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Alicia Menezes, Sonya Shah, Eman Elhawy, Bruno Faria, Tao Ming Thomas Chia, Lan Lu, L Jay Katz; Long Term Effectiveness and Complications associated with LPI in Treatment of Acute Angle Closure. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1871.
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Acute primary angle closure is an emergent ocular condition often treated with laser peripheral iridotomy (LPI). While numerous studies have examined the outcomes of LPI, many focus predominantly on the Asian population and few have long term follow-up. This study aimed to evaluate the long-term outcomes of LPI after acute primary angle closure in a more diverse population.
A retrospective chart review was performed from 2002 to 2012. Patients who presented to the Wills Eye Emergency Room with acute primary angle closure and treated with LPI were included. Those with less than 6 months of follow up were excluded. Ocular exam findings including intraocular pressure (IOP) and visual acuity (VA) were documented at presentation, pre-LPI and at the last follow up visit. The development of complications, need for glaucoma medications and need for further surgery were studied.
Over 10 years, 67 patients presented with primary angle closure attack of which 20 patients and 22 eyes met inclusion criteria. There were 15 females (68%) and 7 males (32%). Patients included 7 Caucasians (32%), 2 African Americans (9%), 6 Asians (27%) and 7 patients of unknown race (32%). The average age was 65. Mean follow-up time was 33 months. Initial mean VA was 1.4 ± 0.7 (LogMAR), and initial mean IOP was 47.5 mmHg ± 14.7mmHg. All patients were phakic. 19 (86.4%) had nuclear sclerosis. Mean time to LPI was 5 days. Mean pre-LPI VA was 1.2 ± 0.8 and IOP was 26.2 mmHg ± 17.4mmHg; mean VA at last follow-up was 0.72 ± 0.88 (p=0.008), and IOP was 15.3 mmHg ± 6.5 mmHg (p=0.008). 4 eyes (18.2%) required cataract extraction, 5 required trabeculectomy (22.7%). None developed retinal tear or detachment. At the last follow-up visit 13 patients (54%) were on glaucoma medications with an average of 2.2 medications being used.
Acute primary angle closure can occur in individuals of diverse races. Female gender and nuclear sclerosis may be predisposing factors. LPI is a safe and effective treatment for acute primary angle closure attack.
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