Evaluation of changes in anterior segment morphology using Sirius Scheimpflug-Placido disk topographer following laser peripheral iridotomy in primary angle-closure disease

Purpose: To assess the morphological changes in the anterior segment following laser peripheral iridotomy (LPI) in primary angle?closure disease (PACD) using Sirius Scheimpflug?Placido disk corneal topographer. Methods: This was a prospective observational study. A total of 52 eyes of 27 patients with PACD who underwent LPI were analyzed for iridocorneal angle (ICA), anterior chamber depth (ACD), anterior chamber volume (ACV), horizontal visible iris diameter (HVID), corneal volume (CV), central corneal thickness (CCT), and horizontal anterior chamber diameter (HACD) 1 week following LPI, using Sirius Scheimpflug?Placido disk corneal topographer. Data analysis was done using Statistical Package for the Social Sciences (SPSS) software version 19.0, and paired t?test was used to assess the statistical significance. Results: Laser peripheral iridotomy was performed in 43 eyes with primary angle?closure suspect (PACS), six eyes with primary angle closure (PAC), and three eyes with primary angle?closure glaucoma (PACG). The analysis of the data showed statistically significant changes in anterior segment parameters of ICA, ACD, and ACV. Post?laser increase in ICA from 34.13° ± 2.64° to 34.75° ± 2.84° (P < 0.041), mean ACD increase from 2.21 ± 0.25 to 2.35 ± 0.27 mm (P = 0.01), and mean ACV increase from 98.19 ± 12.13 to 104.15 ± 11.16 mm3 (P = 0.001) were noted. Conclusion: Significantly quantifiable short?term changes in the anterior chamber parameters of ICA, ACD, and AC volume were seen after LPI in patients with PACD on Sirius Scheimpflug?Placido disc corneal topographer.

Medium-long-term efficacy of trabeculectomy in the treatment of pigmentary glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the medium-long-term efficacy of trabeculectomy in the treatment of pigmentary glaucoma(PG).METHODS: The clinical data of 38 patients(51 eyes)who were diagnosed with PG and received trabeculectomy at the Affiliated Hospital of Yunnan University from January 2010 to September 2022 were retrospectively analyzed. The postoperative follow-up ranged from 3 to 144mo. The intraocular pressure(IOP), visual acuity and refractive status were analyzed, complications were recorded and surgical efficacy was evaluated.RESULTS: The average preoperative use of IOP lowering drugs was 2.90±0.12, with a mean IOP of 18.89±7.40mmHg. The IOP at 3d, 1, 3, 6mo, 1a after surgery and the last follow-up visit were 14.68±5.08, 13.99±2.95, 14.25±2.50, 14.36±2.83, 14.33±2.66, 14.94±1.95mmHg, respectively, and postoperative IOP was significantly lower at all time points than that before surgery(P&#x003C;0.05), while there was no significant difference at all time points after surgery(P&#x003E;0.05). During the follow-up period, the visual acuity of all patients was stable, and no endophthalmitis or malignant glaucoma occurred. At the last follow-up, the complete success rate was 90%, the qualified success was 8%, and the failure rate was 2%.CONCLUSION: Trabeculectomy is a safe and effective treatment method for PG, which can effectively control the IOP, and stabilize the visual acuity and relieve the reverse pupil block.

Increase in anterior chamber angle depth after topical pilocarpine measured by spectral domain optical coherence tomography: A possible additional indicator for laser peripheral iridotomy in primary angle-closure suspects in an opportunistic set-up

