Abstract
A prospective trial of argon laser trabeculoplasty (ALT) in narrow angle glaucoma (NAG) was undertaken. In eyes with NAG the mechanism of the glaucoma could be a combination of pupil block with subsequent irido-trabecular adhesion and trabecular damage with an increase in outflow resistance. To achieve relief of pupil block, eyes were randomly assigned to treatment with short pulsed laser iridotomy (LI) with the YAG or Dye lasers, or surgical peripheral iridectomy (PI). Alternatively, argon laser iridoplasty (IP) was performed to widen the anterior chamber angle sufficiently to permit ALT. Fifty-two eyes were treated and follow-up was from 12 to 22 months. A high rate of failure to control IOP with topical medication and progression of visual field loss occurred in all treatment groups.
Iridoplasty followed by ALT was particularly unsuccessful as, in 50 per cent of cases, progressive synechial closure of the anterior chamber angle occurred following treatment.
In eyes treated with PI/LI and ALT, the IOP control was improved in 12 per cent, unchanged in 30 per cent and remained uncontrolled in 58 per cent. By 15 months follow-up, a satisfactory outcome (IOP<21mmHg on topical medication, visual field and acuity stable) was obtained in 24 per cent of the 33 eyes treated with PI/LI and ALT. Thirty-one of these eyes showed visual field loss. Of the 10 eyes that did not receive ALT following PI or LI, 90 per cent had a satisfactory outcome. Eight of these eyes showed little or no visual field loss.
The authors conclude that iridoplasty followed by ALT is an unsuitable treatment for eyes with NAG. We further conclude that ALT is unlikely to be of benefit in eyes with NAG and visual field loss, even after pupil block has been relieved. Relief of pupil block alone may help eyes with early NAG without visual field loss.
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Hitchings RA and Powell DJ : Pilocarpine and narrow angle glaucoma. Trans Ophthalmol Soc UK 1981, 101: 214–7.
Chandler PA and Simmons RJ : Anterior chamber deepening for gonioscopy at time of surgery. Arch Ophthalmol 1965, 74: 177–90.
Simmons RJ, Kimbrough RL, Belcher CD, Dulit RA : Laser gonioplasty for special problems in angle closure glaucoma. In Symposium on Glaucoma. Transactions of the New Orleans Academy of Ophthalmology, St Louis, CV Mosby. 1981: 220–235.
Wishart PK and Hitchings RA : Neodymium YAG and Dye laser iridotomy—a comparative study. Trans Ophthalmol Soc UK 1986, 105: 521–40.
Thomas JV, Simmons RJ, Belcher CD III: Argon laser trabeculoplasty in the presurgical glaucoma patient. Ophthalmology 1982, 89: 187–97.
Schwartz LW, Spaeth GL, Traverso C, Greenidge KC : Variation of techniques on the results of argon laser trabeculoplasty. Ophthalmology 1983, 90: 781–4.
Schwartz AL and Kopleman J : Four year experience with argon laser trabecular surgery in uncontrolled open angle glaucoma. Ophthalmology 1983, 00: 771–80.
Migdal C and Hitchings RA : Control of chronic simple glaucoma with primary medical, surgical and laser treatment. Trans Ophthalmol Soc UK 1986, 105: 653–6.
Wise JB : Complications of laser trabeculoplasty. In symposium on the laser in ophthalmology and glaucoma update. Transactions of the New Orleans Academy of Ophthalmology. CV Mosby, St Louis. 1985, 134–8.
Spaeth GL : The normal development of the human anterior chamber angle: a new system of descriptive grading. Trans Ophthalmol Soc UK 1971, 91: 709–39.
Fontana ST and Brubaker RF : Volume and depth of the anterior chamber in the normal ageing human eye. Arch Ophthalmol 1980, 98: 1803–8.
Prince AM and Ritch R : Clinical signs of the pseudoexfoliation syndrome. Ophthalmology 1986, 93: 803–7.
Wishart PK, Spaeth GL, Poryzees EM : Anterior chamber angle in the exfoliation syndrome. Br J Ophthalmol 1985, 69: 103–7.
