Resident-performed laser peripheral iridotomy in primary angle closure, primary angle closure suspects, and primary angle closure glaucoma

Abstract

PurposeTo investigate the power use and complication frequency of resident-performed laser peripheral iridotomy (LPI).MethodsA retrospective analysis of 196 eyes from 103 patients who underwent neodymium: yttrium-aluminum-garnet laser iridotomy performed by resident physicians from January 1, 2010 through April 30, 2015 at a university-based county hospital was done. All patients were treated for primary angle closure, primary angle closure suspects, and primary angle closure glaucoma. Data were collected on pre- and post-laser intraocular pressure (IOP), ethnicity, laser parameters and complications. Mean power use and frequency of complications were evaluated. Complications included elevated post-laser IOP at 30–45 minutes (≥8 mmHg), hyphema, aborted procedures, and lasering non-iris structures. The number of repeated LPI procedures, was also recorded.ResultsMean total power used for all residents was 78.2±68.7 mJ per eye. Power use by first-year trainees was significantly higher than second- and third-year trainees (103.5±75.5 mJ versus 73.7±73.8 mJ and 67.2±56.4 mJ, respectively, p=0.011). Complications included hyphema or microhyphema in 17.9% (35/196), IOP spikes in 5.1% (10/196), aborted procedures in 1.1% (3/196) and lasering non-iris structures in 0.5% (1/196). LPI was repeated in 22.4% of cases (44/196) with higher incidence of repeat LPI among non-Caucasian compared to the Caucasian subjects (p=0.02). Complication rates did not differ with increased training (p=0.16).ConclusionTotal power used for LPI decreased with increased resident training, while the complication rate did not differ significantly among resident classes. Complication rates were comparable to rates reported in the literature for attending-performed LPIs.

<p>Surgical Grade and Repeat Laser Peripheral Iridotomy Procedures with Risk Stratification and Educational Considerations</p>

“…17 However, the literature has identified Asian ethnicity as an independent prognostic factor for increasing the likelihood of requiring RPs. 9,18 When analyzing our data on ethnicity and RP rates, we observed no statistical significance, likely because of the small non-Caucasian population of the study (2%), which is representative of the local population, but differs from demographic data documented in other studies that have observed this difference. 9 The difference in RP rate for Asian ethnicity observed in other literature is believed to be due to greater laser-energy requirement to penetrate the iris to perform an iridotomy on the thicker dark-brown irides, more common in the Asian population.…”

Laser Peripheral Iridotomy Curriculum: Lecture and Simulation Practical

“…These logs could be reviewed by an attending ophthalmologist and feedback provided to the residents. At our institution, once this curriculum has been given for a few consecutive years, it is our hope to conduct a follow-up study to the one published by Kam and colleagues 6 to assess for improvements in LPI proficiency.…”

“…4,5 The University of Washington recently reviewed all residentperformed LPIs over a 5-year period and found that while total energy use and complication rates were comparable to attending-performed LPIs in the literature, there was a higher incidence of repeat laser to reopen or enlarge peripheral iridotomies. 6 In an effort to standardize LPI teaching and decrease the incidence of repeat LPI, as well as to help maintain minimal complication rates, an LPI curriculum including a lecture and a skills practice session was introduced.…”

“…A study by Kam, Zepeda, Ding, and Wen demonstrated decreasing power usage among residents performing LPI procedures with increasing resident training stage, suggesting that decreased total power to complete an LPI might represent increasing procedural proficiency. 6 Therefore, assessing total number of laser shots in this curriculum was a way to measure procedural proficiency. Lastly, learners were asked to rate pre-and postcurriculum confidence scores for the three learning objectives and to provide feedback on the curriculum.…”

Massive Hyphaema Following Laser Iridotomy in a Patient on Dual Antiplatelet Therapy (Aspirin plus Ticagrelor): Case report and literature review

“…Preventative laser iridotomies are currently performed in most patients with narrow anterior chamber angles; the prevalence of this condition in adults varies from 0.7–10% depending on race 7–10. In addition, given the growing frequency of patients taking antiplatelet or anticoagulant agents, the number of patients requiring a laser iridotomy is increasing.…”