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J. Shimazaki, Y. Uchino, K. Tsubota; Late Irreversible Corneal Edema After Laser Iridotomy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4686.
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© ARVO (1962-2015); The Authors (2016-present)
To report clinical characteristics of increasing cases of laser iridotomy-related irreversible edema of the cornea.
Retrospective chart review was made for patients with irreversible corneal edema developed following laser iridotomy (LI) that was treated in our hospital. Incidence, patients` profile, methods of laser treatment, and surgical outcomes were studied.
We performed a total of 81 cases (98 eyes) of corneal transplantation for the LI-related corneal edema between 1995 and 2005. This number corresponded to approximately 3.6% of the total corneal transplants performed in our hospital, and the incidence has been increasing A mean age of the patients was 71.6 ± 6.9 years with female predominance (81.5%). They likely to reflect epidemiological trends of acute angle-closure glaucoma, one of the major causes of blindness in East Asia. Nearly three-quarter of the patients had LI for prophylaxis purpose, mainly for an occludable angle. As a laser instrument, argon laser was used in a majority of cases. Mean number of laser pulse was 421 (range; 6 - 1990), and mean laser energy was 22.5 J (range; 0.9 - 80.2). Although some eyes, especially eyes with acute glaucoma attack, received high laser energy, the condition of laser application was within normal range for Japanese dark-brown eyes. A mean duration between LI and development of corneal edema was 7.4 years, suggesting chronic, rather than acute mechanism exerted for the corneal endothelial damage. Corneal transplantation combined with cataract surgery was performed in most cases, and 93% of eyes achieved clear grafts. Corrected visual acuity ranged from light perception to 20/30 with a mean value of 0.029 preoperatively, and 94.8% achieved more than 2 lines of visual improvement at 1 year following corneal transplantation. Graft rejection was noted in 8 eyes (8.2%). Post-surgical glaucoma was noted in 18 eyes (18.4%) in which 2 eyes had glaucoma before surgery
Laser treatment for angle-closure glaucoma can induce irreversible corneal damage. Although surgical outcome seems to be feasible, physicians should be alert to this previously unrecognized iatrogenic disorder.
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