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Study: Iridoplasty an alternative to drugs for phacomorphic angle closure
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FLORENCE, Italy — Argon laser peripheral iridoplasty can be a safe alternative to topical and systemic medications as an immediate treatment for patients with acute phacomorphic angle closure, according to a surgeon speaking here.
Jonathan Chan, MD, discussed management of phacomorphic angle closure at the European Glaucoma Society meeting. He said traditional management of the acute condition, in which a hypermature cataract causes angle closure and a subsequent rise in IOP, has been drug therapy. The drug therapy options include systemic acetazolamide, which carries significant risks, he said.
Dr. Chan and colleagues studied the use of argon laser peripheral iridoplasty (ALPI) in 10 consecutive patients with a first attack of phacomorphic angle closure causing an IOP of at least 40 mm Hg. Patients were initially treated with topical atropine, prednisolone and timolol. ALPI was then applied in five to 10 spots per quadrant. Once the acute phase subsided, patients underwent either phacoemulsification or extracapsular cataract extraction. All patients underwent posterior chamber IOL implantation.
The study patients’ mean IOP of 56.1 mm Hg at baseline dropped to 45.3 mm Hg at 15 minutes postop, to 37.7 mm Hg at 30 minutes postop, to 34.2 mm Hg at 60 minutes postop and to 25.6 mm Hg at 120 minutes postop. Mean IOP was 12.3 mm Hg at about 6.5 months postoperatively, Dr. Chan said.
No systemic acetazolamide was used in any case, Dr. Chan said, and topical medication was needed in one eye of one patient. No serious complications were experienced, he said.