Korean J Ophthalmol.  2009 Dec;23(4):286-290. 10.3341/kjo.2009.23.4.286.

Prognostic Factors for the Success of Laser Iridotomy for Acute Primary Angle Closure Glaucoma

• Lee JW
• Lee JH
• Lee KW

• KMID: 754765
• DOI: http://doi.org/10.3341/kjo.2009.23.4.286

Abstract

PURPOSE
To identify the prognostic factors for successful laser iridotomy for acute angle-closure glaucoma (AACG).
METHODS
We retrospectively reviewed the medical records of 77 eyes of 77 patients with AACG with initial intraocular pressure (IOP) above 40 mmHg. All of the patients received maximum tolerable medical therapy (MTMT) followed by laser iridotomy. In order to comparatively analyze the factors affecting successful laser iridotomy, an increase in IOP on follow-up was defined as increase in IOP greater than 21 mmHg requiring medical or surgical treatment.
RESULTS
Successful laser iridotomy was achieved in 59.7% (46/77 eyes). Thirty-one eyes (40.3%) exhibited increased IOP on follow-up, and of these, 30 eyes developed an increase in IOP within six months after the first attack. The success rate was higher (92.9%) in 42 patients who had greater than 30% IOP reduction by MTMT at the first attack compared to the 35 patients whose IOP reduction was less than 30%, of which 24 eyes (72.7%) showed more than 30% IOP reduction after intravenous hyperosmotic agent treatment (p=0.012). The success rate was higher in patients treated within seven days after the development of symptoms than in those treated after seven days (Odds ratio, 4.51; 95% confidence interval, 1.38 to 14.75).
CONCLUSIONS
Our data suggest that we can expect successful IOP control after laser iridotomy in eyes with AACG if the patient can be treated within seven days after the development of symptoms and if the IOP reduction was more than 30% by MTMT.

Keyword

Acute angle-closure glaucoma; Laser iridotomy

MeSH Terms

Acute Disease
Adult
Aged
Aged, 80 and over
Female
Filtering Surgery/*methods
Follow-Up Studies
Glaucoma, Angle-Closure/physiopathology/*surgery
Humans
Intraocular Pressure/physiology
Iris/*surgery
Laser Therapy/*methods
Male
Middle Aged
Prognosis
Retrospective Studies

Reference

1. Rivera AH, Brown RH, Anderson DR. Laser iridotomy vs surgical iridectomy. Have the indications changed? Arch Ophthalmol. 1985. 103:1350–1354.

2. Robin AL, Pollack IP. Argon laser peripheral iridotomies in the treatment of primary angle closure glaucoma: long-term follow-up. Arch Ophthalmol. 1982. 100:919–923.

3. Hong C, Hahn SH, Sohn YH. Argon laser iridotomy for acute angle closure glaucoma. J Korean Ophthalmol Soc. 1983. 24:807–811.

4. Han CW, Kim JW. Effect of YAG laser iridotomy on IOP in chronic angle closure glaucoma. J Korean Ophthalmol Soc. 1995. 36:1730–1736.

5. Lee HB, Hwang WS, You JM, et al. Sequential Argon and Nd: YAG laser iridotomies in angle closure glaucoma. J Korean Ophthalmol Soc. 1990. 40:2245–2251.

6. Gazzard G, Friedman DS, Devereux JG, et al. A prospective ultrasound biomicroscopy evaluation of changes in anterior segment morphology after laser iridotomy in Asian eyes. Ophthalmology. 2003. 110:630–638.

7. Buckley SA, Reeves B, Burdon M, et al. Acute angle-closure glaucoma: relative failure of YAG iridotomy in affected eyes and factors influencing outcome. Br J Ophthalmol. 1994. 78:529–533.

8. Fleck BW, Wright E, Fairly EA. A randomized prospective comparison of operative peripheral iridectomy and Nd:YAG laser iridotomy treatment of acute angle closure glaucoma: 3 year visual acuity and IOP control outcome. Br J Ophthalmol. 1997. 81:884–888.

9. Kashiwagi K, Abe K, Tsukahara S. Quantitive evaluation of changes in anterior segment biometry by peripheral laser iridotomy using newly developed scanning peripheral anterior chamber depth analyser. Br J Ophthalmol. 2004. 88:1036–1041.

10. Yoon DH. Glaucoma. 2008. v. 1:4th ed. Seoul: Korean Glaucoma Society;chap. 4.

11. Kim YY, Jung HR. Clarifying the nomenclature for primary angle-closure glaucoma. Surv Ophthalmol. 1997. 42:125–136.

12. Chung JH, Park JS, Choi YI. Long-term IOP outcome after successful laser iridotomy for the acute primary angle-closure glaucoma. J Korean Ophthalmol Soc. 2003. 44:1102–1106.

13. Aung T, Ang LP, Chan SP, Chew PT. Acute primary angle-closure: Long-term intraocular pressure outcome in Asian eyes. Am J Ophthalmol. 2001. 131:7–12.

14. Lee HJ, Kim JH, Sohn YH. Long-term intraocular pressure change in attacked and fellow eyes with acute angle-closure glaucoma after laser iridotomy. J Korean Ophthalmol Soc. 2004. 45:1298–1303.

15. Oh YG, Minelli S, Spaeth GI, Steinman WC. The anterior chamber angle is different racial groups, a gonioscopic study. Eye. 1994. 8:104–108.

16. Lowe RF. Clinical types of primary angle-closure glaucoma. Aust N Z J Ophthalmol. 1988. 16:245–250.

17. Lee JY, Kim YY, Jung HR. Distribution and characteristics of peripheral anterior synechiae in primary angle-closure glaucoma. Korean J Ophthalmol. 2006. 20:104–108.

18. Kim YY, Jung HR. Dilated, miotic-resistant pupil and laser iridotomy in primary angle-closure glaucoma. Ophthalmologica. 1997. 211:205–208.