Laser Iridotomy-Induced Bullous Keratopathy in Korea: Clinical Features and Comparison with Pseudophakic Bullous Keratopathy

Seung Yong Choi; Soon Il Choi; Sung A Lim; Man Soo Kim

doi:10.3341/jkos.2016.57.1.14

Journal List > J Korean Ophthalmol Soc > v.57(1) > 1010392

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Choi, Choi, Lim, and Kim: Laser Iridotomy-Induced Bullous Keratopathy in Korea: Clinical Features and Comparison with Pseudophakic Bullous Keratopathy

Original Article

J Korean Ophthalmol Soc 2015;57(1):14-19.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2016.57.1.14

Laser Iridotomy-Induced Bullous Keratopathy in Korea: Clinical Features and Comparison with Pseudophakic Bullous Keratopathy

Seung Yong Choi, M.D, Soon Il Choi, M.D, Sung A Lim, M.D, Man Soo Kim, M.D, PhD

Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Man Soo Kim, MD, PhD Department of Ophthalmology, The Catholic University of Korea Seoul St. Mary’s Hospital, #222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: 82-2-2258-2846, Fax: 82-2-599-7405 E-mail: mskim@catholic.ac.kr

‗ This study was presented as an e-poster at the 111th Annual Meeting of the Korean Ophthalmological Society 2014.

Received 5 June 201515 September 2015 Accepted 14 November 2015

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 permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the clinical features and prevalence of patients with laser iridotomy-induced bullous keratopathy in Korea.

Methods

Using a retrospective study, the patients with laser iridotomy-induced bullous keratopathy who underwent penetrating keratoplasty were selected. We investigated the duration from iridotomy to corneal decompensation, preoperative anterior chamber depth, axial length, keratometry, and survival time of the grafted cornea. The data were compared with the data of pa-tients with pseudophakic bullous keratopathy as controls.

Results

Laser iridotomy-induced bullous keratopathy was found in 17 eyes, which represented 2.3% of penetrating keratoplasty cases (727) and 8.5% of bullous keratopathy cases (201), with a mean age of 66.9 years. The laser iridotomy-induced bullous keratopathy group showed a higher female ratio (15 out of 17), shorter mean axial length (22.09 ± 0.79 mm) and anterior cham-ber depth (1.91 ± 0.36 mm) than the control group (15 out of 50, 24.30 ± 2.54 mm and 3.27 ± 0.66 mm, respectively) with a stat-istical significance ( p = 0.002, p < 0.001 and p < 0.001, respectively). Mean survival time of the grafted cornea was 39.9 ± 8.6 months in the group of laser iridotomy-induced bullous keratopathy, which was shorter than the control group (47.8 ± 3.1 months) without statistical significance ( p = 0.47).

Conclusions

In Korea, laser iridotomy-induced bullous keratopathy shows non-negligible prevalence and should be further investigated.

Keywords: Bullous keratopathy, Laser iridotomy, Penetrating keratoplasty

References

1. Quigley HA. Long-term follow-up of laser iridotomy. Ophthalmology. 1981; 88:218–24.

2. Robin AL, Pollack IP. Argon laser peripheral iridotomies in the treatment of primary angle closure glaucoma. Long-term fol-low-up. Arch Ophthalmol. 1982; 100:919–23.

3. Schwartz AL, Martin NF, Weber PA. Corneal decompensation af-ter argon laser iridectomy. Arch Ophthalmol. 1988; 106:1572–4.

4. Lim LS, Ho CL, Ang LP. . Inferior corneal decompensation following laser peripheral iridotomy in the superior iris. Am J Ophthalmol. 2006; 142:166–8.

5. Ang LP, Higashihara H, Sotozono C. . Argon laser iridot-omy-induced bullous keratopathy a growing problem in Japan. Br J Ophthalmol. 2007; 91:1613–5.

6. Wilhelmus KR. Corneal edema following argon laser iridotomy. Ophthalmic Surg. 1992; 23:533–7.

7. Smith J, Whitted P. Corneal endothelial changes after argon laser iridotomy. Am J Ophthalmol. 1984; 98:153–6.

8. Jeng S, Lee JS, Huang SC. Corneal decompensation after argon la-ser iridectomy-a delayed complication. Ophthalmic Surg. 1991; 22:565–9.

9. Zabel RW, MacDonald IM, Mintsioulis G. Corneal endothelial de-compensation after argon laser iridotomy. Can J Ophthalmol. 1991; 26:367–73.

10. Kim YY, Lee JH, Ahn MD. . Angle closure in the Namil study in central South Korea. Arch Ophthalmol. 2012; 130:1177–83.

11. Lee TY, Yu S, Kim JH. . Seasonal variations of acute angle-clo-sure glaucoma in patients visiting the hospital. J Korean Ophthalmol Soc. 2012; 53:1637–41.

12. Shimazaki J, Amano S, Uno T. . National survey on bullous keratopathy in Japan. Cornea. 2007; 26:274–8.

13. Robin AL, Pollack IP. A comparison of neodymium: YAG and ar-gon laser iridotomies. Ophthalmology. 1984; 91:1011–6.

14. Moster MR, Schwartz LW, Spaeth GL. . Laser iridectomy. A controlled study comparing argon and neodymium: YAG. Ophthalmology. 1986; 93:20–4.

