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Article: Argon laser peripheral iridoplasty versus conventional systemic medical therapy in treatment of acute primary angle-closure glaucoma: A prospective, randomized, controlled trial

TitleArgon laser peripheral iridoplasty versus conventional systemic medical therapy in treatment of acute primary angle-closure glaucoma: A prospective, randomized, controlled trial
Authors
Issue Date2002
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/ophtha
Citation
Ophthalmology, 2002, v. 109 n. 9, p. 1591-1596 How to Cite?
AbstractObjective: To study whether argon laser peripheral iridoplasty (ALPI) is as effective and safe as conventional systemic medications in treatment of acute primary angle-closure glaucoma (PACG) when immediate laser peripheral iridotomy is neither possible nor safe. Design: Prospective, randomized, controlled trial. Participants: Seventy-three eyes of 64 consecutive patients with their first presentation of acute PACG, with intraocular pressure (IOP) levels of 40 mmHg or more, were recruited into the study. Intervention: The acute PACG eye of each consenting patient received topical pilocarpine (4%) and topical timolol (0.5%). The patients were then randomized into one of two treatment groups. The ALPI group received immediate ALPI under topical anesthesia. The medical treatment group was given 500 mg of intravenous acetazolamide, followed by oral acetazolamide 250 mg four times daily, and an oral potassium supplement until IOP levels normalized. Intravenous mannitol also was administered to the latter group if the presenting IOP was higher than 60 mmHg. The acute PACG eye of both groups continued to receive topical pilocarpine (1 %) until peripheral iridotomy could be performed. Main Outcome Measures: Intraocular pressure profile, corneal clarity, symptoms, visual acuity, angle status by indentation gonioscopy, and complications of treatment. Results: Thirty-three acute PACG eyes of 32 patients were randomized to receive immediate ALPI, whereas 40 acute PACG eyes of 32 patients had conventional systemic medical therapy. Both treatment groups were matched for age, duration of attack, and IOP at presentation. The ALPI-treated group had lower IOP levels than the medically treated group at 15 minutes, 30 minutes, and 1 hour after the start of treatment. The differences were statistically significant. The difference in IOP levels became statistically insignificant from 2 hours onward. The duration of attack did not affect the efficacy of ALPI in reducing IOP in acute PACG. No serious laser complications occurred, at least in the early postlaser period. Conclusions: Argon laser peripheral iridoplasty significantly is more effective than conventional systemic medications in reducing IOP levels in acute PACG in eyes not suitable for immediate laser peripheral iridotomy within the first 2 hours from the initiation of treatment. Argon laser peripheral iridoplasty is a safe and more effective alternative to conventional systemic medications in the management of acute PACG not amenable to immediate laser peripheral iridotomy. © 2002 by the American Academy of Ophthalmology.
Persistent Identifierhttp://hdl.handle.net/10722/176390
ISSN
2015 Impact Factor: 6.75
2015 SCImago Journal Rankings: 4.745
References

 

