Lens extraction versus laser peripheral iridotomy for acute primary angle closure.
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ABSTRACT:
SUBMITTER: Ong AY
PROVIDER: S-EPMC9994579 | biostudies-literature | 2023 Mar
REPOSITORIES: biostudies-literature
Publications
Lens extraction versus laser peripheral iridotomy for acute primary angle closure.
Ong Ariel Yuhan AY McCann Paul P Perera Shamira A SA Lim Fiona F Ng Sueko M SM Friedman David S DS Chang Dolly D
The Cochrane database of systematic reviews 20230308
<h4>Background</h4>Acute primary angle closure (APAC) is a potentially blinding condition. It is one of the few ophthalmic emergencies and carries high rates of visual morbidity in the absence of timely intervention. Laser peripheral iridotomy (LPI) has been the standard of care thus far. However, LPI does not eliminate the long-term risk of chronic angle closure glaucoma and other associated sequelae. There has been increasing interest in lens extraction as the primary treatment for the spectru ...[more]
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Project description:ObjectivesTo evaluate the effect of miosis and laser peripheral iridotomy (LPI) on intraocular lens (IOL) power prediction and ocular biometry in eyes with primary angle closure disease (PACD).MethodsIn this prospective observational study, primary angle closure suspects (PACS), and subjects classified with primary angle closure (PAC)/primary angle-closure glaucoma (PACG) undergoing LPI were enrolled. Ocular biometric parameters were measured with IOLMaster700 at baseline (T0), one week after pilocarpine instillation (T1), and another week post LPI (T2). Biometric changes and the IOL power predicted for emmetropia using Barrett Universal II, Haigis, Holladay2, Hoffer Q and SRK/T formulae were analysed and compared among different time points.Results100 eyes of 50 PACS and 50 PAC/PACG patients were enrolled. Following pilocarpine-induced miosis, lens thickness (LT) increased and anterior chamber depth (ACD) decreased (all groups p < 0.01), while white-to-white diameter decreased and central corneal thickness increased significantly only in the PACS cohort (both p < 0.01). Compared to baseline, LPI induced an increase of ACD and a slight decrease of LT in PACS (both p < 0.01), whereas only axial length changed significantly (p = 0.012) in the PAC/PACG cohort. Regardless of the formula used, no significant difference to the predicted IOL power for emmetropia existed among the three time points in each group (all p > 0.1).ConclusionWe report the changes of anterior segment parameters induced by miosis and LPI in PACD. These interventions do not significantly affect the IOL power calculation predicted for emmetropia in Chinese eyes when common third-, fourth-and new generation IOL formulae are used.
| S-EPMC10482892 | biostudies-literature
Project description:BackgroundChina has the largest burden of primary angle-closure glaucoma (PACG) worldwide. The mechanism of the angle closure is complex and includes pupillary block and non-pupillary block. Currently, opinion is that laser peripheral iridotomy (LPI) alone is not sufficient to prevent disease progression. Laser peripheral iridoplasty (LPIP) is an alternative and effective way of widening the angle recess in eyes that are affected by primary angle closure (PAC). However, it is not known if greater benefit would be achieved using LPI plus LPIP for PAC with multiple mechanisms (MAC). Thus, the aim of this study is to demonstrate if LPI plus LPIP would be more effective than single LPI in controlling the progression of PAC with multiple mechanisms, based on ultrasound biomicroscopy (UBM) classification. A secondary aim is to determine whether or not this would result in the use of less medication and/or prolong the time to antiglaucoma surgery.MethodsThis multiple-mechanism angle-closure study will comprise a 3-year, multicenter, randomized, parallel-group, open-label, superiority trial, the aim of which will be to evaluate the safety and efficacy of LPI plus LPIP versus LPI for PAC. It is anticipated that 240 adults, diagnosed with PAC (the mechanism of angle closure will be assessed by UBM and it will be determined whether or not it involves multiple mechanisms) will be recruited from ten ophthalmic centers in China. Participants will be randomly allocated to receive either single LPI or LPI plus LPIP. Participant assessment will be designed to test the rate of disease progression and who will be followed up for 3 years. The primary outcome will be the disease progression rate and a comparison will be made between the LPI and LPI plus LPIP groups using Pearson's χ2 test. Logistic regression analysis will be performed to account for the central effect.DiscussionIf the LPI plus LPIP is found to significantly decrease the rate of PAC progression, this intervention could potentially be a standard therapy to be used to treat PAC when multiple mechanisms are involved in angle closure. Subsequently, this would have the potential to delay the rate of PAC progression to PACG and delay the time to the administration of antiglaucoma medication or trabeculectomy surgery.Trial registrationClinicalTrials.gov, NCT02613013 . Registered on 24 November 2015. In fact, the study was due to start in late October 2015, however, there were no patients recruited in October, and when we registered at ClinicalTrials.gov on 5 November 2015, we received suggestions on the English translation of our protocol from the PRS Team at Clinicaltrial.gov, so the final successful registration date was on 24 November 2015.
