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Immediate changes in intraocular pressure after laser peripheral iridotomy in primary angle-closure suspects
Yuzhen Jiang1, Dolly S Chang, Paul J Foster
1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Purpose:
To determine the immediate changes in intraocular pressure (IOP) after laser peripheral iridotomy in primary angle-closure suspects.
Design:
Prospective, randomized controlled trial (split-body design).
Participants:
Seven hundred thirty-four Chinese people 50 to 70 years of age.
Methods:
Primary angle-closure suspects underwent iridotomy using a neodymium:yttrium-aluminum-garnet laser in 1 randomly selected eye, with the fellow eye serving as a control. Intraocular pressure was measured using Goldmann applanation tonometry before treatment and 1 hour and 2 weeks after treatment. Total energy used and complications were recorded. Risk factors for IOP rise after laser peripheral iridotomy were investigated.
Main Outcome Measures:
Intraocular pressure.
Results:
The proportion of treated eyes with an IOP spike (an elevation of ≥8 mmHg more than baseline) at 1 hour and 2 weeks after treatment was 9.8% (95% confidence interval [CI], 7.7-12.0) and 0.82% (95% CI, 0.2-1.5), respectively. Only 4 (0.54%) of 734 eyes (95% CI, 0.01-1.08) had an immediate posttreatment IOP of 30 mmHg or more and needed medical intervention. The average IOP 1 hour after treatment was 17.5±4.7 mmHg in the treated eyes, as compared with 15.2±2.6 mmHg in controls. At 2 weeks after treatment, these values were 15.6±3.4 mmHg in treated eyes and 15.1±2.7 mmHg in controls (P<0.001). No significant difference was detected in the baseline IOP of the treated and untreated eyes. Logistic regression showed that the incidence of IOP spike was associated with greater laser energy used and shallower central anterior chamber.
Conclusions:
Laser peripheral iridotomy in primary angle-closure suspects resulted in significant IOP rise in 9.8% and 0.82% of cases at 1 hour and 2 weeks, respectively. Eyes in which more laser energy and a higher number of laser pulses were used and those with shallower central anterior chambers were at increased risk for IOP spikes at 1 hour after laser peripheral iridotomy.
Insights
Laser peripheral iridotomy can cause temporary intraocular pressure (IOP) spikes in primary angle-closure suspects. Higher laser energy and shallower anterior chambers increase the risk of an IOP rise after the procedure.
Area of Science:
- Ophthalmology
- Laser Surgery
- Glaucoma Research
Background:
- Primary angle-closure suspects are at risk of developing angle-closure glaucoma.
- Laser peripheral iridotomy (LPI) is a common procedure to prevent angle closure.
- Immediate changes in intraocular pressure (IOP) post-LPI require careful monitoring.
Purpose of the Study:
- To evaluate the immediate and short-term changes in intraocular pressure (IOP) following laser peripheral iridotomy (LPI).
- To identify risk factors associated with IOP elevation after LPI in primary angle-closure suspects.
Main Methods:
- Prospective, randomized controlled trial with a split-body design.
- 734 Chinese participants (50-70 years) with primary angle-closure suspects underwent LPI in one eye.
- Intraocular pressure (IOP) measured using Goldmann applanation tonometry pre-treatment, 1 hour, and 2 weeks post-treatment.
Main Results:
- A significant IOP spike (≥8 mmHg elevation) occurred in 9.8% of treated eyes at 1 hour and 0.82% at 2 weeks.
- Only 0.54% of eyes required medical intervention for IOP ≥30 mmHg immediately post-treatment.
- Increased laser energy and shallower central anterior chambers were associated with higher risk of IOP spikes.
Conclusions:
- Laser peripheral iridotomy (LPI) can cause transient IOP elevations in a small percentage of primary angle-closure suspects.
- Risk factors for post-LPI IOP spikes include higher laser energy and shallower anterior chamber depth.
- Close IOP monitoring is recommended in the immediate period following LPI.
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