Acute angle closure glaucoma: relative failure of YAG iridotomy in affected eyes and factors influencing outcome.

Abstract

The treatment ofacute angle closure glaucoma has been influenced by the development of the YAG laser and its ability to perform iridotomies as an outpatient procedure. In this retrospective study the results of YAG iridotomy were compared with surgical peripheral iridectomy. When compared with surgical peripheral iridectomy patients, YAG iridotomy patients were at greater risk of proceeding to further surgery, with this risk being significantly associated with increasing duration of attack. The authors suggest that in selected cases, surgical iridectomy should be given consideration as a primary procedure.

A randomised prospective comparison of operative peripheral iridectomy and Nd:YAG laser iridotomy treatment of acute angle closure glaucoma: 3 year visual acuity and intraocular pressure control outcome

“…The results of this study, and previous retrospective studies,8 9 suggest that Nd:YAG laser iridotomy is a satisfactory alternative to operative iridectomy in the treatment of AACG eyes. However, in view of the relatively small number of patients in our study, and the inherently unsatisfactory nature of retrospective studies of this disease,7-9 doubt must persist as to which treatment is optimal 16.…”

“…While there was a trend towards worsening acuity with time in both groups, presumably because of age related lens changes, there was no significant change in visual acuity after 3 years compared with either visual acuity following initial medical control or visual acuity 2 months following treatment. Buckley et al , in a retrospective study, found no significant difference in visual acuity outcome following operative iridectomy or laser iridotomy 8. In their study visual acuity in the fellow eye at presentation was used as an assumption of the visual acuity in the affected eye before the episode of AACG.…”

“…The long term effectiveness of Nd:YAG laser iridotomy is less well documented in acute angle closure glaucoma (AACG) eyes 7-9. A retrospective comparison of Nd:YAG laser iridotomy and operative peripheral iridectomy has suggested that operative peripheral iridectomy may be a superior treatment of AACG in patients who have had prolonged attacks of AACG 8. We have performed a randomised prospective comparison of bilateral Nd:YAG laser iridotomy and bilateral peripheral iridectomy in a consecutive group of patients presenting with uniocular AACG.…”

Dilated, Miotic-Resistant Pupil and Laser Iridotomy in Primary Angle-Closure Glaucoma

“…The indications of initial trabeculectomy in PACG were an inability to control the IOP on presentation [8,16,17] and advanced optic disk changes with the presence of PAS covering more than 75% of the trabular meshwork [18,19], We believe that there arc some racial differences in manifestations and managements of PACG between Caucasians and Orientals. The Asian pa tients frequently fail to present until permanently reduced vision is noted during the progression, and iridotomy alone may be insufficient to cure the glaucoma [6].…”

Long-term Therapeutic Outcome of Acute Primary Angle Closure in Japanese

“…Playfair and Watson 6 and Krupin et al 7 reported that controlled IOP was achieved with surgical PI or LPI alone in 72% and 76% of eyes, respectively, and with antiglaucoma agents in 84% and 96% of eyes, respectively. In 137 APAC patients who underwent LPI or surgical PI as a primary treatment, Buckley et al 17 showed that good IOP was maintained in 80 eyes (58.4%) that required no further medications, while 21 eyes (15.3%) ultimately required trabeculectomy. A recent study from the United Kingdom 18 found that no additional treatment after LPI was required in 44% of cases, and that further medical or surgical intervention was required in 21% and 35% of cases, respectively.…”