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Vitor G. Prado, Pilar A. Moreno, Eglailson D. Almeida, Jr., Aline S. Sousa, Tiago S. Prata; Eyes With Occludable Angles Despite Patent Iridotomy: How Efficient Is Laser Iridoplasty In These Cases?. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5955. doi: https://doi.org/.
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We aimed to investigate the efficacy of laser iridoplasty in eyes with occludable angles despite patent iridotomy.
We analyzed the medical charts of patients who underwent laser iridoplasty between July 2009 and September 2011. Data collected included patients age, gender, race, presence (and type) of glaucoma, angle-closure mechanism, and pre-and post-laser intraocular pressure (IOP) values and gonioscopy appearance. Laser treatment efficacy was evaluated by magnitude of IOP reduction and angle widening. An occludable angle was defined as posterior trabecular meshwork not visible in two or more quadrants without indentation. Eyes with previous incisional surgery or more than 90° of peripheral anterior synechiae were not included in the analysis.
A total of 27 patients (41 eyes) were included in the study. Most patients were women (56%), white (78%), with a mean age [±standard deviation (SD)] of 58.9±11.8 years. Black and Asian patients comprised 15% and 7% of the study population, respectively. Regarding the diagnoses, 17 (63%) patients had Plateau Iris Syndrome and 10 (37%) had lens induced angle-closure (phacomorphic component), as determined by gonioscopy. Ultrasound biomicroscopy was used to confirm the diagnosis in difficult cases. Patients with Plateau Iris Syndrome were significantly younger than those with lens induced angle closure (55.3 vs 64.8 years, p=0.03). Most patients with Plateau Iris Syndrome were women (75%), while more than half of the patients with lens induced angle closure were men (70%), revealing a significant difference regarding sex (p<0.01). The average number of antiglaucomatous medications used before the laser procedure was 1.5±1.1. Mean follow-up period was 7.8±4.3 months. Mean baseline IOP was reduced from 18.2±4.7 mmHg to 14.6±3.8 mmHg at the last visit, with a a significant IOP reduction of 3.6±4.5 (approximately 20%) mmHg (p<0.01). There was no significant difference in IOP reduction between eyes with Plateau Iris Syndrome and those with phacomorphic component (p=0.22). After the laser procedure, over 93% of the eyes (38 out of 41) showed open angles. In 3 eyes (7,5%), a persistent IOP increase was documented (IOP increase ≥10%, observed in two consecutive visits). Finally, one patient underwent a filtering surgery during follow-up.
In eyes with occludable angles despite a patent iridotomy, laser iridoplasty was an efficient procedure, leading to angle widening and moderate IOP reduction in most of the cases, with few serious complications. There was no significant difference in laser outcomes between eyes with ciliary body (Plateau Iris Syndrome) or lens induced mechanisms.
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