Purpose: Indication of laser peripheral iridotomy (LPI) is often conjectural due to dependency on gonioscopy and strict dichotomous classification of occludability. Indentation gonioscopy is the gold standard but is under?utilized for various reasons. The prevalence of primary angle closure disease (PACD) in eastern India is 1.5–1.9%, with a 22% five?year progression rate. Many angle closure patients may go blind without timely diagnosis and iridotomy. General ophthalmologists need alternate, validated methods for diagnoses. Pilocarpine eye drop causes miosis, and flattens the iris, producing angle changes detectable by spectral domain optical coherence tomography (SD?OCT). We hypothesized that the amount of angle change may be a suitable indicator for iridotomy. Methods: Our prospective cross?sectional single?masked observational study evaluated pilocarpine?induced changes in angle parameters detected by SD?OCT. Out of 372 patients enrolled, 273 patients (539 eyes) remained, with a mean age of 48.6 years (SD = 10.36). All eyes were graded by the Van Herick (VH) method, gonioscopy, and anterior segment (AS) SD?OCT and reassessed after pilocarpine drops. Results: The sensitivity and specificity of tomography measurements against gonioscopy grades were 61% and 85%, respectively. The receiver operating characteristic (ROC) curve was 0.85. Pilocarpine?induced angle widening was significant in gonioscopically narrower angles. Low Van Herick grades (217 eyes), narrow gonioscopy grades (238 eyes), and a narrow OCT angle value (165 eyes) were candidates for iridotomy. Conclusion: Our study results showed that pilocarpine?induced angle widening detected by SD?OCT could be a strong objective indicator for LPI

Observation on the efficacy of Nd:YAG laser peripheral iridotomy in the treatment of drug-uncontrollable PACG in acute attack / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the effects of Nd:YAG laser peripheral iridotomy(LPI)in the treatment of drug-uncontrollable primary angle-closure glaucoma(PACG)in acute attack.<p>METHODS: A prospective study was conducted on 22 eyes of 20 patients with drug-refractory primary angle-closure glaucoma treated in the Department of Ophthalmology of Xiangyang No.1 People's Hospital from May 2019 to June 2020. All subjects underwent Nd:YAG LPI. Visual acuity, intraocular pressure, chamber angle closure range, anterior chamber angle(ACA), anterior chamber volume(ACV), central anterior chamber depth(CACD)and peripheral anterior chamber depth(PACD)were measured before and after the operation. And observe the complications of LPI.<p>RESULTS:All patients can implement LPI. All subjects' chamber angle closure range were >180° before LPI and 9 eyes(41%)were ≤180° after LPI. The intraocular pressure of 21 eyes(95%)had significantly lower than postoperative(<i>P</i><0.05). Postoperative anterior chamber parameters such as ACA, ACV and PACD were increased(<i>P</i><0.05). During the operation,15 eyes(68%)had iris cascade or silk hemorrhage and 5 eyes(23%)had corneal epithelial damage.<p>CONCLUSION: LPI has high safety and can be implemented in the acute attack stage of drug-uncontrollable PACG. It can reduce intraocular pressure effectively and relieve symptoms, which has a significant effect in the patients.

Correlation factors on progression of primary angle-closure into glaucoma after laser peripheral iridotomy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To determine the factors associated with primary angle-closure(PAC)progression to glaucoma(PACG)after laser peripheral iridotomy(LPI)at baseline.<p>METHODS: This was a prospective cohort study. Subjects were consecutively enrolled among the patients with PAC at the ophthalmology clinic of our Hospital between January 2017 and December 2017. Among these 86 eyes of 86 PAC patients who fulfilled the inclusion criteria, 65 eyes of 65 patients who fulfilled the inclusion criteria of 5 or more VFs and 2 years or more of follow-up were selected. The mean follow-up period was 2.65±0.27 years. According to the occurrence of visual field defects and corresponding glaucomatous optic nerve damage, the patients were divided into the progressive group and the non-progressive group, and the correlative factors of PAC progression after LPI were analyzed in PAC patients.<p>RESULTS: PAC progression after LPI was observed in 9 of 65 eyes(14%). There were significant differences in age and inter-visit IOP fluctuations between the progressive group(68.67±7.03 years, 10.11±4.17mmHg)and the non-progressive group(61.95±8.03 years, 5.54±2.73mmHg)(<i>P</i><0.05). The frequency of PAC progressing into PACG with VCDR≥0.6, PAS≥1 quadrants, all angle-closure>2 quadrants was significantly higher in the progressing eyes than in the non- progressing eyes(<i>P</i><0.05). PAC progression was significantly positively correlated with age, inter-visit IOP fluctuations, VCDR≥0.6, PAS≥1 quadrants, and all angle-closure >2 quadrants(<i>r</i>s=0.304, 0.396, 0.495, 0.268, 0.309).<p>CONCLUSION:PAC patients after LPI with PAS≥1 quadrants and all angle-closure >2 quadrants, VCDR≥0.6, older age,higher inter-visit IOP fluctuations were more likely to progress to glaucoma.

