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In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
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Long-term Persistent Angle Closure and Anatomic Changes after Laser Iridotomy in Suspected Primary Angle-Closure.

Andrea Servillo1, Tin A Tun2, Chungkwon Yoo3

  • 1Department of Glaucoma, Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore; Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy.

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Summary
This summary is machine-generated.

Laser peripheral iridotomy (LPI) effectively widens angles in most primary angle-closure suspects, but persistent angle closure can occur. Thicker irises and narrower angles at baseline predict this outcome 5 years post-LPI.

Keywords:
Angle closureAnterior segment OCTLaser peripheral iridotomyRandomized controlled trial

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Area of Science:

  • Ophthalmology
  • Anatomic studies
  • Glaucoma research

Background:

  • Primary angle-closure suspect (PACS) is a precursor to angle-closure glaucoma.
  • Laser peripheral iridotomy (LPI) is a common treatment for PACS.
  • Long-term outcomes of LPI in PACS are crucial for clinical management.

Purpose of the Study:

  • To determine the rate of persistent angle closure 5 years after LPI in PACS.
  • To identify baseline anatomical predictors of persistent angle closure.
  • To assess anterior segment changes over 5 years post-LPI.

Main Methods:

  • Subanalysis of the Singapore Asymptomatic Narrow Angles Laser Iridotomy Study (SALSA).
  • Evaluated 375 phakic patients with 5-year follow-up after LPI.
  • Utilized gonioscopy and anterior segment imaging to assess angle closure and anatomical parameters.

Main Results:

  • Persistent gonioscopic angle closure occurred in 33.1% of eyes at 5 years post-LPI.
  • Greater baseline iris thickness (IT750) and younger age predicted persistent angle closure.
  • Angle width increased within 2 years post-LPI and remained stable.

Conclusions:

  • LPI provides sustained angle widening in approximately two-thirds of patients.
  • Baseline iris thickness and narrow angles are significant predictors of persistent angle closure despite LPI.
  • These findings aid in risk stratification and management of PACS.