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Prophylactic laser peripheral iridotomy may be overused

Issue: March 2019

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David S. Friedman

SAN FRANCISCO — As a prophylactic measure in patients labeled primary angle-closure suspects, laser peripheral iridotomy may be overused, a speaker said.

At the American Glaucoma Society annual meeting, David S. Friedman, MD, MPH, PhD, delivered 72-month findings of the Zhongshan Angle Closure Prevention (ZAP) study, which looked at Chinese patients with PACS bilaterally who underwent laser peripheral iridotomy in one eye with the contralateral eye remaining untreated. Results were published concurrently in The Lancet.

“We used a composite endpoint,” Friedman said. “We wanted to know if people developed elevated pressure that was sustained on two separate occasions, if they developed at least one clock hour of peripheral anterior synechiae, and if they developed acute angle-closure attacks.”

Of more than 10,000 subjects aged between 50 and 70 years who underwent community-wide screening for angle closure, 889 were enrolled and followed up for 6 years. All patients had angle closure of 6 or more clock hours, no peripheral anterior synechiae and IOP less than or equal to 21 m Hg. The study eye was randomly selected for treatment.

For the composite endpoint, there were few events in both groups, but iridotomy did reduce the number of events more than in the control group: 19 in the LPI group vs. 36 in the control group.

“In view of the low incidence rate of outcomes that have no immediate threat to vision, the benefit of prophylactic laser peripheral iridotomy is limited; therefore, widespread prophylactic laser peripheral iridotomy for primary angle-closure suspects is not recommended,” the study authors conclude.

Because the community population was entirely Chinese, the results may not apply to all populations, Friedman said. – by Patricia Nale, ELS

References:

Friedman DS. Are we doing too many LPIs? Presented at: American Glaucoma Society annual meeting; March 14-17, 2019; San Francisco.

He M, et al. Lancet. 2019;doi:10.1016/S0140-6736(18)32607-2.

Disclosure: Friedman reports no relevant financial disclosures.