Quantitative evaluation of anterior chamber angle after laser peripheral iridotomy by spectral-domain anterior segment optical coherence tomography (AS-OCT) / 眼科新进展

Objective To quantitatively assess anterior chamber angle of primary angle-closure glaucoma (PACG) and primary angle-closure (PAC) patients after laser pheripheral iridotomy (LPI) by spectral-domain anterior segment optical coherence tomography (SD-AS-OCT),and investigate which parameters should be used in these patients and the clinical significance of these parameters in screening and follow-ups of glaucoma.Methods Fifty-five eyes of 40 patients diagnosed with PACG remission (11 eyes,8 patients),PAC (20 eyes,20 patients) or PAC suspect (24 eyes,12 patients) were examined.Each eye was examined by SD-AS-OCT at upper,lower,nasal,and temporal sides.Anterior chamber angle (ACA),trabecular iris angle (TIA),and trabecular iris space area (TISA500/750) were measured or calculated.All results were analyzed.Results The points from the inside to the corneal scleral spur 500 μm and 750 pm were selected,AOD,TIA,ACA,TISA at upper,lower,nasal,and temporal sides were measured,which were included into 500 series and 750 series.The mean values of TIA,ACA and AOD in the 500 series and 750 series were the largest in the temporal side and the lowest in the nasal side.The mean values of TISA measurement was the largest in the lower side and the smallest at the upper side.Pearson correlation analysis showed that TIA500 and ACA500 (r =0.799,P =0.00),TIA750 and ACA750 (r =0.799,P =0.00),TIA500 and TISA500 (r=0.919,P =0.00),TIA750 and TISA750 (r =0.920,P =0.00) had positive correlation.With TIA500 as independent variable x and TISA500 as dependent variable y,the regression equation was obtained:y =-0.300 + 0.005x (F =1195,P =0.00),which showed TISA500 and TIA500 were linearly positive correlated.With TIA750 as independent variable x,and TISA750 as dependent variable y,the regression equation was obtained:y =-0.440 + 0.009x (F =854,P =0.00),which showed TISA750 and TIA750 were linearly positive correlated.The coefficient of variation of the 750 series parameters were less than the 500 Series in the four directions.Conclusion SD-AS-OCT is an efficient tool for efficiency evaluation and follow-up during the course of PACG and PAC after LPI.For narrow angles,as the parameters of 750 series parameters have less variability,so 750 series are more recommended in clinical application.

Research advances in surgical management approaches for uveitic glaucoma / 眼科新进展

Uveitic glaucomas (UG) are complex in cause or disease and response to treatment.UG typically is associated with very high intraocular pressure and more intense optic nerve damage than other glaucoma types.This secondary glaucoma requires an early diagnosis and adequate management of both uveitis and glaucoma.Recently,a multitude of novel medical therapies and surgical techniques have been added to the armamentarium of existing therapeutic modalities.This article reviews the surgical treatment of UG,including Trabeculectomy,laser peripheral iridotomy,nonperforating deep sclerectomy,glaucoma drainage implants,minimally invasive glaucoma surgery,and also briefly discusses the application and effect of these surgical treatments.

Efficacy of laser peripheral iridotomy for different type of primary angle closure suspect based on UBM / 局解手术学杂志

