Abstract
Purpose :
The impact of laser selection on rates of complications following laser peripheral iridotomy (LPI) has been underexplored in diverse patient populations. We performed a retrospective chart review to determine the frequency of intraocular pressure (IOP) spikes and iritis following LPI with Neodymium-doped Yttrium Aluminium Garnet (Nd:YAG) compared with sequential argon-Nd:YAG in patients with anatomical narrow angles.
Methods :
An electronic chart review was conducted to identify patients with a diagnosis of anatomical narrow angles who underwent either Nd:YAG or sequential argon-Nd:YAG LPI at the University of Pennsylvania between 2010 and 2018. Patients were excluded if they had a prior diagnosis of primary angle closure glaucoma. Average IOP within 30 days before LPI (Baseline IOP), post-LPI IOP at 1 hour, and presence of iritis within 60 days after LPI were evaluated. Multivariate logistic regression models were used to assess the association of laser type and race with incidence of IOP spike and iritis, adjusting by age, gender, and history of diabetes and hypertension.
Results :
2,564 LPI procedures (1066 Nd:YAG, 419 argon-Nd:YAG) of 1,485 patients were included. The cohort was 43.4% African-American, 3.4% Asian, 45.6% Caucasian, and 7.5% Other. The incidence of post-LPI IOP elevation ≥ 8 mmHg at 1 hour was 3.49%. Iritis occurred at a rate of 2.46%. Multivariate analysis showed that sequential argon-Nd:YAG LPI was associated with a significantly higher risk of post-LPI iritis (odds ratio [OR] 2.41, 95%CI 1.29-4.50, p=.02). African-Americans were also more likely to develop post-LPI iritis (OR 4.37, 95%CI 1.87-10.22, p=.005). The incidence of post-LPI IOP elevation ≥ 8 mmHg did not differ by race (p=.36) or laser type (p=.19).
Conclusions :
In patients with anatomical narrow angles requiring LPI, sequential argon-Nd:YAG was associated with higher rates of post-LPI iritis. Anterior chamber inflammation after LPI was also more likely to occur in African-Americans, likely necessitating prolonged use of topical steroids. Interestingly, the incidence of IOP elevation ≥ 8 mmHg at 1 hour did not differ based upon the type of laser utilized. This study identified risk factors for iritis after LPIs which may function to inform patterns of care following this commonly performed laser procedure.
This is a 2020 ARVO Annual Meeting abstract.