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Gus Gazzard - One of the best experts on this subject based on the ideXlab platform.
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The Cochrane Library - Iridotomy to slow progression of visual field loss in angle-closure glaucoma.
Cochrane Database of Systematic Reviews, 2018Co-Authors: Benjamin Rouse, Gus GazzardAbstract:Background Primary angle-closure glaucoma is a type of glaucoma associated with a physically obstructed anterior chamber angle. Obstruction of the anterior chamber angle blocks drainage of fluids (aqueous humor) within the eye and may raise intraocular pressure (IOP). Elevated IOP is associated with glaucomatous optic nerve damage and visual field loss. Laser peripheral Iridotomy (often just called 'Iridotomy') is a procedure to eliminate pupillary block by allowing aqueous humor to pass directly from the posterior to anterior chamber through use of a laser to create a hole in the iris. It is commonly used to treat patients with primary angle-closure glaucoma, patients with primary angle closure (narrow angles and no signs of glaucomatous optic neuropathy), and patients who are primary angle-closure suspects (patients with reversible obstruction). The effectiveness of Iridotomy on slowing progression of visual field loss, however, is uncertain. Objectives To assess the effects of Iridotomy compared with no Iridotomy for primary angle-closure glaucoma, primary angle closure, and primary angle-closure suspects. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 9) which contains the Cochrane Eyes and Vision Trials Register; MEDLINE Ovid; Embase Ovid; PubMed; LILACS; ClinicalTrials.gov; and the ICTRP. The date of the search was 18 October 2017. Selection criteria Randomized or quasi-randomized controlled trials that compared Iridotomy to no Iridotomy in primary angle-closure suspects, patients with primary angle closure, or patients with primary angle-closure glaucoma in one or both eyes were eligible. Data collection and analysis Two authors worked independently to extract data on study characteristics, outcomes for the review, and risk of bias in the included studies. We resolved differences through discussion. Main results We identified two trials (2502 eyes of 1251 participants) that compared Iridotomy to no Iridotomy. Both trials recruited primary angle suspects from Asia and randomized one eye of each participant to Iridotomy and the other to no Iridotomy. Because the full trial reports are not yet available for both trials, no data are available to assess the effectiveness of Iridotomy on slowing progression of visual field loss, change in IOP, need for additional surgeries, number of medications needed to control IOP, mean change in best-corrected visual acuity, and quality of life. Based on currently reported data, one trial showed evidence that Iridotomy increases angle width at 18 months (by 12.70°, 95% confidence interval (CI) 12.06° to 13.34°, involving 1550 eyes, moderate-certainty evidence) and may be associated with IOP spikes at one hour after treatment (risk ratio 24.00 (95% CI 7.60 to 75.83), involving 1468 eyes, low-certainty evidence). The risk of bias of the two studies was overall unclear due to lack of availability of a full trial report. Authors' conclusions The available studies that directly compared Iridotomy to no Iridotomy have not yet published full trial reports. At present, we cannot draw reliable conclusions based on randomized controlled trials as to whether Iridotomy slows progression of visual field loss at one year compared to no Iridotomy. Full publication of the results from the studies may clarify the benefits of Iridotomy.
