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Dysphotopsia and location of laser iridotomy: a systematic review

Eye (2024)Cite this article

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Abstract

This systematic review aimed to clarify the relationship between the location of laser peripheral iridotomy (LPI), a common procedure to prevent or treat angle-closure glaucoma, and the incidence of post-procedure visual disturbances known as dysphotopsias. Understanding this relationship is crucial due to the high frequency of LPIs performed and the significant impact dysphotopsia can have on vision and quality of life. Articles investigating the relationship between LPI location and dysphotopsia in at least five patients were identified via a literature search of OVID MEDLINE (1946-November 19, 2022) and EMBASE (1946-November 19, 2022). Non-comparative and non-English studies were excluded. Studies did not require a control group to be included. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system and Cochrane Risk of Bias 2 (RoB2) tool were used to appraise included studies. Our review included three studies encompassing 1756 eyes from 878 patients. The location of LPI was grouped into superior (604 patients, 889 eyes), inferior (150 patients, 150 eyes), and nasal/temporal (443 patients, 717 eyes). The analysis showed no significant difference in the incidence of any new dysphotopsia types among the location groups post-LPI. Overall, the incidence of lines, ghost images, and blurring significantly increased after LPI, while halos and glare significantly decreased. In conclusion, the current literature suggests that the location of LPI has no significant relationship to the types and rates of dysphotopsia experienced thereafter. While there is a 2–3% risk of linear dysphotopsia after LPI regardless of location, LPI may also resolve pre-existing halos and glare.

摘要

周边虹膜激光切开术 (LPI) 是预防或治疗闭角型青光眼的一种常见手术, 本综述旨在阐明周边虹膜激光切开术 (LPI) 选择的位置与术后视力障碍发生率之间的关系。由于 LPI 手术的高频率以及视力障碍对视力和生活质量的重要影响, 对其了解至关重要。通过对 OVID MEDLINE (1946 年至 2022 年 11 月 19 日) 和 EMBASE (1946 年至 2022 年 11 月 19 日) 数据库进行文献检索, 发现至少有五名患者的 LPI 位置与视力障碍之间关系的研究文章。非比较型研究和非英文研究被排除在外。纳入研究无需对照组。采用推荐、评估、发展和评价分级 (GRADE) 系统和 Cochrane Risk of Bias 2 (RoB2) 工具对纳入的研究质量进行评估。本综述包括三项研究, 涉及 878 名患者的1756只眼睛。LPI 的位置分为上侧 (604名患者, 889只眼) 、下侧 (150名患者, 150只眼) 和鼻/颞侧 (443名患者, 717只眼) 。分析结果表明, LPI 后各位置组的新发生的视力障碍类型发生率无明显差异。总体而言, LPI后线性视力障碍、黑影和视物模糊的发生率明显增加, 而光晕和眩光则明显减少。总之, 目前文献表明, LPI位置与术后出现的视力障碍类型和发生率没有相关性。无论在哪个位置, LPI后都有 2%-3% 的线性视力障碍风险, 但LPI 也可以解决之前存在的光晕和眩光问题。

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Fig. 1: PRISMA flowchart.
Fig. 2: Forest plot comparing new-onset linear dysphotopsia.

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References

  1. Radhakrishnan S, Chen PP, Junk AK, Nouri-Mahdavi K, Chen TC. Laser peripheral iridotomy in primary angle closure: a report by the American Academy of Ophthalmology. Ophthalmology. 2018;125:1110–20.

    Article  PubMed  Google Scholar 

  2. Spaeth GL, Idowu O, Seligsohn A, Henderer J, Fonatanarosa J, Modi A, et al. The effects of iridotomy size and position on symptoms following laser peripheral iridotomy. J Glaucoma. 2005;14:364–7.

    Article  PubMed  Google Scholar 

  3. Tester R, Pace NL, Samore M, Olson RJ. Dysphotopsia in phakic and pseudophakic patients: incidence and relation to intraocular lens type. J Cataract Refract Surg. 2000;26:810–6.

    Article  CAS  PubMed  Google Scholar 

  4. Davison JA. Positive and negative dysphotopsia in patients with acrylic intraocular lenses. J Cataract Refract Surg. 2000;26:1346–55.

    Article  CAS  PubMed  Google Scholar 

  5. Fişuş AD, Madaras Z, Horváth KU. The Prevalence of Dysphotopsia in Patients with Recent Cataract Surgery. Acta Marisiensis Ser Med. 2017;63:15–8.

    Article  Google Scholar 

  6. Vámosi P, Csákány B, Németh J. Intraocular lens exchange in patients with negative dysphotopsia symptoms. J Cataract Refract Surg. 2010;36:418–24.

