Evaluating the Need for Anti-Inflammatory Medication Post-Laser Peripheral Iridotomy

To evaluate whether the administration of topical steroids is beneficial after elective laser peripheral iridotomy (LPI).

A prospective, randomized, double-masked, placebo-controlled clinical trial.

Twenty-eight patients (56 eyes) with anatomical narrow angles and no other ocular diseases requiring bilateral LPI.

Participants underwent LPI in both eyes 1 week apart. Following the first LPI, eyes were randomized to receive either topical steroid (prednisolone acetate 1%) or placebo eye drops (artificial tears) 4 times daily for 4 days. The fellow eye received the alternative treatment after the second LPI.

Intraocular pressure (IOP), iridotomy patency, anterior segment inflammation, and symptoms assessed via the Ocular Surface Disease Index (OSDI) questionnaire.

Baseline characteristics and laser parameters were similar between arms. At 1 week, anterior chamber inflammation was absent in all control eyes and present in 2 steroid-treated eyes (7.4%); at 1 month, no eyes had inflammation. Iridotomy was not patent in 3 control eyes (10.7%) and 4 steroid eyes (14.3%) at 1 month (P > 0.99). The OSDI scores were low and similar between arms at each visit. Mean IOP did not change significantly from baseline across visits (overall P = 0.603) and did not differ between arms (overall P = 0.243). In multivariable analyses, baseline IOP was the only variable independently associated with follow-up IOP at all time-points; treatment assignment had no effect.

Our study suggests no clear advantage to topical steroids after high-powered pulsed LPI. These findings should be confirmed in larger, multicenter studies.

The authors have no proprietary or commercial interest in any materials discussed in this article.