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Iridotomy to slow progression of visual field loss in angle closure glaucoma
Cochrane Database of Systematic Reviews, 2018Co-Authors: Benjamin Rouse, Gus GazzardAbstract:Background Primary angle-closure glaucoma is a type of glaucoma associated with a physically obstructed anterior chamber angle. Obstruction of the anterior chamber angle blocks drainage of fluids (aqueous humor) within the eye and may raise intraocular pressure (IOP). Elevated IOP is associated with glaucomatous optic nerve damage and visual field loss. Laser peripheral Iridotomy (often just called 'Iridotomy') is a procedure to eliminate pupillary block by allowing aqueous humor to pass directly from the posterior to anterior chamber through use of a laser to create a hole in the iris. It is commonly used to treat patients with primary angle-closure glaucoma, patients with primary angle closure (narrow angles and no signs of glaucomatous optic neuropathy), and patients who are primary angle-closure suspects (patients with reversible obstruction). The effectiveness of Iridotomy on slowing progression of visual field loss, however, is uncertain. Objectives To assess the effects of Iridotomy compared with no Iridotomy for primary angle-closure glaucoma, primary angle closure, and primary angle-closure suspects. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 9) which contains the Cochrane Eyes and Vision Trials Register; MEDLINE Ovid; Embase Ovid; PubMed; LILACS; ClinicalTrials.gov; and the ICTRP. The date of the search was 18 October 2017. Selection criteria Randomized or quasi-randomized controlled trials that compared Iridotomy to no Iridotomy in primary angle-closure suspects, patients with primary angle closure, or patients with primary angle-closure glaucoma in one or both eyes were eligible. Data collection and analysis Two authors worked independently to extract data on study characteristics, outcomes for the review, and risk of bias in the included studies. We resolved differences through discussion. Main results We identified two trials (2502 eyes of 1251 participants) that compared Iridotomy to no Iridotomy. Both trials recruited primary angle suspects from Asia and randomized one eye of each participant to Iridotomy and the other to no Iridotomy. Because the full trial reports are not yet available for both trials, no data are available to assess the effectiveness of Iridotomy on slowing progression of visual field loss, change in IOP, need for additional surgeries, number of medications needed to control IOP, mean change in best-corrected visual acuity, and quality of life. Based on currently reported data, one trial showed evidence that Iridotomy increases angle width at 18 months (by 12.70°, 95% confidence interval (CI) 12.06° to 13.34°, involving 1550 eyes, moderate-certainty evidence) and may be associated with IOP spikes at one hour after treatment (risk ratio 24.00 (95% CI 7.60 to 75.83), involving 1468 eyes, low-certainty evidence). The risk of bias of the two studies was overall unclear due to lack of availability of a full trial report. Authors' conclusions The available studies that directly compared Iridotomy to no Iridotomy have not yet published full trial reports. At present, we cannot draw reliable conclusions based on randomized controlled trials as to whether Iridotomy slows progression of visual field loss at one year compared to no Iridotomy. Full publication of the results from the studies may clarify the benefits of Iridotomy.
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The Cochrane Library - Iridotomy to slow progression of angle‐closure glaucoma
Cochrane Database of Systematic Reviews, 2016Co-Authors: Benjamin Rouse, Gus GazzardAbstract:The objectives are as follows: The primary objective is to assess the role of Iridotomy - compared with observation - in the prevention of visual field loss for individuals who have primary angle closure or primary angle-closure glaucoma in at least one eye. We will also examine the role of Iridotomy in the prevention of elevated intraocular pressure (IOP) in individuals with narrow angles (primary angle-closure suspect) in at least one eye.
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Iridotomy to slow progression of angle closure glaucoma
Cochrane Database of Systematic Reviews, 2016Co-Authors: Benjamin Rouse, Gus GazzardAbstract:The objectives are as follows: The primary objective is to assess the role of Iridotomy - compared with observation - in the prevention of visual field loss for individuals who have primary angle closure or primary angle-closure glaucoma in at least one eye. We will also examine the role of Iridotomy in the prevention of elevated intraocular pressure (IOP) in individuals with narrow angles (primary angle-closure suspect) in at least one eye.