Objective This thesis is aimed to compare and analyze the effectiveness of laser peripheral iridotomy ( LPI) in treating pu-pillary block primary angle-closure suspect ( PACS) and multimechanism PACS in eyes .Methods A total of 85 eyes of 75 patients with PACS in ophthalmology department of Daping hospital affiliated to army medical university were divided by using ultrasound biomicroscopy (UBM) into two groups:pupillary block PACS group(36 eyes) and multimechanism PACS group(49 eyes).All patients received LPI treat-ment,and the images of anterior chamber angle were collected by anterior segment optical coherence tomography (AS-OCT) at the time of be-fore,1 week and 3 months after treatment.Then,the parameter values (AOD500,AOD750,TISA500,TISA750,ACV,ACD,ACW,CCT)of an-terior chamber in AS-OCT images were recorded .Results Comparing to the parameter values before treatment ,AOD500,AOD750,TISA500, TISA750,ACV and ACD significantly increased at the time of 1 week and 3 months after LPI in both groups(P<0.05),while ACW or CCT remain unchanged(P>0.05).Moreover,the increasement in AOD500,AOD750,TISA500 and TISA750 in pupillary block group was more significant than that in multimechanism group 1 week and 3 months after treatment(P<0.05).The differences of AOD500,AOD750,TI-SA500 and TISA750 between pre-operation and post-operation(1 week and 3 months after treatment) in pupillary block group were more sig-nificantly increased than those in multimechanism group (P<0.05).Conclusion LPI can significantly increase the angle width in PACS , which is more effective for pupillary block group than multimechanism group .

Clinical observation of the early complications after Neodymium: YAG laser peripheral iridotomy in patients with different anterior angle status / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the early complications after Nd: YAG laser peripheral iridotomy(LPI)in patients with different anterior angle status and analysis the indications for laser treatment. <p>METHODS:This was a retrospective case series. Totally 362 cases(512 eyes)were involved in the treatment of Nd:YAG laser peripheral iridotomy in Xijing Hospital between January 2013 to June 2015. The early complications including iridemia, intraocular pressure spike, iridocyclitis, corneal or lens injury and others after laser peripheral iridotomy were analyzed and followed up for 3mo. <p>RESULTS:Totally 274 females(416 eyes)and 88 males(96 eyes)were involved in the study. Among the 512 eyes identified, 248 eyes had primary angle closure glaucoma(PACG), 108 eyes had primary angle closure(PAC), 72 eyes had primary angle closure suspect(PACS), 66 eyes had no signs or symptoms(the fellow eye of PACG), and 18 eyes had secondary glaucoma or ocular hypertension with pupillary block. After LPI, 107 eyes(20.9%)had iridemia, 85 eyes(16.6%)had intraocular pressure spike, 14 eyes(2.7%)had iridocyclitis, 10 eyes(2%)had corneal injury, 2 eyes(0.4%)had lens injury, 1 eye(0.2%)had decompression retinopathy, and 2 eyes(0.4%)had exudative retinal detachment. The incidence of iridemia was highest among patients with acute PACG(33.7%, <i>P</i>=0.019), and the incidence of intraocular pressure spike was highest among patients with chronic PACG(23.0%, <i>P</i>=0.047). <p>CONCLUSION: The most common complications of Nd:YAG LPI include iridemia and intraocular pressure spike. Whether PACG patients are more likely to have these complications needs further study. Rare serious complications like decompression retinopathy and exudative retinal detachment should be considered. The indications and timing of LPI should also be chosen carefully according to the patient's specific condition.

Anterior Segment Changes after Laser Iridotomy for the Treatment and Prevention of Angle-closure Glaucoma

PURPOSE: To evaluate the changes and characteristics of the anterior segment of the eye after laser peripheral iridotomy (LPI) conducted on patients with acute angle closure crisis (AACC) for both therapeutic purposes and prophylactic purposes in the fellow eye. METHODS: Anterior segments were examined by topography, laser interferometry, anterior segment optical coherence tomography, anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), angle opening distance (AOD), central corneal thickness (CCT), and axial length as compared to prior procedures in 20 eyes with glaucoma (treatment group) and 20 contralateral eyes (prophylactic group) in 20 patients diagnosed with AACC. RESULTS: Before laser treatment, there were no significant differences in pre-LPI ACV, ACA, AOD and axial length, although differences in the CCT and ACD existed between the groups. Compared to prior laser treatment at 1 and 3 months after laser treatment, the ACV, ACA, AOD 500, and AOD 750 increased in both groups. When both groups were compared 1 month after their laser treatments, the AOD 750 was increased in the treatment group. There were no significant differences between two groups 3 months post LPI. CONCLUSIONS: Other than changes in the ACD and CCT, no significant differences were observed in the anterior segment characteristics in AACC affected and contralateral eyes prior to LPI. After LPI, the treatment group showed greater changes in their anterior segments; however, the open angle was maintained at 1 month post treatment.

