Comparison of Argon-Laser Peripheral Iridoplasty and Medical Therapy in Immediate Treatment of Acute Primary Angle Closure
Narrative Responses:
Purpose
To compare the effect of argon laser peripheral iridoplasty (ALPI) and conventional systemic medical therapy in the immediate treatment of acute primary angle closure (APAC) using anterior segment optical coherence tomography (ASOCT).
Methods
27 consecutive patients with APAC were prospectively recruited and randomized either to immediate ALPI or medical therapy. IOP was assessed and ASOCT imaging (Visante prototype, Carl Zeiss Meditec, USA) was performed immediately before and one hour after ALPI or medical therapy. Custom software was used to measure the pupil distance (PD), anterior chamber depth (ACD), anterior chamber area (ACA, anterior chamber width (ACW) and the angle opening distance (AOD500) and trabecular iris space area (TISA500) at 500 um from the scleral spur.
Results
The mean age of the patients was 60.9 ± 7.5 years and 11 patients (40.7%) were male. The mean IOP in the APAC eye was 54.4 ± 10.0 mmHg at presentation, and 29.6 ± 13.3 mmHg one hour after treatment (p<0.001). The decrease in IOP one hour after treatment did not differ significantly between patients who underwent ALPI or medical therapy. APAC eyes which underwent ALPI had a larger increase in ACA (p=0.001), AOD500 (p<0.001) and TISA500 (p<0.001) compared to APAC eyes which received conventional systemic medical therapy.
Conclusion
ALPI and medical therapy resulted in similar IOP reduction in APAC eyes, but there was a larger increase in most anterior segment parameters in APAC eyes that underwent ALPI compared to those that received medical therapy.