Argon Laser Peripheral Iridoplasty for Primary Angle-Closure Glaucoma: A Randomized Controlled Trial.
Narayanaswamy Arun, Baskaran Mani, Perera Shamira A, Nongpiur Monisha E, Htoon Hla M, Tun Tin A, Wong Tina T, Goh David, Su Daniel H, Chew Paul T K
AI Summary
This study found Argon Laser Peripheral Iridoplasty (ALPI) was less effective than prostaglandin eye drops for primary angle-closure glaucoma after laser iridotomy, showing higher failure rates and less IOP reduction.
Abstract
Purpose
To determine the effectiveness of argon laser peripheral iridoplasty (ALPI) in primary angle closure (PAC) and primary angle-closure glaucoma (PACG).
Design
Randomized controlled trial.
Participants
Eighty PAC or PACG subjects who underwent laser iridotomy (LI) and had at least 180° of persistent appositional angle closure and intraocular pressure (IOP) of more than 21 mmHg were enrolled.
Methods
Subjects were randomized to receive either 360° ALPI (Visulas 532s; Carl Zeiss Meditec, Jena, Germany) or medical therapy (Travoprost 0.004%; Alcon-Couvreur, Puurs, Antwerp, Belgium). Repeat ALPI was performed if the IOP reduction was less than 20% from baseline along with inadequate angle widening at the month 1 or month 3 visit. Intraocular pressure was controlled with systematic addition of medications when required.
Main outcome measures
The primary outcome measure was success rates after ALPI at 1 year. Complete success was defined as an IOP of 21 mmHg or less without medication, and qualified success was defined as an IOP of 21 mmHg or less with medication. Failure was defined as an IOP more than 21 mmHg despite additional medications or requiring glaucoma surgery.
Results
Forty subjects (51 eyes) were randomized to ALPI and 40 subjects (55 eyes) were randomized to medical therapy. Complete success (IOP ≤21 mmHg without medication) was achieved in 35.0% eyes of the ALPI group compared with 85.0% of eyes in the prostaglandin analog (PGA) group (P < 0.001), and qualified success (IOP ≤21 mmHg with medication) was achieved in 35.0% and 7.5%, respectively (P = 0.003). The IOP decreased by 4.9 mmHg (95% confidence interval [CI], 3.5-6.3 mmHg) in the ALPI group (P < 0.001) and by 6.1 mmHg (95% CI, 5.1-7.1 mmHg) in the medication group (P < 0.001). A failure rate of 30.0% was noted in the ALPI group compared with 7.5% in the medication group (P = 0.01). No treatment-related complications were recorded in either group.
Conclusions
After 1 year, ALPI was associated with higher failure rates and lower IOP reduction compared with PGA therapy in eyes with persistent appositional angle closure and raised IOP after LI.
MeSH Terms
Shields Classification
Key Concepts6
In a randomized controlled trial involving 80 subjects (106 eyes) with primary angle closure (PAC) or primary angle-closure glaucoma (PACG) who underwent laser iridotomy (LI) and had at least 180° of persistent appositional angle closure and intraocular pressure (IOP) of more than 21 mmHg, argon laser peripheral iridoplasty (ALPI) was associated with higher failure rates and lower IOP reduction compared with prostaglandin analog (PGA) therapy after 1 year.
In a randomized controlled trial, complete success (IOP ≤21 mmHg without medication) was achieved in 35.0% of eyes in the argon laser peripheral iridoplasty (ALPI) group compared with 85.0% of eyes in the prostaglandin analog (PGA) group (P < 0.001) at 1 year in subjects with primary angle closure (PAC) or primary angle-closure glaucoma (PACG) with persistent appositional angle closure and raised IOP after laser iridotomy (LI).
In a randomized controlled trial, qualified success (IOP ≤21 mmHg with medication) was achieved in 35.0% of eyes in the argon laser peripheral iridoplasty (ALPI) group and 7.5% of eyes in the prostaglandin analog (PGA) group (P = 0.003) at 1 year in subjects with primary angle closure (PAC) or primary angle-closure glaucoma (PACG) with persistent appositional angle closure and raised IOP after laser iridotomy (LI).
In a randomized controlled trial, the intraocular pressure (IOP) decreased by 4.9 mmHg (95% confidence interval [CI], 3.5-6.3 mmHg) in the argon laser peripheral iridoplasty (ALPI) group (P < 0.001) and by 6.1 mmHg (95% CI, 5.1-7.1 mmHg) in the prostaglandin analog (PGA) medication group (P < 0.001) in subjects with primary angle closure (PAC) or primary angle-closure glaucoma (PACG) with persistent appositional angle closure and raised IOP after laser iridotomy (LI).
In a randomized controlled trial, a failure rate of 30.0% was noted in the argon laser peripheral iridoplasty (ALPI) group compared with 7.5% in the prostaglandin analog (PGA) medication group (P = 0.01) at 1 year in subjects with primary angle closure (PAC) or primary angle-closure glaucoma (PACG) with persistent appositional angle closure and raised IOP after laser iridotomy (LI).
In a randomized controlled trial comparing argon laser peripheral iridoplasty (ALPI) and prostaglandin analog (PGA) therapy for primary angle closure (PAC) or primary angle-closure glaucoma (PACG), no treatment-related complications were recorded in either group.
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