[A clinical study on laser peripheral iridoplasty for primary angle-closure glaucoma with positive provocative tests...

To evaluate the therapeutic effects of laser peripheral iridoplasty for primary angle closure glaucoma with positive dark room and prone test after laser peripheral iridectomy.

A long-term prospective study of 56 eyes (34 cases) with primary angle-closure glaucoma was carried out. The patients presented with positive dark room and prone provocative test after laser peripheral iridectomy, and laser peripheral iridoplasty by Double-Frequency Nd:YAG laser was performed on them. Their extent of goniosynechia was less than 1/2 circumference of the anterior chamber angle. Forty-nine eyes (27 cases) of all those studied were acute angle-closure glaucoma and the other 7 eyes (7 cases) were chronic angle-closure glaucoma. The inferior peripheral anterior chamber depth, anterior chamber angle, the configuration of peripheral iris and intraocular pressure were observed carefully, and the dark room, prone and mydriatic provocative tests were performed. The postoperative follow-up ranged from 1 year to 4 years.

The results showed that in all these cases, the peripheral anterior chamber depth was increased, the anterior chamber angle was widened on goniscope and the trabecular meshwork could be visualized widely in static state. All patients did not have ocular hypertension and damage of visual field in the follow up. Mydriatic, dark room and prone provocative tests following laser peripheral iridoplasty were negative.

In some acute angle-closure glaucoma and chronic angle-closure glaucoma patients, the pupillary block is relieved by laser peripheral iridectomy, but provocative tests can also be positive because of the abnormal configuration of the peripheral iris. Pupillary dilation results in peripheral iris bunching, and the surface of the trabecular meshwork can be blocked, hypertension then occurs. But the laser peripheral iridoplasty can improve the shape of the peripheral iris effectively and it can prevent the disease from deteriorating. The goniscopic examination and provocative tests following laser peripheral iridectomy are very important and also effective in detecting this kind of glaucoma.