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Randomised trial of sequential pretreatment for Nd:YAG laser Iridotomy in dark irides
British Journal of Ophthalmology, 2011Co-Authors: D Julian De Silva, Alexander C Day, Gus Gazzard, Catey Bunce, Paul J FosterAbstract:Aims To compare Iridotomy outcomes in dark irides by 1064 nm pulsed Nd:YAG laser with and without 532 nm continuous-wave Nd:YAG (frequency-doubled) green laser pretreatment. Methods 30 patients with occludable anterior chamber angles underwent bilateral standard pulsed 1064 nm Nd:YAG laser Iridotomy with one eye randomly assigned to sequential pretreatment with 532 nm continuous-wave Nd:YAG laser. Outcome measures were Iridotomy patency and complications including haemorrhage and elevated intraocular pressure (IOP). Results Median pulsed YAG power in the standard treatment group was 37.5 mJ (IQR 25–77) and 22.5 mJ (IQR 14–32) in the sequential treatment group (p=0.0079). Iris haemorrhage occurred in 43% of the standard treatment group and 13% of the sequential treatment group (p=0.0126). All iridotomies were patent at the end of the procedure in the sequential treatment group, while 2/30 in the standard treatment group were abandoned due to significant haemorrhage. Mean IOP at 1 h was significantly lower than pre-laser values in both groups (with magnitude of reduction significantly more in the sequential treatment group). There was no significant change in IOP at 1 week. All iridotomies were patent at last follow-up of median 38.5 months (IQR 32.0–42.3). Conclusions This study provides evidence that Iridotomy with pretreatment using a continuous-wave Nd:YAG laser is safer and more effective than pulsed Nd:YAG-only laser Iridotomy for dark irides and should be considered as the preferred technique.
Robert Ritch - One of the best experts on this subject based on the ideXlab platform.
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iridolenticular contact decreases following laser Iridotomy for pigment dispersion syndrome
Archives of Ophthalmology, 1999Co-Authors: Peter J Breingan, Jeffrey M Liebmann, Robert Ritch, Kohji Esaki, Hiroshi Ishikawa, David S GreenfieldAbstract:OBJECTIVE To evaluate changes in anterior segment anatomy after laser Iridotomy for pigment dispersion syndrome. METHODS Ultrasound biomicroscopy was performed on 7 eyes of 7 untreated patients with reverse pupillary block and pigment dispersion syndrome. A radially oriented image with the probe perpendicular to the eye in the superior meridian was obtained before and at least 1 week after laser Iridotomy in each eye. We assessed changes in angle recess area and iris-lens contact distance. RESULTS Mean +/- SD patient age was 31.3 +/- 5.7 years and mean +/- SD refractive error was -5.0 +/- 3.9 diopters. Angle recess area (mean +/- SD, 0.78 +/- 0.28 vs 0.35 +/- 0.11 mm2; P=.001, paired t test) and iris-lens contact distance (2.05 +/- 0.28 vs 0.79 +/- 0.13 mm; P<.001) decreased following Iridotomy. Central anterior chamber depth did not change. CONCLUSION Flattening of the iris following laser Iridotomy for pigment dispersion syndrome causes a decrease in iris-lens contact and angle width while lens position remains constant.
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increase in iris lens contact after laser Iridotomy for pupillary block angle closure
American Journal of Ophthalmology, 1996Co-Authors: Ronald M Caronia, Jeffrey M Liebmann, Zeev Stegman, Joseph Sokol, Robert RitchAbstract:Purpose To quantitate changes in anterior ocular segment anatomy after laser Iridotomy for pupillary block angle closure. Method We prospectively performed ultrasound biomicroscopy and A-scan biometry in 13 eyes of 13 consecutive untreated patients with relative pupillary block and appositional angle closure, without peripheral anterior synechiae on indentation gonioscopy. A radial, perpendicular image in the horizontal temporal meridian was obtained with ultrasound biomicroscopy before and one week after laser Iridotomy in each eye. Results Mean age of the 13 patients was 69.3 ± 1.8 (S.E.) years, mean refractive error was + 1.37 ± 0.39 diopters, and mean axial length was 22.54 ± 0.20 mm. In 13 eyes, before and after laser Iridotomy measurements of angle-opening distance (0.11 ± 0.02 vs. 0.18 ± 0.02 mm) (P = .0004; paired t test), angle aperture (8.3 ± 1.3 vs 18.6 ± 2.8 degrees) (P = .0003) and iris-lens contact distance (0.58 ± 0.06 vs 1.18 ± 0.14 mm) (P = .0003) were greater postoperatively, but anterior chamber depth was unchanged (P = .7). Conclusion Flattening of the iris after laser Iridotomy for pupillary block causes an increase in iris-lens contact. The change in angle configuration after Iridotomy results more from an alteration in aqueous pressure gradients across the iris rather than from posterior lens movement.
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Argon laser peripheral iridoplasty for angle-closure glaucoma in sibilings with weill-marchesani syndrome.
