Comparing combined laser iridoplasty and surgical iridectomy with trabeculectomy in treatment of refractory acute primary angle closure without significant cataract: a randomized controlled trial.

Abstract

OBJECTIVES:

To compare the safety and efficacy of combined laser iridoplasty followed by surgical iridectomy (LI-SI) versus trabeculectomy in the management of medically unresponsive acute primary angle closure (APAC) with minimal cataract.

PATIENTS AND METHODS:

This was a randomized controlled trial conducted among patients with medically unresponsive APAC without significant cataract. Study participants were randomized into: LI-SI or unaugmented trabeculectomy. Primary outcome of the study was the rate of post-operative surgical complications in the first 3 months after surgery. Secondary outcome assessed at 1 year was whether treatment was completely successful (IOP < 21 mmHg without IOP lowering drops), or partially successful (IOP < 21 mmHg with IOP lowering drops). Failure was defined as IOP ≥ 21 mmHg with IOP lowering drops.

RESULTS:

The study included 67 eyes of 67 patients (59 females/8 males = 7.4/1) who were randomized into 2 groups: LI-SI (Group 1, 37 eyes), and trabeculectomy (Group 2, 30 eyes). There was no statistical difference between the two groups at baseline. Overall, there were more post-operative complications in Group 1 versus Group 2 (45.9% versus 33.3% - p = 0.23), although all responded well to medical treatment and resolved without sequelae. Complete success was found in 97.1% (34/35 eyes) in Group 1 and 92.6% in group 2 (p = 0.19, Fisher's exact test).

CONCLUSIONS:

There was a higher rate of post-operative complications after LI-SI compared to trabeculectomy performed for medically unresponsive APAC with minimal cataract. Both procedures had similar surgical outcomes at 1 year.

• Authors: Hiep X Nguyen, Ngan D Nguyen, Huong T Nguyen, Kenric Rui-Pin Fan, Hang T Vo, Cuong V Nguyen, Ha T T Pham, Tin Aung, Hien D T N Nguyen, Tan Do
• Journal: Eye (London, England) (Eye (Lond)) Vol. 37 Issue 10 Pg. 2139-2144 (07 2023) ISSN: 1476-5454 [Electronic] England
• PMID: 36402857 (Publication Type: Randomized Controlled Trial, Journal Article)
• Copyright: © 2022. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.

Topics

• Male
• Female
• Humans
• Trabeculectomy (methods)
• Iridectomy
• Intraocular Pressure
• Cataract (complications)
• Iris (surgery)
• Lasers
• Treatment Outcome
• Glaucoma, Angle-Closure (surgery, complications)