long term follow-up of laser peripheral iridotomy in acute primary angle closure

ABSTRACT

To determine the success rate and complications of YAG laser peripheral iridotomy during a long term follow up in patients of acute primary angle closure glaucoma. Descriptive prospective case series using a combination of quantitative and qualitative analysis. Study was conducted at the Department of Ophthalmology Dow University of Health Sciences; Eye Unit 1, Civil Hospital Karachi between October 2005 and September 2010. Patients were recruited from the outpatient department with a diagnosis of acute primary angle closure. After medical control of intraocular pressure forty eight patients underwent YAG laser peripheral iridotomy with pulse energies ranging from 5-8 mJ. Patients were examined at 1 hour, 1 day, one week, two weeks and 1, 3, 6, months, one year and after two to three years. Findings were recorded on proforma and statistically analyzed. Mean age was 54.6 [ +/- 6.7, range = 45 -74] years. Mean duration of attack was 2.65 [ +/- 1.4, range 1-6] days. The commonest intra-operative complication was bleeding from the iris in 33.3% eyes. Mean follow-up period was 48.81[ +/- 9.03, range 32-65] months. Thirty six [75%] eyes developed significant cataract. Iridotomy was closed in six [12.6%] eyes. Complete success was observed in 12 [24.5%] eyes. Twenty two [44.9%] eyes required additional anti-glaucoma medication [partial success] while complete failure was observed in 14 [28.6%] eyes. YAG laser peripheral iridotomy is associated with a significant number of short term and long term complications in Asian eyes. Other alternative methods should be taken into consideration to prevent blindness in this part of the world