Serous Retinal Detachment Following Laser Peripheral Iridotomy for the Angle Closure Secondary to Posterior Scleritis / 계명의대학술지

This study was aimed to report a case of serous retinal detachment following laser peripheral iridotomy (LPI) for the treatment of angle closure secondary to posterior scleritis. A 55-year-old man with bilateral ocular pain, redness, and headache was referred to Keimyung University Dongsan Medical Center. At the initial examination, his visual acuity was 1.0 in the both eyes. The intraocular pressure (IOP) was 25 mmHg in the right eye and 28 mmHg in the left eye. Slit lamp examination showed a shallow anterior chamber, which was found to be Shaffer grade I by gonioscopy. There were no specific findings in the fundus, except a slightly edematous disc margin in both eyes. LPI was performed on both eyes. Fourth day after LPI, the patient complained of a central scotoma and visual disturbance of the left eye, in which the visual acuity had decreased to 0.06. The optical coherence tomography showed serous retinal detachment at the posterior pole. Fluorescein angiography revealed a focal leakage in the superotemporal area, as well as multiple hyperfluorescence lesions. Posterior scleritis of the left eye was diagnosed. Systemic steroid therapy was initiated and the area with the leakage was treated by focal laser photocoagulation. Two weeks later, the serous retinal detachment of the left eye resolved and visual acuity improved to 0.63. Laser peripheral iridotomy can exacerbate serous retinal detachment in patients with posterior scleritis that presented as acute angle closure.

Pigment Dispersion Syndrome and Reverse Pupillary Block after Implantable Collamer Lens with Central Hole Implantation

PURPOSE: To report a case of pigment dispersion syndrome and reverse pupillary block secondary to the implantation of implantable collamer lens (ICL) with a central hole (AQUA ICL®) that was treated with ICL removal and laser peripheral iridotomy (LPI). CASE SUMMARY: A 29-year-old woman with myopia in both eyes underwent implantation of AQUA ICL®. Four weeks postoperatively, the intraocular pressure (IOP) increased to 34 mm Hg and the patient showed pigment dispersion syndrome in both eyes. Since the IOP did not reduce with the maximum tolerable medical therapy, the ICLs were removed 8 weeks after implantation. The pigment dispersion subsided and IOP reduced shortly after ICL removal. However, 4 weeks after removal of ICL, posterior iris bowing and reverse pupillary block occurred in the right eye and the IOP increased to 46 mm Hg. LPI was performed in the right eye, and the reverse pupillary block was dissolved after a reduction in pigment dispersion. The IOP subsequently normalized to 13 mm Hg. Two weeks later, prophylactic LPI was performed in the left eye. Four weeks after prophylactic LPI, selective laser trabeculoplasty was performed on both eyes. As a result, the IOP was 11 mm Hg in the right eye and 12 mm Hg in the left eye after 4 weeks of treatment with topical IOP-lowering medications. CONCLUSIONS: The present case indicates that implantation of ICL with a central hole can lead to early postoperative pigment dispersion syndrome. When this condition persists and is accompanied by reverse pupillary block after ICL removal, LPI can be partially effective.

Relationship between appositional angle closure and darkroom provocative test in fellow eyes of acute primary angle closure after laser peripheral iridotomy / 中华实验眼科杂志

