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Jamie Ng, Tian Loon Lee, Monisha Nongpiur, Wai-Jia Tan, Tin Aung, Shamira Perera; Intraocular Pressure Spikes following Sequential Laser Peripheral Iridotomy for Angle Closure. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1855.
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To determine the incidence of intraocular pressure (IOP) spikes within the first 30 minutes after sequential argon-Nd:YAG laser peripheral iridotomy (LPI) in patients with angle closure and to explore risk factors for their occurrence.
428 consecutive eyes of 298 patients who had undergone LPI at the Singapore National Eye Centre (SNEC) between June 2011 and August 2011 were reviewed retrospectively. There were 238 primary angle closure suspect (PACS) eyes, 85 primary angle closure (PAC) eyes, 92 primary angle closure glaucoma (PACG) eyes and 13 acute primary angle closure (APAC) eyes. The pre and post-LPI IOP, gonioscopic findings, medications, laser parameters and the need for acute IOP-lowering treatment were recorded.
The proportion of patients with a post-LPI IOP elevation ≥ 8mmHg was 10.7% (n=46) and those with a significant IOP spike of ≥ 30mmHg was 31 (7.2%). There were no significant differences between those with or without a post-LPI IOP elevation ≥ 8mmHg and those with or without a post-LPI IOP of ≥ 30mmHg, in terms of age, gender, race, total laser energy utilised and seniority of the physician performing the procedure. Patients who experienced IOP spike ≥ 8mmHg were on fewer pre-LPI medications (p=0.009). On logistic regression, patients with APAC had a significantly higher probability of an IOP spike (p=003).
There was a low incidence of post-LPI IOP spikes after sequential LPI. The primary diagnosis of APAC was a risk factor, and using pre-procedure ocular hypotensives can potentially reduce their occurrence.
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