Journal of Glaucoma, 1992Co-Authors: Robert Ritch, Leon D. SolomonAbstract:: A patient with Weill-Marchesani syndrome and angle-closure glaucoma had persistent appositional closure after laser Iridotomy that was unrelieved by topical application of either miotic or cycloplegic agents. Argon laser peripheral iridoplasty successfully opened the angle. The patient's sister also had Weill-Marchesani syndrome and angle closure unrelieved by laser Iridotomy. Angle closure in Weill-Marchesani syndrome and the response to laser Iridotomy and treatment with either miotic or cycloplegic agents may be complex and depends on the relative proportion of pupillary block as a mechanism underlying the angle closure, the functional status of the zonular apparatus, and the degree of angle crowding by the peripheral iris in the presence or absence of peripheral anterior synechiae.
Benjamin Rouse - One of the best experts on this subject based on the ideXlab platform.
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The Cochrane Library - Iridotomy to slow progression of visual field loss in angle-closure glaucoma.
Cochrane Database of Systematic Reviews, 2018Co-Authors: Benjamin Rouse, Gus GazzardAbstract:Background Primary angle-closure glaucoma is a type of glaucoma associated with a physically obstructed anterior chamber angle. Obstruction of the anterior chamber angle blocks drainage of fluids (aqueous humor) within the eye and may raise intraocular pressure (IOP). Elevated IOP is associated with glaucomatous optic nerve damage and visual field loss. Laser peripheral Iridotomy (often just called 'Iridotomy') is a procedure to eliminate pupillary block by allowing aqueous humor to pass directly from the posterior to anterior chamber through use of a laser to create a hole in the iris. It is commonly used to treat patients with primary angle-closure glaucoma, patients with primary angle closure (narrow angles and no signs of glaucomatous optic neuropathy), and patients who are primary angle-closure suspects (patients with reversible obstruction). The effectiveness of Iridotomy on slowing progression of visual field loss, however, is uncertain. Objectives To assess the effects of Iridotomy compared with no Iridotomy for primary angle-closure glaucoma, primary angle closure, and primary angle-closure suspects. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 9) which contains the Cochrane Eyes and Vision Trials Register; MEDLINE Ovid; Embase Ovid; PubMed; LILACS; ClinicalTrials.gov; and the ICTRP. The date of the search was 18 October 2017. Selection criteria Randomized or quasi-randomized controlled trials that compared Iridotomy to no Iridotomy in primary angle-closure suspects, patients with primary angle closure, or patients with primary angle-closure glaucoma in one or both eyes were eligible. Data collection and analysis Two authors worked independently to extract data on study characteristics, outcomes for the review, and risk of bias in the included studies. We resolved differences through discussion. Main results We identified two trials (2502 eyes of 1251 participants) that compared Iridotomy to no Iridotomy. Both trials recruited primary angle suspects from Asia and randomized one eye of each participant to Iridotomy and the other to no Iridotomy. Because the full trial reports are not yet available for both trials, no data are available to assess the effectiveness of Iridotomy on slowing progression of visual field loss, change in IOP, need for additional surgeries, number of medications needed to control IOP, mean change in best-corrected visual acuity, and quality of life. Based on currently reported data, one trial showed evidence that Iridotomy increases angle width at 18 months (by 12.70°, 95% confidence interval (CI) 12.06° to 13.34°, involving 1550 eyes, moderate-certainty evidence) and may be associated with IOP spikes at one hour after treatment (risk ratio 24.00 (95% CI 7.60 to 75.83), involving 1468 eyes, low-certainty evidence). The risk of bias of the two studies was overall unclear due to lack of availability of a full trial report. Authors' conclusions The available studies that directly compared Iridotomy to no Iridotomy have not yet published full trial reports. At present, we cannot draw reliable conclusions based on randomized controlled trials as to whether Iridotomy slows progression of visual field loss at one year compared to no Iridotomy. Full publication of the results from the studies may clarify the benefits of Iridotomy.
