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Harry Dang, Rajen Tailor, Francisco Otarola, Keith Barton; Outcomes of surgical iridectomy for the management of acute angle closure in patients with uveitis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6521. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Acute angle closure in uveitis is potentially devastating. Unlike primary angle closure, in which laser iridotomy may suffice, surgical iridectomy is frequently required. The purpose of this study is to evaluate the intraocular pressure (IOP) lowering effect of surgical iridectomy in the management of acute angle closure from secluded pupil in patients with uveitis.
A retrospective review of consecutive eyes that underwent a surgical iridectomy with goniosynechiolysis for the management of acute angle closure in uveitis was conducted. All cases were performed under the care of a single surgeon at Moorfields Eye Hospital, London, UK between January 2005 and January 2015. An institutional review ethics board approval was obtained from the Moorfields Eye Hospital Department of Clinical Audit prior to initiation of the study. The primary outcome measure was IOP and the secondary outcome measures were the reduction in number of glaucoma medications, corrected distance visual acuity (CDVA), need for further surgery to control the IOP and surgical complications.
A total of 16 eyes of 16 patients were included. The mean age of the cohort was 40.1 years (range 27-70). Two patients had a previous failed laser iridotomy and one patient had an aqueous shunt implant. The mean follow-up was 36.10 ± 29.90 months. The mean IOP dropped from 33.13 ±11.80 mmHg at baseline to 10.93 ± 3.39 at day one (p=0.001) and to 12.63 ± 7.36 at final follow-up (p=0.002). There was a reduction in mean number of ocular hypotensive medications from 2.00 ± 1.41 pre-operatively to 0.94 ± 1.34 at last follow-up (p=0.043). During the follow-up, three patients (19%) required different surgical treatments for uncontrolled IOP (augmented trabeculectomy, aqueous shunt and cyclodiode laser). There was no significant change in mean CVDA from baseline over the follow-up period. No vision-threatening complications were observed.
Surgical iridectomy resulted in a decrease in IOP and the number of hypotensive medications over 36 months in patients with acute angle closure secondary to uveitis.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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