Peripheral yttrium aluminium garnet (YAG) iridotomy versus phacoemulsification in primary angle closure: prospective comparative study.

PURPOSE: A study was designed to determine and describe the changes induced in the anterior segment of the eye and the intraocular pressure (IOP) after laser peripheral iridotomy (LPI) versus phacoemulsification in primary angle closure suspects (PACS) and primary angle closure (PAC). METHODS: Forty-seven eyes (47 patients) with Shaffer gonioscopy 0-II were included and split into 2 groups: cataract surgery (n=29) or LPI (n=18), depending on the lens sclerosis and visual acuity. Tonometry, gonioscopy, funduscopy, and automated measurements of the anterior chamber by Pentacam were performed before the intervention, and one and 3 months after the technique. RESULTS: Phacoemulsification reduces IOP after one and 3 months (P<.01). LPI reduces IOP after 3 months (P<.04), and after one month (P<.38). IOP was 16.2mmHg (SD: 3.59) in the phacoemulsification group vs. 16.83mmHg (SD: 2.36) in the LPI group after one month (P=.4), and 15.52 (SD: 2.95) vs. 16.05 (SD: 2.46) in the third month (P=.5). There were no significant differences in the antiglaucoma drugs. Shaffer gonioscopy grading was greater in the phacoemulsification group vs. in the LPI group one and 3 months after the intervention (P=.01). The highest difference between both techniques was found in the superior quadrant. The anterior chamber depth, angle and volume by Pentacam were wider in the phacoemulsification group after one and 3 months (P<.01). CONCLUSIONS: Although phacoemulsification and LPI could both be effective techniques in the prevention of pupillary block in PAC, faster and greater amplitude of the angle and the anterior chamber can be obtained after phacoemulsification than after LPI.

Características estructurales del disco óptico y la capa de fibras neurorretinianas mediante tomografía confocal láser en la sospecha de cierre angular primario / Structural characteristics of the optic disc and the neuroretinal nerve fiber layer observed by confocal laser tomography in suspected primary angle closure

Objetivo: evaluar las características del disco óptico y la capa de fibras neurorretinianas en la sospecha de cierre angular primario, el desempeño de las funciones discriminantes y la influencia del tamaño del disco en estos.Métodos: estudio de serie de casos de corte transversal en 47 ojos (30 pacientes) con sospecha de cierre angular primario. Se utilizó el tomógrafo confocal de barrido láser (HRT 3, Heidelberg Engineering, Alemania). Para el análisis de la influencia del tamaño del disco se consideraron tres grupos: área de disco menor de 1,6 mm2, entre 1,6 y 2 mm2 y mayor de 2,0 mm2.Resultados: el área de disco se relacionó positivamente con el área de copa, área de anillo, volumen de copa, área de sección transversal de la capa de fibras neurorretinianas y tamaño de copa (p=0,023, p=0,009, p=0,022, p=0,026, p=0,020 respectivamente) y negativamente con la curvatura horizontal de la capa de fibras neurorretinianas (p=0,019). Hubo una relación significativa con la variación de la altura del contorno (p=0,008), fundamentalmente a expensas de las diferencias de los discos pequeños con los medianos. Para las funciones MRA, GPS y FSM el mejor desempeño fue en el disco pequeño (aproximandamente 92 porciento de concordancia con el disco sano en cada una). La función RB mostró la mayor coincidencia (100, 96 y 100 porciento; según grupos de área de disco), mientras el GPS, la menor (92, 72 y 55,6 porciento respectivamente).Conclusiones: el área de disco se relaciona con el área de copa, área de anillo, volumen de copa, área de sección transversal y curvatura horizontal de la capa de fibras neurorretinianas, tamaño de copa y variación de altura del contorno. Las funciones MRA, GPS y FSM identifican el disco sano con mayor certeza cuando es pequeño. La función RB se desempeña mejor mientras el GPS peor, independientemente del valor de área de disco

