Early intraocular pressure change after peripheral iridotomy with ultralow fluence pattern scanning laser and Nd:YAG laser in primary angle-closure suspect: Kowloon East Pattern Scanning Laser Study Report No. 3.

PURPOSE: Our purpose was to assess the early intraocular pressure (IOP) changes of ultralow fluence laser iridotomy using pattern scanning laser followed by neodymium:yttrium-aluminum-gamet (Nd:YAG) laser. METHODS: This is a prospective interventional study. Thirty-three eyes of 33 adult Chinese primary angle-closure suspect subjects were recruited for prophylactic laser peripheral iridotomy. Sequential laser peripheral iridotomy was performed using pattern scanning laser followed by Nd:YAG laser. Visual acuity (VA) and IOP were measured before treatment, at 1 h, 1 day, 1 week, 1 month, 3 months and 6 months after laser. Laser energy used and complications were documented. Corneal endothelial cell count was examined at baseline and 6 months. Patency of the iridotomy was assessed at each follow-up visit. RESULTS: All subjects achieved patent iridotomy in a single session. The mean energy used was 0.335+/-0.088 J for the pattern scanning laser, and 4.767+/-5.780 mJ for the Nd:YAG laser. The total mean energy was 0.339+/-0.089 J. None of the eyes developed a clinically significant IOP spike (≥ 8 mmHg) at 1 h and 1 day after laser use. Only four eyes developed higher IOP at 1 h and all were ≤3 mmHg compared to baseline. The mean IOP was 13.8+/-2.5 mmHg at 1 h and 11.5+/-2.2 mmHg at 1 day, both were significantly lower than baseline (15.8+/-2.1 mmHg) (P < 0.001). Mean VA (logMAR) was similar at 1 h post laser compared to baseline (0.23 vs 0.26). There was also no statistically significant difference in mean VA at other follow-up visits compared to baseline. Peripheral iridotomy closure was encountered in two (6.1%) eyes, one at 1 month and another at 6 months follow-up. There were no complications including hyphema, peripheral anterior synechia formation nor prolonged inflammation throughout the follow-up period. There was no significant loss in corneal endothelial cell counts at 6 months (2255+/-490) compared to baseline (2303+/-386) (P = 0.347). CONCLUSIONS: Sequential LPI using an ultralow fluence pattern scanning laser, followed by a Nd:YAG laser, is safe and efficacious, and produces no IOP spike in dark irides of primary angle-closure suspects. Further studies to investigate its role in the treatment of other angle-closure conditions are warranted.

Combined Phacoendoscopic Cyclophotocoagulation versus Combined Phacotrabeculectomy in the Management of Coexisting Cataract and Glaucoma: A Comparative Study.

PURPOSE: To compare the surgical outcome of combined phacoemulsification and endoscopic cyclophotocoagulation (phacoECP) versus combined phacoemulsification and mitomycin C-augmented trabeculectomy (phacoTbx) in patients with coexisting glaucoma and visually significant cataract. METHODS: A retrospective review of 89 eyes of 89 patients who received phacoECP (N=49) and phacoTbx (N=40) was carried out at a tertiary eye center in Hong Kong. The minimum follow-up period was 6 months. Criterion of success was reduction of IOP at least 30% or absolute IOP of 15 mmHg or below without (complete success) or with (qualified success) antiglaucomatous medication. RESULTS: PhacoTbx had more reduction of antiglaucomatous medication (4 vs 1, P < 0.001). At postoperative year one, there was more IOP reduction for phacoTbx than phacoECP (8 mmHg vs 3 mmHg, P=0.012). The one-year complete success rate was also higher for phacoTbx (46.2% vs 8.2%, P < 0.001), while qualified success was comparable between the 2 groups (74.4% vs 73.5%, P=0.925). Operation time was shorter for phacoECP (37 vs 73 minutes, P < 0.001). The number of postoperative follow-up visits was less (6 vs 11.5, P < 0.001) for phacoECP. Additional surgical procedures were more common in phacoTbx (55% vs 0%, P < 0.001). There was no postoperative cystoid macula edema, hypotony, or endophthalmitis reported in both groups. CONCLUSIONS: PhacoECP is significantly less effective than phacoTbx in reduction of both IOP and number of antiglaucomatous medications for patients with medically uncontrolled glaucoma and cataract. Its complete success rate is also significantly lower than that of phacoTbx. With its comparable qualified success, shorter operation time, less number of postoperative visits, and secondary surgical intervention, phacoECP may still have a role in very selected cases.