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Study of power use and complication frequency of Nd:YAG laser iridotomy in the management of primary angle closure glaucoma
Affiliations- Department of Ophthalmology, Mallareddy Institute of Medical Sciences, GHMC Quthbullapur Jeedimetla, Hyderabad, Telangana, India
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Abstract
Background: The aim of the study was to assess the power use and efficacy of Nd:YAG laser iridotomy in the management of primary angle closure (PAC).
Material and methods: A prospective cross-sectional analysis was done in 146 eyes of 81 cases who underwent neodymium: yttrium-aluminum-garnet laser iridotomy. There were 42 patients with chronic primary angle closure glaucoma (PACG), 46 with acute and subacute PAC, and 11 with PACS (suspects). After initial intraocular pressure (IOP) controlling, all patients were treated with Nd:YAG laser iridotomy. Before and after the laser therapy, IOP, laser parameters, mean power use, and complications, if any, were noted.
Results: The average total power used was 78.56 ± 8.1 mJ per eye. The anatomy of angle structures improved by one or two of Shaffer’s grades. Controlled IOP was noted in 71% (17) of patients with PACG (chronic) and 93% (43) of patients with PAC (acute and subacute). The average total power used was 78.568.1 mJ per eye. Junior residents used more power than senior residents (88.5 62.5 mJ vs. 63.55 ± 5.8 mJ, p = 0.011). Complications included elevated IOP in 38.27% (31/81), aqueous flare/debris in 34.56% (24/81), iris bleeding in 18.51% (15/81), corneal burns in 4.93% (4/81), and lens damage in 3.71% (3/81). Laser peripheral iridotomy (LPI) was repeated in 48.14% of cases (39/81), with junior residents having a higher rate of repeat LPI than senior residents (p = 0.02). Complication rates differed between residents who performed the procedure (p = 0.16). In PACS subjects, 63.6% had a history of repeated LPI, followed by 58.33% in PACG and 39.1% in PAC cases. At follow-up, 3% of PAC eyes had glaucomatous optic neuropathy.
Conclusion: Laser iridotomy in managing early PACG reduces IOP and improves patient acuity. Nd:YAG laser iridotomy is effective in widening the drainage angle and lowering elevated IOP in patients with PAC.
Abstract
Background: The aim of the study was to assess the power use and efficacy of Nd:YAG laser iridotomy in the management of primary angle closure (PAC).
Material and methods: A prospective cross-sectional analysis was done in 146 eyes of 81 cases who underwent neodymium: yttrium-aluminum-garnet laser iridotomy. There were 42 patients with chronic primary angle closure glaucoma (PACG), 46 with acute and subacute PAC, and 11 with PACS (suspects). After initial intraocular pressure (IOP) controlling, all patients were treated with Nd:YAG laser iridotomy. Before and after the laser therapy, IOP, laser parameters, mean power use, and complications, if any, were noted.
Results: The average total power used was 78.56 ± 8.1 mJ per eye. The anatomy of angle structures improved by one or two of Shaffer’s grades. Controlled IOP was noted in 71% (17) of patients with PACG (chronic) and 93% (43) of patients with PAC (acute and subacute). The average total power used was 78.568.1 mJ per eye. Junior residents used more power than senior residents (88.5 62.5 mJ vs. 63.55 ± 5.8 mJ, p = 0.011). Complications included elevated IOP in 38.27% (31/81), aqueous flare/debris in 34.56% (24/81), iris bleeding in 18.51% (15/81), corneal burns in 4.93% (4/81), and lens damage in 3.71% (3/81). Laser peripheral iridotomy (LPI) was repeated in 48.14% of cases (39/81), with junior residents having a higher rate of repeat LPI than senior residents (p = 0.02). Complication rates differed between residents who performed the procedure (p = 0.16). In PACS subjects, 63.6% had a history of repeated LPI, followed by 58.33% in PACG and 39.1% in PAC cases. At follow-up, 3% of PAC eyes had glaucomatous optic neuropathy.
Conclusion: Laser iridotomy in managing early PACG reduces IOP and improves patient acuity. Nd:YAG laser iridotomy is effective in widening the drainage angle and lowering elevated IOP in patients with PAC.
Keywords
primary angle closure glaucoma; intraocular pressure; Nd:YAG laser iridotomy; complications
About this articleTitle
Study of power use and complication frequency of Nd:YAG laser iridotomy in the management of primary angle closure glaucoma
Journal
Issue
Vol 7 (2022): Continuous Publishing
Article type
Original paper
Pages
211-218
Published online
2022-12-09
Page views
3452
Article views/downloads
451
DOI
Bibliographic record
Ophthalmol J 2022;7:211-218.
Keywords
primary angle closure glaucoma
intraocular pressure
Nd:YAG laser iridotomy
complications
Authors
Praneeth Putti
Sannidhi Dhamuka
References (32)- Wright C, Tawfik MA, Waisbourd M, et al. Primary angle-closure glaucoma: an update. Acta Ophthalmol. 2016; 94(3): 217–225.
- Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006; 90(3): 262–267.
- Foster PJ, Johnson GJ. Glaucoma in China: how big is the problem? Br J Ophthalmol. 2001; 85(11): 1277–1282.