Objective: to evaluate the characteristics of the optic disc and of the retinal nerve fiber layer in the suspected primary angle closure, the performance of glaucomatous discriminant functions, and the influence of the optic disc size in the results.Methods: a cross-sectional case series study in 47 eyes (30 patients) with suspected primary angle-closure, for which the confocal laser tomography (HRT 3, Heidelberg Engineering, Germany), was used to obtain the images. The influence of the optic disc size was analized in 3 groups: < 1,6mm2, 1,6 - 2,0 mm2 y > 2,0 mm2.Results: the disc area was positively related to the cup area, the rim area, the cup volume, the retinal nerve fiber layer cross sectional area, and the cup size (p=0,023, p=0,009, p=0,022, p=0,026, p=0,020 respectively) and negatively related with the horizontal curvature of the retinal nerve fiber layer (p=0,019). There was a significant relation to the variation of contour height (p=0,008), particularly to differences between small and medium size discs. Discriminant functions such as MRA, GPS and FSM performed better in small discs (approximately 92 per cent of agreement with the normal discs for each one). The RB function obtained the greater coincidence (100, 96 and 100 per cent for respective groups of disc areas), whereas GPS obtained the smallest (92, 72 and 55,6 per cent respectively).Conclusions: the disc area is related to cup area, rim area, cup volume, retinal nerve fiber layer cross sectional area, retinal nerve fiber layer horizontal curvature, cup size and the variation of contour height. The MRA, GPS and FSM discriminant functions identify better the normal optic disc when it is small. The RB function performs the best whereas the GPS performs the worst, regardless of the disc area

Características estructurales del disco óptico y la capa de fibras neurorretinianas mediante tomografía confocal láser en la sospecha de cierre angular primario / Structural characteristics of the optic disc and the neuroretinal nerve fiber layer observed by confocal laser tomography in suspected primary angle closure

Objetivo: evaluar las características del disco óptico y la capa de fibras neurorretinianas en la sospecha de cierre angular primario, el desempeño de las funciones discriminantes y la influencia del tamaño del disco en estos.Métodos: estudio de serie de casos de corte transversal en 47 ojos (30 pacientes) con sospecha de cierre angular primario. Se utilizó el tomógrafo confocal de barrido láser (HRT 3, Heidelberg Engineering, Alemania). Para el análisis de la influencia del tamaño del disco se consideraron tres grupos: área de disco menor de 1,6 mm2, entre 1,6 y 2 mm2 y mayor de 2,0 mm2.Resultados: el área de disco se relacionó positivamente con el área de copa, área de anillo, volumen de copa, área de sección transversal de la capa de fibras neurorretinianas y tamaño de copa (p=0,023, p=0,009, p=0,022, p=0,026, p=0,020 respectivamente) y negativamente con la curvatura horizontal de la capa de fibras neurorretinianas (p=0,019). Hubo una relación significativa con la variación de la altura del contorno (p=0,008), fundamentalmente a expensas de las diferencias de los discos pequeños con los medianos. Para las funciones MRA, GPS y FSM el mejor desempeño fue en el disco pequeño (aproximandamente 92 porciento de concordancia con el disco sano en cada una). La función RB mostró la mayor coincidencia (100, 96 y 100 porciento; según grupos de área de disco), mientras el GPS, la menor (92, 72 y 55,6 porciento respectivamente).Conclusiones: el área de disco se relaciona con el área de copa, área de anillo, volumen de copa, área de sección transversal y curvatura horizontal de la capa de fibras neurorretinianas, tamaño de copa y variación de altura del contorno. Las funciones MRA, GPS y FSM identifican el disco sano con mayor certeza cuando es pequeño. La función RB se desempeña mejor mientras el GPS peor, independientemente del valor de área de disco(AU)

Objective: to evaluate the characteristics of the optic disc and of the retinal nerve fiber layer in the suspected primary angle closure, the performance of glaucomatous discriminant functions, and the influence of the optic disc size in the results.Methods: a cross-sectional case series study in 47 eyes (30 patients) with suspected primary angle-closure, for which the confocal laser tomography (HRT 3, Heidelberg Engineering, Germany), was used to obtain the images. The influence of the optic disc size was analized in 3 groups: < 1,6mm2, 1,6 - 2,0 mm2 y > 2,0 mm2.Results: the disc area was positively related to the cup area, the rim area, the cup volume, the retinal nerve fiber layer cross sectional area, and the cup size (p=0,023, p=0,009, p=0,022, p=0,026, p=0,020 respectively) and negatively related with the horizontal curvature of the retinal nerve fiber layer (p=0,019). There was a significant relation to the variation of contour height (p=0,008), particularly to differences between small and medium size discs. Discriminant functions such as MRA, GPS and FSM performed better in small discs (approximately 92 percent of agreement with the normal discs for each one). The RB function obtained the greater coincidence (100, 96 and 100 per cent for respective groups of disc areas), whereas GPS obtained the smallest (92, 72 and 55,6 percent respectively).Conclusions: the disc area is related to cup area, rim area, cup volume, retinal nerve fiber layer cross sectional area, retinal nerve fiber layer horizontal curvature, cup size and the variation of contour height. The MRA, GPS and FSM discriminant functions identify better the normal optic disc when it is small. The RB function performs the best whereas the GPS performs the worst, regardless of the disc area(AU)