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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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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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Safety and Efficacy of 0.1% Nepafenac versus 1% Prednisolone Acetate Eye Drops after Laser Iridotomy a?? A Prospective, Randomized Trial
摘要： Purpose: To compare 0.1% nepafenac, a topical non-steroidal anti-inflammatory drop, with 1% prednisolone acetate in controlling inflammation after Nd:YAG laser peripheral iridotomy (LPI) in primary angle closure suspects (PACS). Design: Prospective randomized controlled trial. Participants: One hundred and fifty-two PACS patients undergoing bilateral LPI. Methods: Patients were randomized to 0.1% nepafenac or 1% prednisolone acetate eye drop in both eyes. Medications were given 4 times daily for 7 days, then twice daily for additional 7 days. Investigators were masked to the type of medication. Right eyes in patients with bilateral PACS and the eye with PACS in asymmetrical disease (primary angle closure in fellow eye) were analyzed. Outcome measures: Non-inferior control of inflammation, defined as absence of cell in the anterior chamber at 2weeks and absence of rebound iritis with medication discontinuation, was the primary outcome, while difference in the rise in intraocular pressure (IOP) was a secondary outcome. Results: Both groups were comparable in baseline characteristics, including IOP, and total laser energy. Nepafenac was non-inferior to prednisolone with regards to inflammation control, with one(1.3%) nepafenac-treated patient failing to meet the primary endpoint because of 1+ anterior chamber cell at 2 weeks and 4(5.4%) prednisolone-treated eyes failing to meet the primary endpoint because of rebound iritis (p <0.001). A greater rise in IOP from baseline to 2 weeks was observed in the prednisolone group compared to the nepafenac group (+2.6 vs. +0.6 mmHg; p=0.004), though at 4 weeks IOPs were not significantly different than baseline in either group (p>0.05 for both). Two weeks after LPI, 3 nepafenac-treated eyes and 10 prednisolone-treated eyes demonstrated a 6-15 mmHg IOP elevation from baseline (p=0.10); while 2 prednisolone-treated eyes and no nepafenac-treated eyes had IOP elevation >15 mmHg (p=0.20). Four weeks after LPI, more prednisolone-treated eyes had IOP elevation of 6-15 mmHg as compared to nepafenac-treated eyes (6 vs. 1, p=0.04); no eyes had IOP elevation >15 mmHg. In an unplanned exploratory analysis, 8 prednisolone-treated patients, but no nepafenac-treated patients required repeat LPI (p=0.003). Conclusions: In our study, nepafenac was non-inferior to prednisolone acetate in controlling post-LPI inflammation with less impact on IOP.
关键词： nepafenac,prednisolone acetate,intraocular pressure,laser peripheral iridotomy,inflammation
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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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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Effect of Anticoagulants and Surgeon-Related Factors on Short-term Outcomes of Laser Peripheral Iridotomy
摘要： To assess the effects of surgeon-related factors on laser peripheral iridotomy (LPI) outcomes by comparing residents and glaucoma specialists, and to look for demographic and clinical predictive factors associated with LPI complications.
关键词： surgeon-related factors,complications,LPI,glaucoma,laser peripheral iridotomy
更新于2025-09-12 10:27:22