- Maurya RP. Biomarkers of Primary open glaucoma. Indian J Clin Exp Ophthalmol. 2019; 3(1): 1.
- Foster PJ, Buhrmann R, Quigley HA, et al. The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol. 2002; 86(2): 238–242.
- Erin AD, Steven JG. How to perform Laser Peripheral Iridotomy. Ophthalmic Pearls 2001. 2001; September/October: 1–3.
- Louis BC. Laser iridotomy. Clin Signs Ophthalmol. 1998; 15(1): 2–8.
- Kitazawa Y, Taniguchi T, Sugiyama K. Use of apraclonidine to reduce acute intraocular pressure rise following Q-switched Nd:YAG laser iridotomy. Ophthalmic Surg. 1989; 20(1): 49–52.
- Sood D, Sood NN. Angle closure and India. Indian J Ophthalmol. 2006; 54(3): 147–148.
- Quigley HA, Broman AT. The number of people with glaucoma world wide. Br J Ophthalmol. 2006; 90: 262–267.
- Ramakrishnan R, Nirmalan P, Krishnadas R, et al. Glaucoma in a rural population of southern India. Ophthalmology. 2003; 110(8): 1484–1490.
- Casson RJ, Newland HS, Muccke J, et al. Gonioscopic findings and prevalence of occludable angles in a Burnese population: the Meiktila eye study. Br J Ophthalmol. 2007; 91: 856–859.
- Baig R, Khan A, Khan AH, et al. Vitamin d deficiency osteomalacia: the continuing challenge. J Coll Physicians Surg Pak. 2008; 18(10): 666–223.
- Gray RH, Nairne JH, Ayliffe WH. Efficacy of Nd-YAG laser iridotomies in acute angle closure glaucoma. Br J Ophthalmol. 1989; 73(3): 182–185.
- Ammar M, Rahman H, Butt IA, et al. Role of YAG laser Iridotomy as Initial Treatment of Primary angle closure. Rawal Med J. 2005; 30: 300–7.
- Laser peripheral iridotomy for pupillary-block glaucoma. American Academy of Ophthalmology. Ophthalmology. 1994; 101(10): 1749–1758.
- Robin AL, Pollack IP. A comparison of neodymium: YAG and argon laser iridotomies. Ophthalmology. 1984; 91(9): 1011–1016.
- Vera V, Naqi A, Belovay GW, et al. Dysphotopsia after temporal versus superior laser peripheral iridotomy: a prospective randomized paired eye trial. Am J Ophthalmol. 2014; 157(5): 929–935.
- Lewis R, Perkins TW, Gangnon R, et al. The rarity of clinically significant rise in intraocular pressure after laser peripheral iridotomy with apraclonidine. Ophthalmology. 1998; 105(12): 2256–2259.
- Jiang Y, Chang DS, Foster PJ, et al. Immediate changes in intraocular pressure after laser peripheral iridotomy in primary angle-closure suspects. Ophthalmology. 2012; 119(2): 283–288.
- Schwartz LW, Moster MR, Spaeth GL, et al. Neodymium-YAG laser iridectomies in glaucoma associated with closed or occludable angles. Am J Ophthalmol. 1986; 102(1): 41–44.
- Golan S, Levkovitch-Verbin H, Shemesh G, et al. Anterior chamber bleeding after laser peripheral iridotomy. JAMA Ophthalmol. 2013; 131(5): 626–629.
- Vijaya L, George R, Arvind H, et al. Prevalence of primary angle-closure disease in an urban south Indian population and comparison with a rural population. The Chennai Glaucoma Study. Ophthalmology. 2008; 115(4): 655–660.e1.
- Thomas R, Parikh R, Muliyil J, et al. Five year risk of progression of primary angle closure suspects to primary angle closure: a population based study. Br J Ophthalmol. 2003; 87(4): 450–454.
- Sihota R, Agarwal HC. Profile of the subtypes of angle closure glaucoma in a tertiary hospital in North India. Indian J Ophthalmol. 1998; 46(1): 25–29.
- He M, Foster PJ, Johnson GJ, et al. Angle-closure glaucoma in East Asian and European people. Different diseases? Eye (Lond). 2006; 20(1): 3–12.
- See JL, Aquino MC, Adeun J, et al. Management of angle closure glaucoma. Indian J Ophthalmol. 2011; 59(Suppl1): S82–S87.
- Chowdhury B, Gupta YK. Long Term Outcome and Predictors of Success of Nd YAG Laser Iridotomy in Chronic Primary Angle Closure Glaucoma. (PACG).
- Naveh A, Zboronsky-Gutman LZ, Blumenthal M. Neodymium-YAG laser iridotomy in angle closure glaucoma: preliminary study. Br J Ophthalmol. 1987; 71(4): 257–261.
- Stefănescu-Dima A. [Preventive iridotomy — a prospective study]. Oftalmologia. 2004; 48(3): 61–71.
- Brazier DJ. Glaucoma, ocular hypertension, cataract, and glucose tolerance. Br J Ophthalmol. 1993; 77(7): 464.
- World Health Organization. Fact Sheet No. 282. Visual impairment and blindness June 2012. http://www.who.int/mediacentre/factsheets /fs282/en.Google Scholar.