| S-EPMC5356270 | biostudies-literature
Project description:Background/objectivesThis study aimed to compare the cost-effectiveness of prophylactic laser peripheral iridotomy (LPI) with that of observation for primary angle-closure suspect (PACS) in Japan.Subjects/methodsA Markov model was developed to compare the costs and utilities of prophylactic LPI with those of observation of 40-year-old patients with PACS. In the model with a yearly cycle over a 20-year time horizon, the disease was postulated to irreversibly progress from PACS to primary angle closure, followed by primary angle-closure glaucoma, unilateral blindness, and bilateral blindness. The parameters were estimated mainly based on a recent randomised controlled trial and analyses of Japanese claims data. The incremental cost-effectiveness ratio was estimated from the healthcare payer's perspective and evaluated at the willingness-to-pay 5 million Japanese Yen per quality-adjusted life-year. The observation period and the age at entry into the cohort was changed to account for a variety of clinical courses in sensitivity analyses. We conducted one-way deterministic sensitivity analysis and probabilistic sensitivity analysis with Monte Carlo simulations with 10 000 iterations.ResultsThe incremental cost-effectiveness ratio of LPI was 2,287,662 Japanese Yen (14,298 pounds sterling) per quality-adjusted life-year, which was below the willingness-to-pay threshold. The ratios were approximately 4 and 8 million in the 15-year and 10-year time horizons, respectively. Increasing the age at entry had little influence on the incremental cost-effectiveness ratio. The deterministic and probabilistic sensitivity analyses indicated that the results were robust.ConclusionsOur results indicate that prophylactic LPI for middle-aged patients with PACS is cost-effective in Japan.
| S-EPMC10966023 | biostudies-literature
Project description:PurposeTo evaluate the association between baseline ocular variables and the widening of the anterior chamber angle by laser peripheral iridotomy (LPI) in primary angle closure suspects (PACS) using a new Fourier-domain swept-source anterior segment optical coherence tomography (FD-ASOCT).MethodSixty-six PACS eyes of 41 individuals were enrolled in this prospective interventional case series. An FD-ASOCT (Casia SS-1000 OCT; Tomey, Nagoya, Japan) was used to measure biometric baseline variables and at 1 month after the LPI. Paired t test was used to compare the difference between pre-and post-LPI measurements. Multivariate regression analysis was used to test for an association between baseline iris thickness and volume, anterior chamber depth and volume, and lens vault with a widening of the angle after an LPI. Changes in trabecular iris space area and angle opening distance after the LPI were main outcome measures.ResultsThe mean age of participants was 58.6 ± 8.7 years, 68.2% of whom were female. The angle opening distance, recess area, and trabecular iris surface area at 500 μm increased by 48 to 73% (all P < 0.001). Lens vault and iris volume did not change. A low anterior chamber volume and low iris volume were associated with angle greater deepening by LPI.ConclusionEyes with a shallow anterior chamber and thinner irises are more likely to experience angle opening from an LPI.
| S-EPMC7809532 | biostudies-literature
Project description: Not available
| S-EPMC8094223 | biostudies-literature
Project description: Not available
| S-EPMC8094583 | biostudies-literature
Project description:BackgroundTo determine how many measurements should be evaluated to determine the iris bow and evaluate changes of iris bow at 12 clock positions after LPI in primary angle closure eyes.MethodsA total of 93 primary angle closure eyes in 93 Chinese patients were enrolled. Anterior iris bowing was evaluated at 12 clock positions and 4 clock positions (3, 6, 9, and 12 o'clock) before, 1 week and 3 months after LPI using swept source optical coherence tomography.ResultsAt baseline, almost all of the eyes exhibited an iris bow when measured using 12 clock positions, consistent with results obtained from measurements at 4 clock positions (Cronbach's alpha = 0.99). LPI caused a relative unified change in all of the clock positions (Cronbach's alpha = 0.91) except the LPI site. After LPI, there was no significant difference between 12 and 4 clock position measurements for the iris bow (both p > 0.05), with ~34.1% vs. 33% of the patients remained iris bow at 1 week and 34% vs. 31.9% of the patients remained iris bow at 3 months. However, the coexisting iris bow configuration was more common when measured using 4 clock positions (16.5% vs. 3.3% at 1 week and 25.5% vs. 10.6% at 3 months).ConclusionsThere was excellent consistency when measuring the iris bow at 4 or 12 clock positions. LPI caused a relatively unified iris bow change at 12 clock positions, and a single LPI relieved only ~2/3 of the iris bow configurations.
