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L.S. Lim; Acute primary angle closure: Configuration of the drainage angle in the first year after laser peripheral iridotomy . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4373.
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Purpose: To evaluate the changes in the drainage angle in the first year after acute primary angle closure (APAC). Methods: This was a prospective observational case series of 44 Asian subjects with APAC. Cases were treated with medical therapy followed by laser peripheral iridotomy (LPI). Indentation gonioscopy was performed in APAC affected and fellow eyes before LPI (baseline) and then at 2 weeks, 4 months and 12 months after presentation. The angles were graded in each quadrant according to the Shaffer scheme, and the number of clock hours of peripheral anterior synechiae (PAS) was recorded. Patients who underwent intraocular surgery at any point during follow–up were excluded from the study. Gonioscopic changes were correlated with the development of elevation in IOP requiring medical treatment. Results: The majority of subjects were Chinese (84%) and female (64%), and the mean age was 60.2 ± 10.7 years. At presentation, 73% of both affected and fellow eyes had very narrow angles (average Shaffer grade < 1), with affected eyes having more extensive PAS (p<0.001). In APAC eyes, there was a significant increase in angle width from baseline to 2 weeks after LPI (p = 0.045), but no change in angle width subsequently. Fellow eyes showed an increase in angle width between baseline and week 2 (p = 0.01) and from week 2 to month 4 (p=0.001). There was no significant change in PAS in either affected or fellow eyes over the 12 months of follow–up. Of the 44 subjects, 19 (41.3%) subsequently developed IOP elevation during follow–up that required treatment. However there was no difference in angle width or amount of PAS between eyes with and without a rise in IOP, and the angle configuration did not change significantly in either group over 1 year. Conclusion: The angle width of APAC eyes increased in the first 2 weeks after LPI, but did not change thereafter over 1 year, and the amount of PAS remained stable throughout. The results indicate the effectiveness of LPI in preventing progressive closure of the angle after APAC.
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