Immediate argon laser peripheral iridoplasty (ALPI) as initial treatment for acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction: a preliminary study

Abstract

Purpose To study the safety and efficacy of immediate argon laser peripheral iridoplasty (ALPI) as initial treatment of acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction. Methods In all, 10 consecutive patients with acute phacomorphic angle-closure and intraocular pressure (IOP) X40 mmHg were recruited into the study. Each patient received topical atropine (1%) and timolol (0.5%), and immediate ALPI as initial treatment. The IOP at 15, 30, 60, and 120 min, and then 1 day, after ALPI were documented by applanation tonometry. Systemic IOP-lowering drugs were only started if IOP remained above 40 mmHg at 2 h after ALPI. Cataract extraction was subsequently performed as definitive treatment. Results In total, 10 patients (five male, five female), with a mean age7SD of 73.1710.3 years were recruited. Mean duration of symptomatic attack was 1287232 h. After ALPI, the mean IOP was reduced from 56.1712.5 to 45.3714.5 mmHg at 15 min, 37.677.5 mmHg at 30 min, 34.279.7 mmHg at 60 min, 25.578.7 mmHg at 120 min, and 13.674.2 mmHg at 1 day. In one patient, systemic acetazolamide was administered, because the IOP remained above 40 mmHg at 2 h after ALPI. All 10 patients had uncomplicated cataract extraction performed within 4 days after ALPI. No complications from the laser procedure were encountered.Conclusion Immediate ALPI, replacing systemic antiglaucomatous medications, appeared to be safe and effective as first-line treatment of acute phacomorphic angle-closure.

Retrospective case series on the long-term visual and intraocular pressure outcomes of phacomorphic glaucoma

“…Phacomorphic glaucoma combines two of the most common causes of visual impairment in the elderly 7 and the reversibility of this acute condition makes it a worthwhile topic of study.…”

Non-pupillary block angle-closure mechanisms: a comprehensive analysis of their prevalence and treatment outcomes

“…In fact, this appears to be the case of our study population, which is mostly composed of middle-aged patients. It is noteworthy that ALPI has also been successfully used as an initial treatment to break acute phacomorphic attacks (23) . Regarding the few cases in which ALPI was not effective in our series, the proportion was similar between eyes with plateau iris and lens-induced component, and we could not identify any predictors of success or failure.…”

Laser Iridoplasty Techniques for Narrow Angles and Plateau Iris Syndrome

“…20,21 More recently, ALPI has been used in the setting of acute angle closure. 16,[22][23][24][25][26][27][28] Chapter 62…”

“…ALPI has been suggested as a fast and safe alternative to medical management to lower IOP and functions as a temporizing modality until cataract surgery can be performed under more favorable circumstances. 20,21 A prospective series of 10 patients presenting with acute phacomorphic induced angle closure, with IOPs greater than 40 mmHg, underwent ALPI. 21 The IOP was reduced to a mean of 25.5 mmHg by 2 h and 13.6 mmHg by 24 h. Uneventful cataract surgery was then performed within 4 days of presentation.…”

“…20,21 A prospective series of 10 patients presenting with acute phacomorphic induced angle closure, with IOPs greater than 40 mmHg, underwent ALPI. 21 The IOP was reduced to a mean of 25.5 mmHg by 2 h and 13.6 mmHg by 24 h. Uneventful cataract surgery was then performed within 4 days of presentation.…”