.

Argon Laser Peripheral Iridoplasty in Angle-Closure Glaucoma

The purpose of this study is to evaluate the clinical factors in eye with continued appositional angle closure in the presence of a patent iridectomy and the clinical avaiability of argon laser peripheral iridoplasty(ALPI). In this study we retrospectively reviewed the outcome in 59 eyes of 32 patients who underwent iridectomy. After Dark Room Prone-position Test(DRPT), 15 eyes among 59 eyes(25.4%) showed DRPT positive and ALPI was successfully performed in 13 eyes among these 15 eyes(86.7%). Patients with DRPT positive were younger than those with DRPT negative. One eye had postoperative complication; iritis more than 1 week. In this study it was found that Argon lader peripheral iridoplasty is a Safe and an effective means of opening an appositionally closed angle in situations in which laser ridotomy does not physically eliminate appositional angle closure.