July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Efficacy of Laser Peripheral Iridotomy for the Prevention of Angle Closure: A Randomized Controlled Trial
Author Affiliations & Notes
  • Mingguang He
    Department of Ophthalmology, Zhongshan Ophthalmic Center Sun Yat-sen University, Guangzhou, China
    Centre for eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
  • Yuzhen Jiang
    NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, United Kingdom
  • Shengsong Huang
    Department of Ophthalmology, Zhongshan Ophthalmic Center Sun Yat-sen University, Guangzhou, China
  • Dolly Shuo-Teh Chang
    Dana Center for Preventive Ophthalmology, Wilmer Eye Institute and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maryland, United States
  • Beatriz Munoz
    Dana Center for Preventive Ophthalmology, Wilmer Eye Institute and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maryland, United States
  • Tin Aung
    Singapore Eye Research Institute and Singapore National Eye Centre, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • Paul J Foster
    NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, United Kingdom
  • David S Friedman
    Dana Center for Preventive Ophthalmology, Wilmer Eye Institute and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maryland, United States
  • Footnotes
    Commercial Relationships   Mingguang He, None; Yuzhen Jiang, None; Shengsong Huang, None; Dolly Chang, None; Beatriz Munoz, None; Tin Aung, None; Paul Foster, None; David Friedman, None
  • Footnotes
    Support  Fight for Sight (no. 1655, UK), the Sun Yat-Sen University 5010 Project Fund (no. 2007033, China), and the National Natural Science Foundation of China (no. 81420108008, China).
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 1784. doi:https://doi.org/
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    • Get Citation

      Mingguang He, Yuzhen Jiang, Shengsong Huang, Dolly Shuo-Teh Chang, Beatriz Munoz, Tin Aung, Paul J Foster, David S Friedman; Efficacy of Laser Peripheral Iridotomy for the Prevention of Angle Closure: A Randomized Controlled Trial. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1784. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Primary angle-closure glaucoma (PACG) affects 20 million people worldwide. People classified as primary angle closure suspects (PACS) have a higher but poorly quantified risk of developing glaucoma. Laser peripheral iridotomy (LPI) is widely practiced as prophylaxis against PACG but its efficacy is unproven.

Methods : In this randomized controlled trial, 11,991 participants aged between 50 and 70 years were screened in the community from Guangzhou, China. People with bilateral PACS were enrolled and received LPI in one randomly selected eye, with the fellow remaining untreated. The primary outcome was incident primary angle closure disease as a composite endpoint of elevation of intraocular pressure, or peripheral anterior synechiae, or acute angle-closure during 72 months of follow up.

Results : Of the 889 subjects who underwent randomization, 889 treated and 889 untreated eyes were included in the intention-to-treat analysis. The incidence rate of primary outcome was 4.2 per 1,000 eye-years in treated eyes versus 8.0 per 1,000 eye-years in untreated eyes (HR 0.53, 95%CI: 0.30–0.92). A primary outcome event occurred in 19 treated eyes and 36 untreated eyes with a statistically significant difference using pair-wise analysis (p=0.004). No serious adverse events were observed during follow up.

Conclusions : The risk of incident angle-closure disease was very low among individuals with PACS identified through community-based screening. LPI had a modest, albeit significant, prophylactic effect. In view of the low incidence rate of outcomes that have no immediate threat to vision, the benefit of prophylactic LPI is limited and thus it should only be offered to those with the highest risk of PACG. (ISRCTN45213099).

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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