Long-Term Intraocular Pressure Outcome in Fellow Eyes with Angle-Closure Glaucoma after Laser Iridotomy and Phacoemulsification

Dongchul Choi; Sunguk Baek; Kyung Wha Lee

doi:10.3341/jkos.2016.57.5.815

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Choi, Baek, and Lee: Long-Term Intraocular Pressure Outcome in Fellow Eyes with Angle-Closure Glaucoma after Laser Iridotomy and Phacoemulsification

Original Article

J Korean Ophthalmol Soc 2016;57(5):815-822.

Published online: 7 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.5.815

Long-Term Intraocular Pressure Outcome in Fellow Eyes with Angle-Closure Glaucoma after Laser Iridotomy and Phacoemulsification

Dongchul Choi, MD¹, Sunguk Baek, MD², Kyung Wha Lee, MD, PhD¹

¹Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea

²Department of Ophthalmology, Armed Forces DaeGu Hospital, Gyeongsan, Korea

Address reprint requests to Kyung Wha Lee, MD, PhD Department of Ophthalmology, Hallym University Sacred Heart Hospital, #22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea Tel: 82-31-380-3834, Fax: 82-31-380-3833 E-mail: kyungwlee@hanmail.net

Received 4 February 201628 March 2016 Accepted 22 April 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/ which perm its unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate long-term change in intraocular pressure (IOP) in the fellow eyes after laser iridotomy and early phacoemusification with laser iridotomy in patients with acute angle-closure glaucoma.

Methods

We performed a retrospective, comparative chart review of 62 patients with acute angle-closure glaucoma; 35 patients (Group A) who underwent only prophylactic laser iridotomy on fellow eyes and 27 patients (Group B) who underwent prophylactic laser iridotomy and early phacoemusification on fellow eyes. Patients were followed up at 1 day, 1 week and 1,3, 6 and 12 months. IOP change was analyzed after laser iridotomy 1 hour and at every follow-up. In addition, visual acuity and complications of laser iridotomy and phacoemusification were determined.

Results

In Group A, the mean IOP increase in fellow eyes occurred within 1 month after laser iridotomy (initial, 15.9 ± 5.0 mm Hg; final, 15.9 ± 2.6 mm Hg), However, in Group B, the mean IOP of fellow eyes was maintained up to 12 months without an increase in IOP (initial, 17.0 ± 3.3 mm Hg; final, 13.3 ± 2.8 mm Hg) Among the fellow eyes, 13 patients in Group A (37.14%) and 4 patients in Group B (14.81%, p = 0.032) underwent further medical therapy. The initial visual acuity of fellow eyes in Group A was 0.78 ± 0.21 and 0.71 ± 0.22 in Group B, and at the final visit, 0.73 ± 0.31 in Group A and 0.93 ± 0.27 in Group B (p = 0.003).

Conclusions

We found that most fellow eyes treated with laser iridotomy and phacoemulsification maintained satisfactory IOP and good vision. These results support that laser iridotomy and phacoemulsification in the fellow eye with acute angle-closure glaucoma is a reasonable prophylactic treatment.

Keywords: Angle-closure glaucoma, Intraocular pressure, Laser iridotomy, Phacoemusification

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Figure 1.

Change in intraocular pressure in the attack eye after peripheral laser iridotomy. PLI = peripherial laser iridotomy.

Figure 2.

Change in intraocular pressure in the contralateral eye after peripheral laser iridotomy. PLI = peripherial laser iridotomy.

Table 1.

General baseline characteristics of patients

	A group	B group	p-value
Number of patients	35	27
Age (years)	68.2 ±7.94	70.8±8.4	0.220^∗
Gender (male:female)	7:28	4:23	0.742^†
Laterality (right:left)	19:16	12:15	0.224^†
Attack IOP (mm Hg)	47.0±13.5	45.1±12.0	0.562^∗
Contralateral IOP (mm Hg)	15.9±5.0	17.0±3.3	0.131^∗

Values are presented as mean ± SD unless otherwise indicated.

IOP = intraocular pressure.

^∗ Independent samples t-test;

^† Pearson’s chi-square test.

Table 2.

Comparisons of pre- and post-prophylactic laser iridotomy intraocular pressure in the fellow eyes

	Group A p-value^∗	Group B p-value^∗	Group A & B p-value^†
Pre PLI	-	-	0.079
1 hour after PLI	0.002	0.002	0.246
1 day after PLI	0.042	0.038	0.406
7 days after PLI	0.013	0.078	0.094
1 month after PLI	0.843	0.001	0.028
3 months after PLI	0.773	0.002	0.001
6 months after PLI	0.092	0.007	0.540
12 months after PLI	0.178	0.009	0.001

PLI = peripherial laser iridotomy.

^∗ Pairedt-test;

^† Independent samples t-test.

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