Management of intermittent angle closure glaucoma with Nd: YAG laser iridotomy as a primary procedure

Abstract

Objective: To assess the efficacy and complications of Nd: YAG laser iridotomy in patients with intermittent (sub-acute) angle closure glaucoma.

Study design: An interventional study.

Place and duration of study: The Ophthalmology Unit-1, Civil Hospital and Dow Medical College, Karachi, from February 2000 to February 2002.

Patients and methods: Twenty-five eyes of twenty-three patients with periodic (intermittent) angle closure, selected in outpatient department, were kept on pilocarpine until YAG laser iridotomy was performed. After YAG laser iridotomy oral acetazolamide and topical dexamethasone was used to control postlaser rise of IOP and inflammation respectively. Patency of iridotomy was confirmed and intra-ocular pressure was measured one hour after the procedure. Immediate complication, if any, was noted. Follow-up was done for six months. Prophylactic laser iridotomy was done in fellow eye with occludable angle. Levene's test for equality of variance and t-test for equality of means were used for statistical analysis.

Results: This study revealed a significant difference in IOP before and after YAG laser iridotomy (p = .002). Complete follow-up of 6 months was possible in 25 eyes of 23 subjects. After YAG Laser iridotomy, 21 (84%) eyes showed negative provocative test, intra-ocular pressure below 19 mmHg without medication and anterior chamber angle no more occludable and were labeled successful. Iridotomy remained patent in 96% of eyes. Iridotomy failed to reduce IOP in 4 (16%) eyes. The complications were minimal and transient.

Conclusion: YAG laser iridotomy offers effective, long lasting, first line treatment for the management of primary angle closure glaucoma at intermittent stage. Laser iridotomy widens drainage angle and reduces IOP, once synechial angle closure occurs in more than one quadrant.