[Combined laser treatment in the management of acute and subacute primary angle closure glaucoma]

Abstract

Primary angle closure glaucoma remains a disease with high visual morbidity worldwide. Patients with primary angle closure glaucoma may have dramatic signs and symptoms that can lead to permanent blindness in a short period of time if not properly treated. Conventionally, medical treatment was used to lower the intraocular pressure (IOP), followed by laser peripheral iridotomy. It acts by elevating pupillary block present in the condition. Laser peripheral iridoplasty is a tehnique using low energy contraction burns to mechanically pull open the angle, thereby reducing the IOP.

Aim: The aim of this study was to evaluate the therapeutic effect and safety of combined laser technique (argon laser iridoplasty and YAG laser peripheral iridotomy) in the management of medically unresponsive acute and subacute angle closure glaucoma.

Patients and methods: Sixteen eyes with acute and subacute primary angle closure glaucoma unresponsive to medical treatment were included in the study. All patients were treated by laser tehnique that included YAG laser peripheral iridotomy and argon laser iridoplasty in the eye without satisfactory response to previous laser treatment. We also documented complications of laser treatment. The IOP levels were documented by applanation tonometry.

Results: In 14 of 16 eyes combined laser treatment resulted in rapid IOP reduction. Only two patients failed to respond to the combined laser therapy and were surgically treated (clear lens extraction). No serious laser complications were recorded during the early period after laser therapy.

Conclusion: YAG laser peripheral iridotomy and argon laser iridoplasty as a combined treatment may be useful for IDP lowering in the management of medically unresponsive acute and subacute primary angle closure glaucoma.