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Sharmini Balakrishnan, Taylor Blachley, Jennifer Weizer, Paul Lee, Joshua Stein; A Longitudinal Analysis of 1,660 Recipients of Bilateral Laser Peripheral Iridotomies to Determine Subsequent Need for Cataract Surgery and Additional Interventions for Glaucoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4386. doi: https://doi.org/.
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To determine the need for medical or surgical interventions for glaucoma and/or cataract surgery among a large cohort of patients who underwent bilateral laser peripheral iridotomies (LPIs).
We identified all enrollees age ≥ 21 in a large nationwide managed care network claims database who underwent bilateral LPIs between 2001-2011. We compared the proportion of enrollees who had been prescribed IOP-lowering medications in the 6, 12, and 24 months prior to versus 6, 12, and 24 months after the LPIs. We assessed the proportion of enrollees who then required subsequent laser or incisional glaucoma surgery or cataract surgery, and the timing of these surgical procedures relative to the LPIs.
Over a mean follow-up of 8.07 ± 2.07 years, of the 1,660 enrollees who underwent bilateral LPI, 1,280 enrollees (77.1%) had no record of IOP-lowering medication use before or after the LPIs, 30 enrollees (1.8%) were on IOP-lowering medications before the LPIs but took no medications afterwards, 205 enrollees (12.3%) had no record of medication use prior to the LPIs but were prescribed medications afterwards, and 145 enrollees (8.7%) were taking IOP-lowering medications before and after the LPIs. Among the 380 enrollees taking IOP-lowering medications before or after the LPIs, 251 individuals (66.1%) required more medications after as compared with before the LPIs. The mean (SD) number of IOP-lowering medications increased from before to after the LPIs (1.48 ± 0.76 versus 1.80 ± 0.97; p<0.0001). A total of 193 enrollees (11.6%) who underwent bilateral LPIs underwent subsequent cataract surgery, including 103 enrollees (53.4%) who underwent cataract surgery within 1 year of the LPIs. There were 75 enrollees (4.5%) who underwent laser or incisional glaucoma surgery within two years after the LPIs.
Nearly three quarters of patients treated with LPIs (77.5%) were not prescribed any IOP-lowering medical or surgical intervention after the LPIs, suggesting that the LPIs were curative and many of these patients did not develop chronic angle closure. However, a sizable number of patients (11.6%) required cataract surgery after LPIs. These findings have important implications for angle closure management.
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