Title: Study of clinical outcome of laser peripheral iridotomy in patient with spectrum of primary angle closure
Authors: Manjula Y.M., Chethana B.S.
DOI: https://dx.doi.org/10.18535/jmscr/v7i8.126
Abstract
Aim: To evaluate the outcome of peripheral laser iridotomy as first line of management in patient with spectrum of primary angle closure, which includes primary angle closure suspect (PACS), primary angle closure (PAC) and primary angle closure glaucoma (PACG).
Material and Methods: In our study prospective analysis of 30 patients with spectrum of primary angle closure visited to BGS Global institute of Medical sciences, Department of ophthalmology glaucoma clinic, were evaluated by one glaucoma consultant using slit lamp, goniolens and treated with Nd-Yag laser peripheral iridotomy as first line of management. Depth of peripheral anterior chamber assessed by slit lamp using van Herick technique. intraocular pressure measured using Goldman applanation tonometer. Angle was assessed using sussman 4 mirror goniolens by shaffers grading. Patients were followed up for 6month post laser peripheral iridotomy.
Result: In our study conducted for 1year from March 2017 to March 2018 and one year follow up, 30 patient with spectrum of primary angle closure, which included primary angle closure suspect (PACS) 4 patient, primary angle closure (PAC) 24 patient and primary angle closure glaucoma(PACG) 2 patient were included. All patient underwent peripheral laser iridotomy as first line of management, intraocular pressure (IOP) was less than 16mmof Hg in 28 patients, 2 patients IOP was more than 20mm of Hg was started on medical management timolol0.5% BID. Peripheral angle depth increased in all patients which were assessed by slit lamp. Using van Herrick technique. angle evaluation was done using sussman goniolens reveled open angle after peripheral laser iridotomy in 28 patients. Except two patients angle remained closed because of synaechial angle closure.
Conclusion: Out of 30 patients with spectrum of primary angle closure treated with peripheral laser iridotomy as first line of management, all patient had increases in peripheral anterior chamber depth,28 patient had IOP less than 16mmof hg and open angle .only two patient angle remained closed with IOP more than 20mm Hg because of synaechial angle closure. Which was managed by medical treatment, So peripheral laser iridotomy is the procedure of choice for first line of management in patient with spectrum of primary angle closure.
Keywords: spectrum of primary angle closure, primary angle closure suspect (PACS), primary angle closure (PAC), primary angle closure glaucoma (PACG), laser peripheral iridotomy.
References
- Sihota R, Tandon R .Parson”s diseases of the eye .21 st edition. Elsevier;2011:280 .
- Khandelwal R, Raje D, Rathi A, Khandelwal R. EVALUATION OF NARROW ANGLE GLAUCOMA CASES ATTENDING A TERTIARY CARE CENTER OF CENTRAL INDIA. Journal of Evidence Based Medicine and Healthcare. 2015;2(43):7724-31.
- Ahram DF, Alward WL, Kuehn MH. The genetic mechanisms of primary angle closure glaucoma. Eye. 2015;29(10):1251-9.
- Grewal SP, Jain R, Grewal D. Evaluation of anterior segment changes following laser peripheral iridotomy using Pentacam Scheimpflug imaging system in eyes with primary angle closure (PAC). Highlights of ophthalmology.2008;36(4):13-14
- Singh P, Tyagi M, Kumar Y, Kuldeep K, Sharma P. Gonioscopy: A Review. Open Journal of Ophthalmology. 2013;03(04): 118-121.
- Foster PJ, Buhrmann R, Quigley HA, Johnson GJ. The definition and classification of glaucoma in prevalence surveys. British journal of ophthalmology. 2002;86(2):238-42.
- He M, Friedman DS, Ge J, Huang W, Jin C, Lee PS, Khaw PT, Foster PJ. Laser peripheral iridotomy in primary angle-closure suspects: biometric and gonioscopic outcomes: the Liwan Eye Study. Ophthalmology. 2007;114(3):494-500.
- Pakravan M, Sharifipour F, Yazdani S, Koohestani N, Yaseri M. Scheimpflug imaging criteria for identifying eyes at high risk of acute angle closure. Journal of ophthalmic & vision research. 2012;7(2):111-7.
- Lopez-caballero C, Puerto-Hernandez B, Munoz-Negrete Fj, Rebolleda G, Contreras I,Cabarga C,Corral A. Quantitative evaluation of anterior chamber depth changes anterior chamber using pentacam anterior segment analyzer .European journal of ophthalmology .2009:20(2):327-32.
- Talajic JC, Lesk MR, Nantel-Battista M, Harasymowycz PJ. Anterior segment changes after pilocarpine and laser iridotomy for primary angle-closure suspects with Scheimpflug photography, journal of glaucoma 2013:22(9):776-9.
- Jain R, Grewal D, Grewal Quantitative analysis of anterior chamber following peripheral Laser iridotomy using pentacam in eyes with primary angle-closure. European journal of ophthalmology. 2012:14:0.doi:10.5301/ejo.5000158.