In their study of Argon Laser Peripheral Iridoplasty (ALPI) as an initial treatment for acute phacomorphic angle closure glaucoma, Tham et al1 did not mention the number of patients they excluded from their trial and the reason for exclusion. Their recruitment rate of five patients per year may not be high enough to justify the cost of round-the-clock availability of facility and operator. This issue would be pertinent in developing countries where resources are more limited.
The authors additionally noted a 50% pressure increase in one of the 10 patients sampled; their suggested explanations imply that ALPI is somewhat unpredictable in its effects. Moreover, they could only postulate on how ALPI is able to reduce IOP as eight out of 10 patients had closed angles on gonioscopy. Their conclusion that ALPI is safe appears premature. Perhaps an in vitro model and ultrasound biomicroscopy would shed more light on the exact mechanism of ALPI in phacomorphic glaucoma.
Tham CCY, Lai JSM, Poon ASY, Chan JCH, Lam SW, Chua JKH et al. Immediate argon laser peripheral iridoplasty (ALPI) as initial treatment for acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction: a preliminary study. Eye 2005; 19: 778–783.
The author has no financial or proprietary interest in the submitted correspondence
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Thyagarajan, S. Immediate argon peripheral iridoplasty (ALPI) as initial treatment phacomorphic glaucoma: a safe and cost-effective treatment?. Eye 20, 1323 (2006). https://doi.org/10.1038/sj.eye.6702190