Corneal changes after a single session of selective laser trabeculoplasty for open-angle glaucoma.

PURPOSE: To investigate the changes in endothelial cell count, central corneal thickness (CCT), and refractive error after a session of selective laser trabeculoplasty (SLT) for open angle glaucoma (OAG). METHODS: This prospective cohort study recruited 111 eyes of 66 consecutive subjects with OAG. Subjects received SLT to 360° of the trabecular meshwork. Endothelial cell count, CCT, and spherical equivalent were measured at baseline before SLT as well as at 1 week and 1 month post SLT. A repeated measure nested ANOVA with Tukey's multiple comparison test was performed to compare the outcome measures before and after SLT. RESULTS: In 111 eyes of 66 subjects, the mean number of laser applications per treatment was 166.9 ± 41.4 with a mean energy level of 1.0 ± 0.07 mJ. The mean endothelial cell count decreased significantly from 2465.0 ± 334.0 cells/mm(2) at baseline to 2355.0 ± 387.0 cells/mm(2) at 1 week (P=0.0004) but increased to baseline levels at 1 month post SLT (2424.0 ± 379.4 cells/mm(2), P=0.3). The CCT, which decreased from a baseline of 549.4 ± 37.6 to 543.9 ± 40.2 µm at 1 week post SLT (P=0.02), also returned to the baseline level by 1 month (P=0.2). The spherical equivalent was static from baseline. A positive correlation was found between total laser energy and CCT at 1 month post treatment (r=0.3, P=0.005). CONCLUSION: The transient reductions in endothelial cell count and CCT following SLT returned to baseline levels 1 month after the procedure. Patients undergoing SLT should be aware of the risk of potential corneal changes.

Correlation of previous acute angle-closure attack with extent of synechial angle closure in chronic primary angle-closure glaucoma patients.

AIM: To document any correlation between previous acute angle-closure attack and the extent of synechial angle closure in chronic primary angle-closure glaucoma (PACG) patients. METHODS: Consecutive cases of chronic PACG with patent peripheral iridotomy had gonioscopy performed. The extents of synechial angle closure of those chronic PACG eyes with previous documented acute angle-closure attack were compared to those eyes without such a history. RESULTS: A total of 102 chronic PACG eyes of 102 patients were recruited. Twenty-seven eyes (26.5%) had a previous documented acute angle closure, while 75 eyes (73.5%) did not. The mean extent of synechial angle closure +/-1 SD was 307+/-68 degrees (range, 150-360 degrees) in those chronic PACG eyes with a history of previous acute angle closure, compared to 266+/-89 degrees (range, 90-360 degrees) in those chronic PACG eyes without such a history (P=0.03, Student's t-test). There were no statistically significant differences between the two groups in age, LogMAR visual acuity, intraocular pressure (IOP), number of glaucoma eye drops, vertical cup-to-disk ratio, mean deviation or pattern SD in Humphrey automated perimetry, and anterior chamber depth (P>0.05). CONCLUSION: Previous acute angle-closure attack correlated with more extensive synechial angle closure in chronic PACG patients in this study.

To compare argon laser peripheral iridoplasty (ALPI) against systemic medications in treatment of acute primary angle-closure: mid-term results.

PURPOSE: To compare the clinical outcome of argon laser peripheral iridoplasty (ALPI) against systemic medications in treatment of acute primary angle-closure (APAC). METHODS: Consecutive patients with APAC were recruited and randomized to receive one of two treatment options: immediate ALPI or systemic acetazolamide +/- mannitol. All eyes were followed up for at least 6 months after laser iridotomy. Main outcome measures were intraocular pressure (IOP) and requirement for glaucoma medications. RESULTS: A total of 41 eyes (39 patients) were randomized into the ALPI group, and 38 eyes (32 patients) into the medical treatment group. There were no significant differences between the two groups in sex, age, presenting IOP, and duration of attack. Mean follow-up duration +/- SD was 15.7 +/- 5.8 months. There were no significant differences between the two groups in mean final IOP and requirement for glaucoma medications. CONCLUSIONS: There were no statistically significant differences in mean IOP and requirement for glaucoma drugs between APAC eyes treated with ALPI and systemic medications.

Immediate argon laser peripheral iridoplasty (ALPI) as initial treatment for acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction: a preliminary study.

PURPOSE: To study the safety and efficacy of immediate argon laser peripheral iridoplasty (ALPI) as initial treatment of acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction. METHODS: In all, 10 consecutive patients with acute phacomorphic angle-closure and intraocular pressure (IOP) > or =40 mmHg were recruited into the study. Each patient received topical atropine (1%) and timolol (0.5%), and immediate ALPI as initial treatment. The IOP at 15, 30, 60, and 120 min, and then 1 day, after ALPI were documented by applanation tonometry. Systemic IOP-lowering drugs were only started if IOP remained above 40 mmHg at 2 h after ALPI. Cataract extraction was subsequently performed as definitive treatment. RESULTS: In total, 10 patients (five male, five female), with a mean age+/-SD of 73.1+/-10.3 years were recruited. Mean duration of symptomatic attack was 128+/-232 h. After ALPI, the mean IOP was reduced from 56.1+/-12.5 to 45.3+/-14.5 mmHg at 15 min, 37.6+/-7.5 mmHg at 30 min, 34.2+/-9.7 mmHg at 60 min, 25.5+/-8.7 mmHg at 120 min, and 13.6+/-4.2 mmHg at 1 day. In one patient, systemic acetazolamide was administered, because the IOP remained above 40 mmHg at 2 h after ALPI. All 10 patients had uncomplicated cataract extraction performed within 4 days after ALPI. No complications from the laser procedure were encountered. CONCLUSION: Immediate ALPI, replacing systemic antiglaucomatous medications, appeared to be safe and effective as first-line treatment of acute phacomorphic angle-closure.