Argon Laser Peripheral Iridoplasty for Primary Angle-Closure Glaucoma: A Randomized Controlled Trial

Area of Science:

• Ophthalmology
• Glaucoma Research
• Laser Therapy

Background:

• Primary angle closure (PAC) and primary angle-closure glaucoma (PACG) are significant causes of vision loss.
• Persistent appositional angle closure despite laser iridotomy (LI) necessitates further treatment.
• Effective management strategies are crucial for preventing irreversible optic nerve damage.

Purpose of the Study:

• To evaluate the efficacy of argon laser peripheral iridoplasty (ALPI) versus medical therapy.
• To compare treatment outcomes in patients with persistent appositional angle closure after LI.

Main Methods:

• A randomized controlled trial involving 80 patients with PAC or PACG.
• Participants received either 360° ALPI or medical therapy (prostaglandin analog).
• Success was defined by intraocular pressure (IOP) ≤21 mmHg with or without medication at 1 year.

Main Results:

• ALPI resulted in a 30.0% failure rate compared to 7.5% with medical therapy (P = 0.01).
• Complete success (IOP ≤21 mmHg without medication) was achieved in 35.0% of ALPI eyes versus 85.0% of medical therapy eyes (P < 0.001).
• Lower IOP reduction was observed in the ALPI group (4.9 mmHg) compared to the medication group (6.1 mmHg).

Conclusions:

• Argon laser peripheral iridoplasty (ALPI) is less effective than prostaglandin analog therapy for persistent angle closure post-LI.
• ALPI is associated with higher failure rates and reduced IOP lowering.
• Medical therapy is a more favorable option for managing elevated IOP in this patient cohort.