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Functional evaluation of an iridotomy in primary angle closure eyes

  • Glaucoma
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the functional efficacy of an iridotomy in primary angle closure (PAC) eyes by measuring IOP responses to provocative tests before and after iridotomy.

Design

Prospective cohort study.

Subjects

50 consecutive adult patients, 40–60 years of age, having primary angle closure.

Methods

Clinical examination, perimetry, biometry and ultrasound biomicroscopy of the angle were done. A darkroom prone provocative test (DRPPT), a mydriatic test and a Valsalva maneuver were performed before and after the iridotomy.

Main outcome measures

IOP change in response to the provocative tests before and after iridotomy, and correlation with baseline parameters.

Results

IOP at baseline and after iridotomy was 14.4 ± 2.7 mmHg and 14.3 ± 2.6 mmHg, respectively (p = 0.)83. There was no significant change on diurnal phasing before and after an iridotomy (p = 0.)11. The mean IOP rise was 5.9 ± 3.7 mmHg on the DRPPT, 4.3 ± 3.5 mmHg on the Mydriatic test and 9.1 ± 4.9 mmHg on the Valsalva maneuver, and was reduced significantly to 3.2 ± 2.1 mmHg, 2.3 ± 1.8 and 6.4 ± 3.5, respectively(p < 0.001 for all tests). The decrease in pupillary block component for all 50 eyes was 46.5 % for the mydriatic test, 45.8 % for the DRPPT and 29.7 % for the Valsalva maneuver. PAC eyes positive on the DRPPT and mydriatic test prior to an iridotomy became negative after laser iridotomy in 75.9 and 84.6 % eyes, respectively, but on the Valsalva maneuver, only 23.8 % became negative. After iridotomy, eyes that continued to be positive on the mydriatic test had a significantly thicker lens (p = 0.02), decreased TCPD (p = 0.014) and narrower trabecular–iris angle (p = 0.048). On the DRPPT, they had a thicker lens (p = 0.03), shorter iris thickness (p = 0.025) and TCPD (p = 0.032), and on the Valsalva maneuver, they had a narrower scleral–ciliary process angle (SCPA; p = 0.019) and shorter TCPD (p = 0.015).

Conclusions

This comprehensive functional evaluation of laser iridotomy in early PAC eyes showed a significant reduction in the pupillary block component of IOP response to provocative testing, possibly decreasing IOP fluctuations over time. An iridotomy does not, however, significantly change mean IOP or diurnal phasing of IOP in PAC eyes. Eyes with a very narrow angle or a thick lens may continue to have angle closure due to other pathomechanisms for angle closure.

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Authors and Affiliations

  1. Glaucoma Research Facility & Clinical Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India

    Ramanjit Sihota, Karandeep Rishi, Geetha Srinivasan, Viney Gupta & Tanuj Dada

  2. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India

    Kulwant Singh

Authors
  1. Ramanjit Sihota
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  2. Karandeep Rishi
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  3. Geetha Srinivasan
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  4. Viney Gupta
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  5. Tanuj Dada
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  6. Kulwant Singh
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Corresponding author

Correspondence to Ramanjit Sihota.

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Funding

No funding was received for this research.

Conflict of interest statement

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Sihota, R., Rishi, K., Srinivasan, G. et al. Functional evaluation of an iridotomy in primary angle closure eyes. Graefes Arch Clin Exp Ophthalmol 254, 1141–1149 (2016). https://doi.org/10.1007/s00417-016-3298-x

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  • DOI: https://doi.org/10.1007/s00417-016-3298-x

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