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Jorge-Emmanuel Morales-León, Celia Elizondo-Olascoaga, Karla Dueñas-Ángeles, Ana-Lilia Gabriel-Mendoza, Enrique O Graue, Curt Hartleben-Matkin; SHORT-TERM OUTCOMES OF IRIDOPLASTY IN PERSISTENT ANGLE CLOSURE DESPITE PATENT IRIDOTOMIES: AN ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY STUDY. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6152.
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To evaluate short-term angle opening after argon peripheral iridoplasty using AS-OCT and to report its complications at 1-week and 1-month follow up in patients with persistent angle closure despite patent iridotomies.
We included patients with an occludable angle in more than two quadrants in dark room indentation gonioscopy and patent iridotomies of at least 2 weeks, with a diagnosis of the etiology of persistent angle closure by ultrabiomicroscopy and A-scan ultrasound between July and November 2012. Patients underwent complete examination and AS-OCT before ALPI, one week and one month after it. We analyzed the images in a masked manner and took the angle opening distance at 500 microns (AOD500) as the main outcome measure for effectiveness.
There were 18 eyes of 10 patients that met inclusion criteria. It was an entirely female population with a mean age of 68.8 (51-78) of Latin origin. The most common cause of secondary angle closure was a mixed component angle closure, caused by both lens and ciliary body documented by A-scan ultrasound and ultrabiomicroscopy. After the procedure we obtained an immediate angle widening in all cases. The mean change in angle opening for the first week was 92 microns of aperture(-0.15 to 0.29 [SD 0.11, p=0.001])in AOD 500, which diminishes at 1 month to 44 microns of aperture (-0.11 to 0.21 [SD 0.09, p=0.002]) but remains statistically significant. Considering effectiveness as a positive balance between the aperture obtained in both meridians (0 and 180), we found an effectiveness of angle opening in 77% of the eyes which underwent iridoplasty and 5.5 to 11% of significant complications (sinechiae in more than three quadrants and/or mydriatic non responsive pupil) . There were no significant changes in visual acuity or intraocular pressure.
Argon laser peripheral iridoplasty is an effective procedure to obtain angular opening in eyes with secondary angle closure posterior to patent iridotomies at 1-month follow up; but it should be left as an alternative to those patients for which cataract surgery is not a viable or an adequate risk-benefit procedure, because it shows a tendency to return to the original angle configuration, carrying also a small percentage of complications for a future procedure.
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