15. Foster PJ. The epidemiology of primary angle closure and asso-ciated glaucomatous optic neuropathy. Semin Ophthalmol. 2002; 17:50–8.

16. Moon SW, Lim SH, Lee HY. Accuracy of biometry for intraocular lens implantation using the new partial coherence interferometer, AL-scan. Korean J Ophthalmol. 2014; 28:444–50.

17. Bourne WM, O'Fallon WM. Endothelial cell loss during penetrat-ing keratoplasty. Am J Ophthalmol. 1978; 85:760–6.

18. Chung SH, Kim HK, Kim MS. Corneal endothelial cell loss after penetrating keratoplasty in relation to preoperative recipient endo-thelial cell density. Ophthalmologica. 2010; 224:194–8.

19. Chung YW, Byun YS, Kim MS. The effect of intraocular lens in-sertion sequence during the triple procedure on corneal endothelial cell survival. J Korean Ophthalmol Soc. 2011; 52:916–21.

20. Yamamoto Y, Uno T, Shisida K. . Demonstration of aqueous streaming through a laser iridotomy window against the corneal endothelium. Arch Ophthalmol. 2006; 124:387–93.

Figure 1.

Clinical photograph of two patients with laser iridotomy-induced bullous keratopathy. Both eyes (A and B) are phakic and have iridotomy site on the superior-nasal side. Diffuse edematous cornea is noted which is consistent with bullous keratopathy.

Figure 2.

Survival time analyzed by Kaplan-Meier curve. Mean survival time of the group of pseudophakic bullous ker-atopathy (47.8 months) is superior to that of the group of laser iridotomy-induced bullous keratopathy (39.9 months) without statistical significance by log-rank test ( p = 0.47).

Table 1.

Demographic data and clinical features of 17 eyes of laser iridotomy-induced bullous keratopathy

Case	Sex	Age (years)	Operation	Time from iridotomy to onset of BK (years)	Purpose of iridotomy	Laser mode	Laser site	Survival period (months)	State of grafted cornea
1	F	69	Triple procedure	8	CACG	Argon:YAG	Superior	75	Failure
2	F	72	PKP only	10	CACG	Argon:YAG	Superior	18	Failure
3	F	48	Triple procedure	10	CACG	Argon	Superior	12	Clear
4	F	67	Triple procedure	12	Prophylactic	Argon	Nasal	6	Failure
5	F	89	Triple procedure	14	Unknown	Unknown	Superior	12	Clear
6	F	58	Triple procedure	10	AACG	Argon:YAG	Superior	38	Failure
7	M	60	Triple procedure	5	AACG	Argon:YAG	Superior	30	Failure
8	M	84	Triple procedure	4	CACG	Argon	Superior	21	Clear
9	F	65	Triple procedure	4	AACG	Argon	Superior	30	Clear
10	F	70	Triple procedure	4	AACG	Argon:YAG	Superior	69	Failure
11	F	69	PKP only	4	AACG	Unknown	Superior	6	Failure
12	F	60	PKP only	8	AACG	Argon:YAG	Superior	3	Rejection
13	F	72	PKP only	4	Unknown	Unknown	Superior	12	Clear
14	F	60	Triple procedure	3	CACG	Argon:YAG	Superior	29	Clear
15	F	60	Triple procedure	3	CACG	Argon	Superior	21	Failure
16	F	65	Triple procedure	3	Prophylactic	Argon:YAG	Superior	18	Clear
17	F	65	Triple procedure	4	AACG	Argon	Superior	18	Clear

BK = bullous keratopathy; F = female; M = male; CACG = chronic angle closure glaucoma; YAG = yttrium aluminium garnet; PKP = penetrating keratoplasty; AACG = acute angle closure glaucoma.

Table 2.

Comparison of laser iridotomy-induced bullous keratopathy and pseudophakic bullous keratopathy by Mann-Whitney U-test

	Laser iridotomy-induced bullous keratopathy (n = 17)	Pseudophakic bullous keratopathy (n = 50)	p-value^*
Age (years, range)	66.6 (48-84)	64.9 (42-85)	0.92
Sex (male:female)	2:15	35:15	0.002
Axial length (mm)	22.09 ± 0.79	24.30 ± 2.54	<0.001
Anterior chamber depth (mm)	1.91 ± 0.36	3.27 ± 0.66	<0.001
White-to-white (mm)	10.9 ± 2.9	11.48 ± 0.57	0.44
Mean keratometry (diopters)	44.79 ± 1.50	43.92 ± 1.71	0.10
Astigmatism magnitude (diopters)	2.96 ± 1.21	3.27 ± 2.42	0.87
WTR:ATR	14:3	33:17	0.37

Values are presented as mean ± SD unless otherwise indicated. WTR = with the rule astigmatism; ATR = against the rule astigmatism.

^* Mann-Whiteny U-test.

TOOLS

Similar articles