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Iridotomy to slow progression of visual field loss in angle closure glaucoma
Cochrane Database of Systematic Reviews, 2018Co-Authors: Benjamin Rouse, Gus GazzardAbstract:Background Primary angle-closure glaucoma is a type of glaucoma associated with a physically obstructed anterior chamber angle. Obstruction of the anterior chamber angle blocks drainage of fluids (aqueous humor) within the eye and may raise intraocular pressure (IOP). Elevated IOP is associated with glaucomatous optic nerve damage and visual field loss. Laser peripheral Iridotomy (often just called 'Iridotomy') is a procedure to eliminate pupillary block by allowing aqueous humor to pass directly from the posterior to anterior chamber through use of a laser to create a hole in the iris. It is commonly used to treat patients with primary angle-closure glaucoma, patients with primary angle closure (narrow angles and no signs of glaucomatous optic neuropathy), and patients who are primary angle-closure suspects (patients with reversible obstruction). The effectiveness of Iridotomy on slowing progression of visual field loss, however, is uncertain. Objectives To assess the effects of Iridotomy compared with no Iridotomy for primary angle-closure glaucoma, primary angle closure, and primary angle-closure suspects. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 9) which contains the Cochrane Eyes and Vision Trials Register; MEDLINE Ovid; Embase Ovid; PubMed; LILACS; ClinicalTrials.gov; and the ICTRP. The date of the search was 18 October 2017. Selection criteria Randomized or quasi-randomized controlled trials that compared Iridotomy to no Iridotomy in primary angle-closure suspects, patients with primary angle closure, or patients with primary angle-closure glaucoma in one or both eyes were eligible. Data collection and analysis Two authors worked independently to extract data on study characteristics, outcomes for the review, and risk of bias in the included studies. We resolved differences through discussion. Main results We identified two trials (2502 eyes of 1251 participants) that compared Iridotomy to no Iridotomy. Both trials recruited primary angle suspects from Asia and randomized one eye of each participant to Iridotomy and the other to no Iridotomy. Because the full trial reports are not yet available for both trials, no data are available to assess the effectiveness of Iridotomy on slowing progression of visual field loss, change in IOP, need for additional surgeries, number of medications needed to control IOP, mean change in best-corrected visual acuity, and quality of life. Based on currently reported data, one trial showed evidence that Iridotomy increases angle width at 18 months (by 12.70°, 95% confidence interval (CI) 12.06° to 13.34°, involving 1550 eyes, moderate-certainty evidence) and may be associated with IOP spikes at one hour after treatment (risk ratio 24.00 (95% CI 7.60 to 75.83), involving 1468 eyes, low-certainty evidence). The risk of bias of the two studies was overall unclear due to lack of availability of a full trial report. Authors' conclusions The available studies that directly compared Iridotomy to no Iridotomy have not yet published full trial reports. At present, we cannot draw reliable conclusions based on randomized controlled trials as to whether Iridotomy slows progression of visual field loss at one year compared to no Iridotomy. Full publication of the results from the studies may clarify the benefits of Iridotomy.
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The Cochrane Library - Iridotomy to slow progression of angle‐closure glaucoma
Cochrane Database of Systematic Reviews, 2016Co-Authors: Benjamin Rouse, Gus GazzardAbstract:The objectives are as follows: The primary objective is to assess the role of Iridotomy - compared with observation - in the prevention of visual field loss for individuals who have primary angle closure or primary angle-closure glaucoma in at least one eye. We will also examine the role of Iridotomy in the prevention of elevated intraocular pressure (IOP) in individuals with narrow angles (primary angle-closure suspect) in at least one eye.
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Iridotomy to slow progression of angle closure glaucoma
Cochrane Database of Systematic Reviews, 2016Co-Authors: Benjamin Rouse, Gus GazzardAbstract:The objectives are as follows: The primary objective is to assess the role of Iridotomy - compared with observation - in the prevention of visual field loss for individuals who have primary angle closure or primary angle-closure glaucoma in at least one eye. We will also examine the role of Iridotomy in the prevention of elevated intraocular pressure (IOP) in individuals with narrow angles (primary angle-closure suspect) in at least one eye.
Dennis S C Lam - One of the best experts on this subject based on the ideXlab platform.