| S-EPMC7182565 | biostudies-literature
Project description:IntroductionApproximately 20 million people worldwide are affected by primary angle closure glaucoma, which is often treated with a laser peripheral iridotomy (LPI). In the United States, at least 60,000 to 80,000 LPIs are performed annually. However, complications can arise from improperly performed LPIs. While the Accreditation Council for Graduate Medical Education requires that all ophthalmology residents perform at least four primary LPIs prior to graduating, formal training is often lacking. In an effort to standardize LPI teaching, an LPI lecture curriculum and skills practice session were introduced.MethodsA lecture and wet-lab curriculum was developed at the University of Washington to formally teach first-year ophthalmology residents the indications and techniques for LPI. Pre- and postcurriculum knowledge was tested, and LPI performance was assessed by comparing pre- and postcurriculum total number of shots and time needed to successfully complete an LPI on a commercially available model eye.ResultsThe course was highly rated by 10 residents (all PGY 2), with an increase in pre- versus posttest scores, an improvement in LPI performance metrics, and an increase in pre- versus postcurriculum scores for the three survey questions regarding curriculum objectives.DiscussionThis course improved learner knowledge and confidence in performing LPI. Test scores improved following the course, as did self-assessed confidence levels of the residents. Residents made a number of positive comments about the course. We plan to continue holding this training session every year at our institution.
| S-EPMC7331967 | biostudies-literature
Project description: Not available
| S-EPMC9827451 | biostudies-literature
Project description:BackgroundPrimary angle-closure glaucoma is a type of glaucoma associated with a physically obstructed anterior chamber angle. Obstruction of the anterior chamber angle blocks drainage of fluids (aqueous humor) within the eye and may raise intraocular pressure (IOP). Elevated IOP is associated with glaucomatous optic nerve damage and visual field loss. Laser peripheral iridotomy (often just called 'iridotomy') is a procedure to eliminate pupillary block by allowing aqueous humor to pass directly from the posterior to anterior chamber through use of a laser to create a hole in the iris. It is commonly used to treat patients with primary angle-closure glaucoma, patients with primary angle closure (narrow angles and no signs of glaucomatous optic neuropathy), and patients who are primary angle-closure suspects (patients with reversible obstruction). The effectiveness of iridotomy on slowing progression of visual field loss, however, is uncertain.ObjectivesTo assess the effects of iridotomy compared with no iridotomy for primary angle-closure glaucoma, primary angle closure, and primary angle-closure suspects.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 9) which contains the Cochrane Eyes and Vision Trials Register; MEDLINE Ovid; Embase Ovid; PubMed; LILACS; ClinicalTrials.gov; and the ICTRP. The date of the search was 18 October 2017.Selection criteriaRandomized or quasi-randomized controlled trials that compared iridotomy to no iridotomy in primary angle-closure suspects, patients with primary angle closure, or patients with primary angle-closure glaucoma in one or both eyes were eligible.Data collection and analysisTwo authors worked independently to extract data on study characteristics, outcomes for the review, and risk of bias in the included studies. We resolved differences through discussion.Main resultsWe identified two trials (2502 eyes of 1251 participants) that compared iridotomy to no iridotomy. Both trials recruited primary angle suspects from Asia and randomized one eye of each participant to iridotomy and the other to no iridotomy. Because the full trial reports are not yet available for both trials, no data are available to assess the effectiveness of iridotomy on slowing progression of visual field loss, change in IOP, need for additional surgeries, number of medications needed to control IOP, mean change in best-corrected visual acuity, and quality of life. Based on currently reported data, one trial showed evidence that iridotomy increases angle width at 18 months (by 12.70°, 95% confidence interval (CI) 12.06° to 13.34°, involving 1550 eyes, moderate-certainty evidence) and may be associated with IOP spikes at one hour after treatment (risk ratio 24.00 (95% CI 7.60 to 75.83), involving 1468 eyes, low-certainty evidence). The risk of bias of the two studies was overall unclear due to lack of availability of a full trial report.Authors' conclusionsThe available studies that directly compared iridotomy to no iridotomy have not yet published full trial reports. At present, we cannot draw reliable conclusions based on randomized controlled trials as to whether iridotomy slows progression of visual field loss at one year compared to no iridotomy. Full publication of the results from the studies may clarify the benefits of iridotomy.
| S-EPMC6026549 | biostudies-literature