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

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

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...

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Bibliographic Details
Published in:Eye (London) Vol. 37; no. 10; pp. 2139 - 2144
Main Authors: Nguyen, Hiep X., Nguyen, Ngan D., Nguyen, Huong T., Fan, Kenric Rui-Pin, Vo, Hang T., Nguyen, Cuong V., Pham, Ha T. T., Aung, Tin, Nguyen, Hien D. T. N., Do, Tan
Format: Journal Article
Language:English
Published: London Nature Publishing Group UK 01-07-2023
Nature Publishing Group
Subjects:
692/308/409
706/648/160
706/703/559
Cataract - complications
Cataracts
Clinical trials
Complications
Female
Glaucoma, Angle-Closure - complications
Glaucoma, Angle-Closure - surgery
Humans
Intraocular Pressure
Iridectomy
Iris - surgery
Laboratory Medicine
Lasers
Male
Medical treatment
Medicine
Medicine & Public Health
Ophthalmology
Patients
Pharmaceutical Sciences/Technology
Postoperative
Surgery
Surgical Oncology
Surgical outcomes
Trabeculectomy - methods
Treatment Outcome
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Summary: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.
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ISSN:0950-222X
1476-5454
1476-5454
DOI:10.1038/s41433-022-02311-z