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

Eye volume 37, pages 2139–2144 (2023)Cite this article

Subjects

Abstract

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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Fig. 1: CONSORT flow diagram.
Fig. 2: Best Corrected Visual Acuity and IOP results.

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Funding

This study was funded by the Budget for Science and Research of The People committee of Hanoi. The data that support the findings of this study are available on request from the corresponding author, [DT]. The data are not publicly available due to individual data privacy.

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Author notes

  1. These authors contributed equally: Hiep X. Nguyen, Ngan D. Nguyen.

Authors and Affiliations

  1. Viet Nam National Eye Hospital, Hanoi, Vietnam

    Hiep X. Nguyen, Ha T. T. Pham & Tan Do

  2. Military Hospital 103, Military Medical University, Hanoi, Vietnam

    Ngan D. Nguyen, Hang T. Vo & Cuong V. Nguyen

  3. Ha Dong Eye Hospital, Hanoi, Vietnam

    Huong T. Nguyen

  4. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore

    Kenric Rui-Pin Fan & Tin Aung

  5. National University of Singapore, Singapore, Singapore

    Tin Aung

  6. Hanoi Medical University, Hanoi, Vietnam

    Hien D. T. N. Nguyen

Authors
  1. Hiep X. Nguyen
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Contributions

TD Concept and design Data acquisition, analysis and interpretation Drafting and revision of manuscript Statistical analysis Funding approval NDN Concept and design Data acquisition, analysis and interpretation Drafting and revision of manuscript Funding approval HXN Concept and design Data acquisition, analysis and interpretation Drafting and revision of manuscript Funding approval HTN Data acquisition, analysis and interpretation Funding approval KR-PF Drafting and revision of manuscript HTV Data acquisition, analysis and interpretation Drafting and revision of manuscript Statistical analysis CVN Data acquisition, analysis and interpretation Drafting and revision of manuscript Statistical analysis HTTP Drafting and revision of manuscript TA Drafting and revision of manuscript HDTNN Drafting and revision of manuscript.

Corresponding author

Correspondence to Tan Do.

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Nguyen, H.X., Nguyen, N.D., Nguyen, H.T. et al. Comparing combined laser iridoplasty and surgical iridectomy with trabeculectomy in treatment of refractory acute primary angle closure without significant cataract: a randomized controlled trial. Eye 37, 2139–2144 (2023). https://doi.org/10.1038/s41433-022-02311-z

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