April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Evaluating the effect of laser peripheral iridotomy on iridotrabecular contact in eyes with primary angle closure
Author Affiliations & Notes
  • Vandana R Minnal
    Ruiz Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, Houston, TX
    Robert Cizik Eye Clinic, Houston, TX
  • Alice Chuang
    Ruiz Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, Houston, TX
  • Laura Baker
    Robert Cizik Eye Clinic, Houston, TX
  • Lauren S Blieden
    Ruiz Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, Houston, TX
    Robert Cizik Eye Clinic, Houston, TX
  • Nicholas P Bell
    Ruiz Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, Houston, TX
    Robert Cizik Eye Clinic, Houston, TX
  • Robert M Feldman
    Ruiz Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, Houston, TX
    Robert Cizik Eye Clinic, Houston, TX
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 4837. doi:
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      Vandana R Minnal, Alice Chuang, Laura Baker, Lauren S Blieden, Nicholas P Bell, Robert M Feldman; Evaluating the effect of laser peripheral iridotomy on iridotrabecular contact in eyes with primary angle closure. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4837.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: Primary angle closure glaucoma is a leading cause of bilateral blindness worldwide. These eyes often demonstrate iridotrabecular contact (ITC) on gonioscopic exam and on imaging with anterior segment optical coherence tomography (ASOCT). If untreated, areas of ITC might form peripheral anterior synechiae (PAS). Laser peripheral iridotomy (LPI) is the first-line treatment for this condition. The purpose of this study is to determine the extent of ITC using ASOCT before and after LPI in eyes with primary angle closure.

Methods: Eighteen eyes of 18 patients scheduled to undergo LPI were enrolled. This included 14 females and 4 males with an average age of 57.8 (+/- 10.4) years. Patients underwent slit lamp examination, gonioscopy, and ASOCT imaging using the CASIA SS-1000 (Tomey, Nagoya, Japan) at baseline and 3 months after LPI. Circumferentially, 128 2D images of each eye were obtained and analyzed. ITC was defined as iris touching any part of the trabecular meshwork (TM). The average extent of ITC at baseline, 3 months after LPI, and average difference were calculated.

Results: Upon baseline gonioscopic examination, 8 patients were open to only Schwalbe’s line, and 10 were open to anterior TM. Nine patients had no PAS, and 8 had 1 to 7 clock hours of PAS. One patient had inadequate preoperative gonioscopy. Three months after LPI, all eyes were noted to have patent iridotomies, and on gonioscopy, 4 were open to scleral spur, 10 to posterior TM, 3 to anterior TM, and 1 to Schwalbe’s line. Seven patients had no PAS, and 11 had 1 to 7 clock hours of PAS. At baseline, ASOCT image analysis revealed an average of 246.09 (+/- 78.90) degrees of ITC, with a range of 79 to 360 degrees. Three months after LPI, the average extent of ITC was 183.44 degrees (+/- 98.19), with a range of 23 to 347 degrees. The average change was -62.66 degrees (+/- 91.93) with a range of -223 to +178, which was statistically significant (P=0.01).

Conclusions: This study demonstrates a significant reduction in the extent of ITC after LPI. It also demonstrates that the extent of ITC can be measured using the CASIA SS-1000 ASOCT.

Keywords: 420 anterior chamber • 421 anterior segment • 550 imaging/image analysis: clinical  
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