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Central serous chorioretinopathy after sequential argon-neodymium: YAG laser iridotomies.
Ophthalmic Surgery Lasers and Imaging, 2009Co-Authors: David T L Liu, Alex H. Fan, Vincent Lee, Philip T H Lam, Dennis S C LamAbstract:Laser peripheral Iridotomy is the standard treatment for acute angle-closure glaucoma. A patient with acute angle-closure glaucoma who developed central serous chorioretinopathy after uneventful laser iridotomies is described. Central serous chorioretinopathy occurring after sequential argon-neodymium:YAG laser peripheral Iridotomy is a novel complication in the English literature and is related to the stress induced by both the initial disease and the subsequent procedure, particularly in psychologically susceptible individuals.
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descemet membrane detachment after sequential argon neodymium yag laser peripheral Iridotomy
American Journal of Ophthalmology, 2002Co-Authors: David T L Liu, Jimmy S M Lai, Dennis S C LamAbstract:Abstract PURPOSE: To report a case of Descemet membrane detachment after sequential argon-neodymium (Nd):yttrium-aluminum-garnet (YAG) laser peripheral Iridotomy. DESIGN: Interventional case report. METHODS: A 72-year-old Chinese man presented with acute primary angle-closure in the left eye. In the fellow right eye, a localized Descemet membrane detachment developed after prophylactic sequential argon-Nd:YAG laser peripheral Iridotomy. Ultrasound biomicroscopy pictures were taken. RESULTS: The Descemet membrane detachment reattached gradually without intervention. The cornea remained clear and the vision was unchanged. CONCLUSION: In sequential argon-Nd:YAG laser peripheral Iridotomy, the shock wave formed during photodisruption may produce linear cracks at the level of Descemet membrane, resulting in detachment. This complication can occur irrespective of the color of the iris.
Paul J Foster - One of the best experts on this subject based on the ideXlab platform.
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immediate changes in intraocular pressure after laser peripheral Iridotomy in primary angle closure suspects
Ophthalmology, 2012Co-Authors: Yuzhen Jiang, Paul J Foster, Tin Aung, Dolly S Chang, Shengsong Huang, David S FriedmanAbstract:Purpose To determine the immediate changes in intraocular pressure (IOP) after laser peripheral Iridotomy in primary angle-closure suspects. Design Prospective, randomized controlled trial (split-body design). Participants Seven hundred thirty-four Chinese people 50 to 70 years of age. Methods Primary angle-closure suspects underwent Iridotomy using a neodymium:yttrium–aluminum–garnet laser in 1 randomly selected eye, with the fellow eye serving as a control. Intraocular pressure was measured using Goldmann applanation tonometry before treatment and 1 hour and 2 weeks after treatment. Total energy used and complications were recorded. Risk factors for IOP rise after laser peripheral Iridotomy were investigated. Main Outcome Measures Intraocular pressure. Results The proportion of treated eyes with an IOP spike (an elevation of ≥8 mmHg more than baseline) at 1 hour and 2 weeks after treatment was 9.8% (95% confidence interval [CI], 7.7–12.0) and 0.82% (95% CI, 0.2–1.5), respectively. Only 4 (0.54%) of 734 eyes (95% CI, 0.01–1.08) had an immediate posttreatment IOP of 30 mmHg or more and needed medical intervention. The average IOP 1 hour after treatment was 17.5±4.7 mmHg in the treated eyes, as compared with 15.2±2.6 mmHg in controls. At 2 weeks after treatment, these values were 15.6±3.4 mmHg in treated eyes and 15.1±2.7 mmHg in controls ( P Conclusions Laser peripheral Iridotomy in primary angle-closure suspects resulted in significant IOP rise in 9.8% and 0.82% of cases at 1 hour and 2 weeks, respectively. Eyes in which more laser energy and a higher number of laser pulses were used and those with shallower central anterior chambers were at increased risk for IOP spikes at 1 hour after laser peripheral Iridotomy. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Randomised trial of sequential pretreatment for Nd:YAG laser Iridotomy in dark irides