Sugar HS : Post-operative cataract in successfully filtering glaucomatous eyes. Am J Ophthalmol 1970, 69: 740–46.
Murphy MB and Spaeth GL : Iridectomy in primary angle closure glaucoma. Arch Ophthalmol 1914, 91: 114–22.
Playfair TJ and Watson PG : Management of chronic or intermittent angle-closure glaucoma: a long-term follow-up of the results of peripheral iridectomy as an initial procedure. Br J Ophthalmol 1979, 63: 23–8.
Coakes R, Lloyd-Jones D, Hitchings RA : Anterior chamber volume. Its measurement and clinical application. Trans Ophthalmol Soc UK 1979, 99: 78–81.
Hitchings RA and Lloyd-Jones D : Peripheral iridectomy for chronic simple glaucoma with narrow angles. Trans Ophthalmol Soc UK 1979, 99: 84–8.
Gelber EC and Anderson DR : Surgical decisions in chronic angle closure glaucoma. Arch Ophthalmol 1976, 94: 1481–4.
Quigley HA : Long-term follow-up of laser iridotomy. Ophthalmology 1981, 88: 218–24.
Gieser DK and Wilensky JT : Laser iridectomy in the management of chronic angle-closure glaucoma. Am J Ophthalmol 1984, 98: 446–50.
Ritch R : The treatment of chronic angle-closure glaucoma. Annals Ophthalmol 1981, 13: 21–3.
Hitchings RA : Combined dye and argon laser treatment for narrow angle glaucoma. Trans Ophthalmol Soc UK 1984, 104: 52–4.
Grierson I : Personal communication.
Kass MA, Meltzer DW, Gordon M, Cooper D, Goldberg J : Compliance with topical pilocarpine treatment. Am J Ophthalmol 1986, 101: 515–23.
Werner EB, Drance SM, Schulzer M : Trabeculectomy and the progression of glaucomatous visual field loss. Arch Ophthalmol 1977, 95: 1374–7.
Hoskins DM, Hetherington JR Jr., Minckler DS et al.: Complications of laser trabeculoplasty. Ophthalmology 1983, 90: 796–9.
Traverso CE, Greenidge KC, Spaeth GL : Formation of peripheral anterior synechiae following argon laser trabeculoplasty: a prospective study to determine relationship to position of laser burns. Arch Ophthalmol 1984, 102: 861–3.
Fankhauser F, Van der Zypen E, Kwasniewska S : Thermal effects on the trabecular meshwork induced by laser irradiation: clinical implications deduced from ultrastructural studies on the Macaca Speciosa monkey. Trans Ophthalmol Soc UK 1986, 105: 555–61.
Wise JB and Witter SL : Argon laser therapy for open angle glaucoma: a pilot study. Arch Ophthalmol 1979, 97: 319–22.
Wishart PK, Sherrard ES, Nagasubramanian S, Kerr Muir M, Hitchings RA : Corneal endothelial changes following short pulsed laser iridotomy and surgical iridectomy. Trans Ophthalmol Soc UK 1986, 105: 541–8.
Godel V and Regenbogen L : Cataractogenic factors in patients with primary angle-closure glaucoma after peripheral iridectomy. Am J Ophthalmol 1977, 83: 180.
Brazier DJ : Neodymium-YAG laser iridotomy. J Roy Soc Med 1986, 79: 658–60.
Schwartz LW, Moster MR, Spaeth GL, Wilson RP, Poryzees E : Neodymium-YAG laser iridotomies associated with closed or occludable angles. Am J Ophthalmol 1986, 102: 41–4.
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Presented at the Annual Congress of the Ophthalmological Society of the United Kingdom, April 1987.
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Wishart, P., Nagasubramanian, S. & Hitchings, R. Argon laser trabeculoplasty in narrow angle glaucoma. Eye 1, 567–576 (1987). https://doi.org/10.1038/eye.1987.87
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DOI: https://doi.org/10.1038/eye.1987.87
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