BackgroundLaser peripheral iridotomy(LPI) can break the pupillary block,and is an effective method of treating acute primary angle closure (APAC).However,a part of APAC eyes may gradually develop a formation and extension of peripheral anterior synechia(PAS) and increased intraocular pressure(IOP) after LPI.ObjectiveTo investigate the relationship between appositional angle closure and darkroom provocative test(DRPT) in the fellow eyes with APAC after LPI.Methods Fellow eyes of APAC without PAS after LPI were studied.Ultrasounic biomicroscopy(UBM) were performed in darkness to observe whether appositional angle closure occurred and compare the relationship between the quadrants with appositional angle closure and the results of DRPT.Results Fifty-four patients were included in the study.Appositional angle closure was observed in at least one quadrant in 20(37.0％ ) of the 54 fellow eyes with APAC after LPI.Fifty-one patients were given DRPT and positive result in 9 patients( 17.6％ ).According to the quadrants with appositional angle closure,there were 5 patients with DRPT positive results in 46 patients with appositional angle closure 0 to 2 quadrants,and 4 patients with DRPT positive results in 5 patients with appositional angle closure 3 to 4 quadrants ( P =0.003 ).Bivariate correlation analysis indicated a positive correlation between the value of the increased IOP in DRPT and the number of quadrants with appositional angle closure in darkness( r =0.397,P =0.004).ConclusionsA certain proportional fellow eyes of APAC appeared appositional angle closure in darkness and DRPT positive result after LPI.The more the quadrants of appositional angle closure after LPI,the greater the likelihood of a positive DRPT.It suggests that the APAC fellow eyes and attack eyes with the same anatomical configuration still have the possibility of angle closure after LPI,and need follow-up and treatment for a long time.

Phacoemulsification versus Combined Phacotrabeculectomy in Closed-Angle Patients with Re-Elevated Intraocular Pressure after Peripheral Iridotomy

PURPOSE: To investigate the clinical courses between phacoemulsification (PE) and PE with combined trabeculectomy (phacotrabeculectomy, PETL) in closed-angle patients with re-elevated intraocular pressure (IOP) after laser peripheral iridotomy (LPI). METHODS: Closed-angle patients whose IOP re-elevated between 19 and 38 mm Hg after LPI were included. Medical records of 26 patients in the PE group and 21 patients in the PETL group who were followed for more than 12 months after surgery were reviewed for clinical course. RESULTS: The IOP courses after surgery showed no statistical difference during the study period except at 1 and 7 days after surgery, in which IOP in the PETL group were lower than that in the PE group. The number of anti-glaucoma drugs also showed no significant difference except at 6 months, when the number was greater in the PE group. Success rates for IOP below 18 mm Hg at 3 years were 96.2% in the PE group, higher than the 69.8% in the PETL group (Log Rank test, p = 0.015). Postoperative complications were found in 2 patients in the PE group and in 8 patients in the PETL group (Fisher's exact test, p = 0.028). CONCLUSIONS: We suggest that PE is a viable surgical alternative to PETL in closed-angle patients who have mildly re-elevated IOP after LPI.

Follow-up of laser peripheral iridotomy in fellow eyes with unilateral acute attack of primary angle closure glaucoma / 中华实验眼科杂志

Background Laser peripheral iridotomy(LPI) is used as the primary therapy for the eyes at risk of angle closure.But there are still 28% eyes with primary angle closure suspect occur angle closure within 2 years after LPI.It is necessary to explore the associated factors of the efficacy of LPI.Objective The aim of this study was to explore the changes of intraocular pressure(IOP) and anterior chamber angle in the fellow eyes of patients with unilateral acute attack of primary angle closure glaucoma (PACG) and analyze the relevant factors influencing the successful rate of LPI.Methods Eighty-seven fellow eyes received LPI from 87 patients with unilateral acute attack of PACG were included in this study and retrospectively analyzed.The IOP and gonioscopy were performed before and 1 week,3,6,9,12 months after LPI.Successful signs of LPI were defined as an IOP 6-21mmHg without any anti-glaucoma medication,none of glaucomatous neuropathy and the coincident visual field loss,and no need of additional glaucomatous medication or surgery.This study was approved by Ethic Committee of the First Hospital of Xinxiang Medical College,and written informed consent was obtained from each patient.Results Seventy-nine eyes of 79 cases finished the medical visit throughout the follow-up duration with the age 61.4±0.4 years and 33(41.8%) males and 46(58.2%) females.The mean IOP was lowed in various time points after LPI in comparison with before operation with the general difference among different time visiting groups(F=4.056,P＜0.01).Shaffer grade was increased in superior,temporal and nasal quadrants and significant differences were found between 1 week group,3 months group or 6 months group and before operation group (P＜0.05).LPI lessened the range of appositional angle closure (AAC) in postoperative 1 week group and 3 months group compared with pre-operative group (P＜0.05),but no statistically significant reduce was seen in range of AAC from 6 months through 12 months after LPI in comparison with pre-operation (P＞0.05).LPI was determined as successful in 61 cases (77.2%) during one-year fellow-up period.Several variables,such as preoperative IOP,Shaffer grade of each quadrant,mean Shaffer grade and the extent of AAC,were significantly different between LPI success and failure group(P＜0.01).Cox stepwise regression analysis found that the success rate was significantly associated with the extent of AAC (Wald=48.150,RR=1.963,P＜0.01) rather than pre-IOP,Shaffer grade of each quadrant,mean Shaffer grade,age and gender (P＞0.05).Conclusion LPI can widen the anterior chamber angle and low IOP in the fellow eyes of PACG attack eyes.The success rate of LPI is associated with the extent of pre-AAC,suggesting that it is necessary for LPI in consideration of the extent of pre-AAC.