British Journal of Ophthalmology, 2011Co-Authors: D Julian De Silva, Alexander C Day, Gus Gazzard, Catey Bunce, Paul J FosterAbstract:Aims To compare Iridotomy outcomes in dark irides by 1064 nm pulsed Nd:YAG laser with and without 532 nm continuous-wave Nd:YAG (frequency-doubled) green laser pretreatment. Methods 30 patients with occludable anterior chamber angles underwent bilateral standard pulsed 1064 nm Nd:YAG laser Iridotomy with one eye randomly assigned to sequential pretreatment with 532 nm continuous-wave Nd:YAG laser. Outcome measures were Iridotomy patency and complications including haemorrhage and elevated intraocular pressure (IOP). Results Median pulsed YAG power in the standard treatment group was 37.5 mJ (IQR 25–77) and 22.5 mJ (IQR 14–32) in the sequential treatment group (p=0.0079). Iris haemorrhage occurred in 43% of the standard treatment group and 13% of the sequential treatment group (p=0.0126). All iridotomies were patent at the end of the procedure in the sequential treatment group, while 2/30 in the standard treatment group were abandoned due to significant haemorrhage. Mean IOP at 1 h was significantly lower than pre-laser values in both groups (with magnitude of reduction significantly more in the sequential treatment group). There was no significant change in IOP at 1 week. All iridotomies were patent at last follow-up of median 38.5 months (IQR 32.0–42.3). Conclusions This study provides evidence that Iridotomy with pretreatment using a continuous-wave Nd:YAG laser is safer and more effective than pulsed Nd:YAG-only laser Iridotomy for dark irides and should be considered as the preferred technique.
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How large should an Iridotomy be
British Journal of Ophthalmology, 2010Co-Authors: Alexander C Day, Paul J FosterAbstract:In 1990, Fleck calculated that an Iridotomy of 10–15 μm diameter should theoretically prevent angle closure glaucoma due to pupil block.1 This was consistent with the required Iridotomy diameter previously reported by Wheeler.2 Fleck used Navier–Stokes continuity equations and assumed an iris thickness of 50 μm. …
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Argon laser Iridotomy-induced bullous keratopathy.
British Journal of Ophthalmology, 2009Co-Authors: Arun Narayanaswamy, Tin Aung, Rajesh Kumar, Paul J FosterAbstract:We read with interest the paper by Ang et al about the problem of bullous keratopathy following laser Iridotomy in a Japanese hospital.1 Corneal decompensation is a serious complication causing visual morbidity, and there is cause for significant concern if the incidence after laser Iridotomy is indeed truly as high as suggested in this study. We have some concerns about the presentation and interpretation of the data in this report, and ultimately the conclusions that were drawn from it. The authors present the number and proportion of all penetrating keratoplasties performed for bullous keratopathy following laser Iridotomy in Kyoto, Singapore and Nottingham (UK). Ang reported that these accounted for 20% of all …
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Laser Iridotomy in dark irides
BRIT J OPHTHALMOL, 2007Co-Authors: Paul J FosterAbstract:Background: Laser Iridotomy is the established treatment for angle-closure glaucoma. Nd: YAG (neodymium: yttrium-aluminium-garnet) laser Iridotomy is challenging in the heavily pigmented irides of African and Asian patients,Aim: To present a modified laser Iridotomy technique for use in dark irides.Methods: The argon laser was applied in two stages: firstly, low-power argon was applied, which created a circular area of pitted iris stroma in the superior iris. High-power argon was then applied in the same area to form a punched-out crater at the level of the radial muscle fibres. The Iridotomy was then completed with low-energy YAG laser.Results: 15 eyes of 8 consecutive patients who underwent successful combined argon-YAG laser Iridotomy using low levels of YAG energy in dark irides is presented. The combined technique avoids common issues associated with the use of pure YAG laser, including high energy levels and a high risk of iris haemorrhage.Conclusions: Combined two-stage argon and YAG laser is an effective technique in the treatment of angle-closure glaucoma of dark irides of African and Asian patients. The technique is more effective and has reduced complications in comparison to pure argon or YAG laser techniques.