    Article  PubMed  Google Scholar 

  7. Murphy PH, Trope GE. Monocular blurring: a complication of YAG laser iridotomy. Ophthalmology. 1991;98:1539–42.

    Article  CAS  PubMed  Google Scholar 

  8. Weintraub J, Berke SJ. Blurring after iridotomy. Ophthalmology. 1992;99:479–80.

    Article  CAS  PubMed  Google Scholar 

  9. Chung RS, Guan AEK. Unusual visual disturbance following laser peripheral iridotomy for intermittent angle closure glaucoma. Graefe’s Arch Clin Exp Ophthalmol. 2006;244:532–3.

    Article  Google Scholar 

  10. Lima V, Prata T, Mehta A, Tello C, Liebmann J, Ritch R. Monocular diplopia induced by posterior chamber intraocular lens in a patient with peripheral laser iridotomy: a case report. Eye. 2009;23:2131–2.

    Article  CAS  PubMed  Google Scholar 

  11. Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, et al. Going from evidence to recommendations. BMJ. 2008;336:1049–51.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. Br Med J. 2019;366:l4898.

    Article  Google Scholar 

  13. Vera V, Naqi A, Belovay GW, Varma DK, Ahmed IIK. Dysphotopsia after temporal versus superior laser peripheral iridotomy: a prospective randomized paired eye trial. Am J Ophthalmol. 2014;157:929–35.e2.

    Article  PubMed  Google Scholar 

  14. Ahmadi M, Naderi Beni Z, Naderi Beni A, Kianersi F. Efficacy of neodymium-doped yttrium aluminum garnet laser iridotomies in primary angle-closure diseases: superior peripheral iridotomy versus inferior peripheral iridotomy. Curr Med Res Opin. 2017;33:687–92.

    Article  CAS  PubMed  Google Scholar 

  15. Kavitha S, Zebardast N, Palaniswamy K, Kader MA, Raman GV, Rajendrababu S, et al. Comparison of new visual disturbances after superior versus nasal/temporal laser peripheral iridotomy: a prospective randomized trial. Ophthalmology. 2018;125:345–51.

    Article  Google Scholar 

  16. Kavitha S, Ramulu PY, Venkatesh R, Palaniswamy K, Kader MA, Raman GV, et al. Resolution of visual dysphotopsias after laser iridotomy: six-month follow-up. Ophthalmology. 2019;126:469–71.e1.

    Article  PubMed  Google Scholar 

  17. Harrad R, Stannard K, Shilling J. Argon laser iridotomy. Br J Ophthalmol. 1985;69:368–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Quigley HA. Long-term follow-up of laser iridotomy. Ophthalmology. 1981;88:218–24.

    Article  CAS  PubMed  Google Scholar 

  19. Drake MV. Neodymium: YAG laser iridotomy. Surv Ophthalmol. 1987;32:171–7.

    Article  CAS  PubMed  Google Scholar 

  20. Foster PJ, Ng WS, Nolan WP, Tanner L, Gazzard G, Day AC, et al. Prevention of angle-closure glaucoma: balancing risk and benefit. Eye. 2022;36:2229–31.

    Article  PubMed  PubMed Central  Google Scholar 

  21. He M, Jiang Y, Huang S, Chang DS, Munoz B, Aung T, et al. Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomised controlled trial. Lancet. 2019;393:1609–18.

    Article  PubMed  Google Scholar 

  22. Azuara-Blanco A, Burr J, Ramsay C, Cooper D, Foster PJ, Friedman DS, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet. 2016;388:1389–97.

    Article  PubMed  Google Scholar 

  23. Baskaran M, Kumar RS, Friedman DS, Lu Q-S, Wong H-T, Chew PT, et al. The Singapore Asymptomatic Narrow Angles Laser Iridotomy Study: five-year results of a randomized controlled trial. Ophthalmology. 2022;129:147–58.

    Article  PubMed  Google Scholar 

  24. Congdon N, Yan X, Friedman DS, Foster PJ, Van Den Berg TJ, Peng M, et al. Visual symptoms and retinal straylight after laser peripheral iridotomy: the Zhongshan Angle-Closure Prevention Trial. Ophthalmology. 2012;119:1375–82.

    Article  PubMed  Google Scholar 

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Funding

Glaucoma Research Society of Canada (GRSC).

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Authors and Affiliations

  1. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Michael Balas

  2. Donald K. Johnson Eye Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada

    David J. Mathew

  3. Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada

    David J. Mathew

  4. Department of Lab Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

    David J. Mathew

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Contributions

MB was responsible for designing the review protocol, conducting the search, screening potentially eligible studies, extracting and analyzing data, interpreting results, updating reference lists and manuscript preparation. DJM was responsible for reviewing the protocol, screening potentially eligible studies, interpreting results, manuscript preparation, and overall supervision of the review process.

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Correspondence to David J. Mathew.

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Balas, M., Mathew, D.J. Dysphotopsia and location of laser iridotomy: a systematic review. Eye (2024). https://doi.org/10.1038/s41433-023-02913-1

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