DC FieldValueLanguage
dc.contributor.authorLam, DSCen_US
dc.contributor.authorLai, JSMen_US
dc.contributor.authorTham, CCYen_US
dc.contributor.authorChua, JKHen_US
dc.contributor.authorPoon, ASYen_US
dc.date.accessioned2012-11-26T09:10:58Z-
dc.date.available2012-11-26T09:10:58Z-
dc.date.issued2002en_US
dc.identifier.citationOphthalmology, 2002, v. 109 n. 9, p. 1591-1596en_US
dc.identifier.issn0161-6420en_US
dc.identifier.urihttp://hdl.handle.net/10722/176390-
dc.description.abstractObjective: To study whether argon laser peripheral iridoplasty (ALPI) is as effective and safe as conventional systemic medications in treatment of acute primary angle-closure glaucoma (PACG) when immediate laser peripheral iridotomy is neither possible nor safe. Design: Prospective, randomized, controlled trial. Participants: Seventy-three eyes of 64 consecutive patients with their first presentation of acute PACG, with intraocular pressure (IOP) levels of 40 mmHg or more, were recruited into the study. Intervention: The acute PACG eye of each consenting patient received topical pilocarpine (4%) and topical timolol (0.5%). The patients were then randomized into one of two treatment groups. The ALPI group received immediate ALPI under topical anesthesia. The medical treatment group was given 500 mg of intravenous acetazolamide, followed by oral acetazolamide 250 mg four times daily, and an oral potassium supplement until IOP levels normalized. Intravenous mannitol also was administered to the latter group if the presenting IOP was higher than 60 mmHg. The acute PACG eye of both groups continued to receive topical pilocarpine (1 %) until peripheral iridotomy could be performed. Main Outcome Measures: Intraocular pressure profile, corneal clarity, symptoms, visual acuity, angle status by indentation gonioscopy, and complications of treatment. Results: Thirty-three acute PACG eyes of 32 patients were randomized to receive immediate ALPI, whereas 40 acute PACG eyes of 32 patients had conventional systemic medical therapy. Both treatment groups were matched for age, duration of attack, and IOP at presentation. The ALPI-treated group had lower IOP levels than the medically treated group at 15 minutes, 30 minutes, and 1 hour after the start of treatment. The differences were statistically significant. The difference in IOP levels became statistically insignificant from 2 hours onward. The duration of attack did not affect the efficacy of ALPI in reducing IOP in acute PACG. No serious laser complications occurred, at least in the early postlaser period. Conclusions: Argon laser peripheral iridoplasty significantly is more effective than conventional systemic medications in reducing IOP levels in acute PACG in eyes not suitable for immediate laser peripheral iridotomy within the first 2 hours from the initiation of treatment. Argon laser peripheral iridoplasty is a safe and more effective alternative to conventional systemic medications in the management of acute PACG not amenable to immediate laser peripheral iridotomy. © 2002 by the American Academy of Ophthalmology.en_US
dc.languageengen_US
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/ophthaen_US
dc.relation.ispartofOphthalmologyen_US
dc.subject.meshAcetazolamide - Therapeutic Useen_US
dc.subject.meshAcute Diseaseen_US
dc.subject.meshAdministration, Oralen_US
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshAged, 80 And Overen_US
dc.subject.meshAntihypertensive Agents - Therapeutic Useen_US
dc.subject.meshCarbonic Anhydrase Inhibitors - Therapeutic Useen_US
dc.subject.meshFemaleen_US
dc.subject.meshGlaucoma, Angle-Closure - Drug Therapy - Physiopathology - Surgeryen_US
dc.subject.meshHumansen_US
dc.subject.meshInfusions, Intravenousen_US
dc.subject.meshIntraocular Pressure - Drug Effects - Physiologyen_US
dc.subject.meshIris - Surgeryen_US
dc.subject.meshLaser Therapy - Methodsen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshProspective Studiesen_US
dc.subject.meshSafetyen_US
dc.subject.meshTreatment Outcomeen_US
dc.subject.meshVisual Acuityen_US
dc.titleArgon laser peripheral iridoplasty versus conventional systemic medical therapy in treatment of acute primary angle-closure glaucoma: A prospective, randomized, controlled trialen_US
dc.typeArticleen_US
dc.identifier.emailLai, JSM: laism@hku.hken_US
dc.identifier.authorityLai, JSM=rp00295en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1016/S0161-6420(02)01158-2en_US
dc.identifier.pmid12208703-
dc.identifier.scopuseid_2-s2.0-0036711659en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0036711659&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume109en_US
dc.identifier.issue9en_US
dc.identifier.spage1591en_US
dc.identifier.epage1596en_US
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridLam, DSC=35500200200en_US
dc.identifier.scopusauthoridLai, JSM=7401939748en_US
dc.identifier.scopusauthoridTham, CCY=7006081241en_US
dc.identifier.scopusauthoridChua, JKH=7005163724en_US
dc.identifier.scopusauthoridPoon, ASY=7103068842en_US

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