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Laser iridotomy shows efficacy as prophylactic treatment for PAC suspects

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Laser peripheral iridotomy significantly lowered IOP and increased angle width in most patients with suspected primary angle closure, a prospective study found. However, one-fifth of patients had residual angle closure postoperatively, the authors noted.

Mingguang He, MD, MPH, of University College London, and colleagues evaluated laser peripheral iridotomy (LPI) outcomes for 72 Chinese patients with suspected bilateral primary angle closure (PAC). Surgeons operated on a single eye, chosen randomly, in each patient.

At 2 weeks' follow-up, investigators found that mean IOP had significantly decreased by 3 mm Hg. Axial anterior chamber length had not significantly changed, although median limbal anterior chamber depth increased from 15% to 25% of peripheral corneal thickness, the authors reported.

They also found that mean iridotrabecular angle width increased, from 0° to 10° in the superior quadrant and from 10° to 30° in the inferior quadrant, according to the study.

Despite these increases, the trabecular meshwork could not be visualized in three or more quadrants in 14 eyes (19.4%), the authors reported.

"This finding suggests that these individuals may have factors other than pupillary block that play a role in closing the angle," they said.

"Anterior rotation of the ciliary body and a thick peripheral iris roll are two possible mechanisms that may lead to post-LPI appositional closure," they said, noting that the lens may also physically cause angle closure.

Preoperatively, 46 eyes had steep gonioscopic iris profiles, which were eliminated in 39 eyes postoperatively. Of 23 eyes with preoperative plateau iris profiles, 15 appeared regular after surgery, according to the study.

"Although this report confirms that iridotomy widens the anterior chamber angle in most PAC suspects, long-term prospective studies with a larger sample size are required to determine if the risks of PAC glaucoma and other related pathologic sequelae are reduced after prophylactic LPI and to investigate the risk-to-benefit ratio before recommending widespread use of prophylactic LPI in this population," the authors said.

The study is published in the March issue of Ophthalmology.