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K. Eliasieh, S. K. Dorairaj, Y. Kashyap, J. T. Nezgoda, C. C. Teng; Evaluation of Argon Laser Peripheral Iridoplasties Performed by Residents: Does It Really Work?. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6321.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the efficacy of Argon Laser Peripheral Iridoplasty (ALPI) performed by second year ophthalmology residents at The New York Eye and Ear Infirmary on patients with Plateau Iris Syndrome (PIS), under the supervision of attending physicians.
Eyes with PIS that underwent ALPI from 2002 to 2008 were evaluated. Prior to performing ALPI, second year residents had an instructional lecture but no clinical experience. Demographic data, refractive error, laser settings including duration, power, laser-spot number and size, complications, and length of follow-up were collected and evaluated. Data including intraocular pressure (IOP), best corrected visual acuity (BCVA), number of medications, and Shaffer angle grading on dark room gonioscopy (DRG), were compared between the pre-procedure and last recorded clinic examination. PIS was defined as an anteriorly positioned ciliary body causing irido-trabecular contact in spite of a patent iridotomy.
Twenty-six eyes of 20 patients with a diagnosis of PIS were enrolled. There were 7 males and 19 females. Ages ranged from 42 to 79 years with an average of 58.6 years ± 10.2. Average refractive error was +3.00. The follow-up period ranged from 3 months to 6.4 years with an average of 19 ± 15 months. Laser settings were: power which ranged from 140 to 550 mw, laser spot size of 500 um, and duration of 0.5 seconds. The mean number of spots was 31.1 (SD 6.4). The mean length of the procedure was 8.2 minutes with a range of 5-15 minutes. ALPI was associated with an increase in the number of open quadrants from 0.54 to 1.79 (p < 0.001). However, in 29% of eyes there was no increase in the number of open quadrants, and in 63% of eyes, only 0-1 quadrants were opened. There was no difference in IOP immediately after ALPI. There was a slight, clinically insignificant increase in IOP from 14.36 mmHg pre-procedure to 15.88 mmHg at the last clinic examination (p=0.25). BCVA declined by at least 1 Snellen line in 58% of eyes and was stable or improved in 42%. There was no significant change in the mean number of pressure-lowering medications pre-procedure (0.72) as compared with the last clinic examination (0.68), p= 0.89. The failure rate for ALPI was 15.4%. Six (27%) eyes had progressive angle closure and had PAS noted on the last DRG.
Results of this study suggest that although resident performed ALPI can result in the opening of closed angles in patients with PIS, there is room for improvement in resident training for this challenging procedure.
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