Outcomes of primary angle closure glaucoma management

Abstract

Objective: To investigate the results of primary angle closure glaucoma (PACG) management on intraocular pressure (IOP).

Methods: This was a cross-sectional study conducted in the ophthalmology Department, Tabriz Medical Sciences University, Nikookary Eye Hospital, Tabriz, Iran. Subjects with angle closure were treated with YAG laser iridotomy at the time of diagnosis. These patients were re-examined in follow-up period for Patency of iridotomy, intraocular pressure (IOP), visual acuity, gonioscopic findings and automated threshold perimetry and peripapillary RNFL thickness for detecting progression. Iridotomy was classified unsuccessful in eyes where further surgical intervention was required or in which there was a loss of visual acuity to < 3/60 from glaucomatous optic neuropathy. All primary angle-closure glaucoma subjects (244 eyes) who had undergone Nd:YAG laser iridotomy between 2005 and 2008 were studied.

Results: A total of 244 patients were studied. The mean age of the study population was 64.60+9. 49 years with a median of 66 years (range: 45-80). The mean follow-up period was 21.59 +/- 12.37 months. Nd:YAG laser iridotomy for primary angle-closure glaucoma controlled the condition without any need for further medical or surgical therapy in 37 (15.2% ) cases, but the remainder who required added treatment included: 152 eyes (62.3%) medical treatment., 23 eyes (9.4%) trabeculectomy, 18 eyes (7.4%) phacoemulsification surgery, 8 eyes (3.3%) phacoemulsification with trabeculectomy and 6 eyes (2.5%) cyclophotocoagulation. In this study Nd:YAG laser iridotomy as a prophylactic procedure in the fellow eye of all patients was effective in preventing an acute angle-closure attack in the all the follow-up period.

Conclusions: For most eyes with primary angle-closure glaucoma after Nd: YAG laser iridotomy, additional medicine and surgery was required in the follow-up period. Medication therapy was needed more than other therapy. Early phacoemulsification appeared to be more effective in preventing IOP rise in uncontrolled cases.