Cataract Progression After Prophylactic Laser Peripheral Iridotomy

Abstract

Abstract: : Purpose: To evaluate changes in lens opacity in the first year after prophylactic laser peripheral iridotomy (LPI) performed in fellow eyes of subjects with acute primary angle closure (APAC). Methods: This was a prospective observational case series of 60 Asian subjects with unilateral APAC. All fellow eyes underwent prophylactic LPI within the first week of presentation followed by one week of topical steroids. The degree of lens opacity was graded at slit–lamp examination using the Lens Opacity Classification System III (LOCS III) standard colour photographs as the reference for grading of lens opacity. This was performed at 2 weeks, 4 months and 12 months after LPI. Progression in lens opacity was defined as an increase in LOCS III grade by 2 or more units. Results: The majority of patients were Chinese (85%) and female (63.3%) with an average age of 61.5 ± 10.6 years. The mean baseline LOCS grades in the nuclear, cortical and PSC regions were 3.58 ± 0.74, 0.57 ± 1.08 and 0.23 ± 0.72 respectively. With 12 months of follow–up, 14 of the 60 eyes (23.3% ± 5.46%) showed significant progression in any region. Progression in the nuclear, cortical and PSC regions was documented in 5%, 6.7% and 16.7% of cases respectively. Using logistic regression, the following factors were not found to be significant for cataract progression in any lens region: age, race, sex, history of hypertension or diabetes, presenting IOP, presence of PAS at baseline, angle width or total laser energy delivered. Conclusions: In fellow eyes of APAC, LPI is complicated by significant cataract progression, mainly in the posterior subcapsular region. These findings may have implications for the role of prophylactic LPI in the prevention of angle closure blindness.

Keywords: laser • cataract • clinical (human) or epidemiologic studies: outcomes/complications