Evaluation methods of anterior chamber and angle structures after laser peripheral iridotomy / 中华实验眼科杂志

Laser peripheral iridotomy ( LPI) is one of the main therapy for glaucoma due to its reliable efficacy of widening peripheral angle and therefore decreasing intraocular pressure by partially relieving pupillary block. The parameters of the anterior chamber angle following the LPI are the main evaluation indexes. At present,the detecting and diagnosis technique for the anterior chamber angle is deeply advancing, including gonioscopy, ultrasound biomicroscopy, anterior segment optical coherence tomography and Pentacam. These methods offer some useful parameters and also present with some limits in the application respectively in the evaluation of anterior chamber and angle structure. This review focuses on the application of Methods mentioned above and morphologic changes of anterior chamber and angle structure following the LPI.

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.

Bilateral Simultaneous Acute Angle Closure Glaucoma Following Sexual Intercourse Aided by Sildenafil Citrate

PURPOSE: The authors of the present study report a case of bilateral simultaneous acute angle closure glaucoma following sildenafil citrate-aided sexual intercourse. CASE SUMMARY: A 63-year-old man visited the emergency department with sudden onset of bilateral ocular pain and blurred vision. The patient had taken 50 mg sildenafil citrate followed by sexual intercourse. His visual acuity on presentation was 0.3 in the right eye and 0.5 in the left eye. Intraocular pressure (IOP) was 54 mm Hg and 46 mm Hg in the right and left eye, respectively. Anterior chamber depths were shallow and angles were closed on gonioscopy in both eyes. The patient was treated with ocular hypotensive medication and subsequently managed with bilateral YAG laser peripheral iridotomies. During the 13 months of follow-up, there was no recurrent angle closure attack and IOPs were well-controlled. CONCLUSIONS: The mechanism of bilateral angle closure glaucoma caused by sildenafil citrate is not proven. Those who are predisposed towards developing angle-closure glaucoma may be at risk when having sexual intercourse aided by sildenafil citrate.

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.

A Case of Decompression Retinopathy After Resolution of Acute Primary Angle-Closure Glaucoma

PURPOSE:To report a case of ocular decompression retinopathy after resolution of acute primary angle closure (APAC) subsequent to medical treatment and laser peripheral iridotomy (LPI). CASE SUMMARY: A patient presented with APAC of the right eye with markedly elevated intraocular pressure (IOP) and a LPI was done after lowering the IOP with medical treatment. On presentation, visual acuity was 0.3 in the right eye (OD) and IOP was 74 mmHg OD. Two hours after medical treatment IOP was found to be 16 mmHg OD. Ten hours after resolution of the acute attack, the patient's visual acuity was 0.2 OD and IOP was 11 mmHg OD. LPI was subsequently performed in the right eye. The post-LPI IOP was 10 mmHg and the patient complained of visual disturbance and floaters OD. Three days after LPI the IOP was normal but her visual acuity had decreased to counting fingers OD. In addition, scattered retinal hemorrhages including alarge pre-retinal hemorrhage on the macula were found upon dilated funduscopic examination. After three months the retinal hemorrhage had been absorbed and her visual acuity was 0.7 OD. CONCLUSIONS: Decompression retinopathy can develop in the posterior pole of the retina in patients with APAC after medical treatment and LPI.