This is a 10-centre randomized controlled clinical trial to explore whether laser peripheral iridoplasty (LPIP) plus laser peripheral iridotomy (LPI) is more effective than single LPI to control the progression of primary angle closure with multi-mechanism based on the UBM classification.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
240
a neodymium:yttrium-aluminum- garnet laser was used to perform the LPI
a frequency-doubled Q-switched neodymium:yttrium-aluminum-garnet 532-nm laser was used to perform the LPIP
30 minutes prior to the procedure, a drop of 2% pilocarpine will be instilled into the eye every 15 minutes, Topical anaesthesia (Proparacaine) will be administered
Zhongshan Ophthalmic Center
Guangzhou, Guangdong, China
RECRUITINGProgression rate determined by number of patients who progress after laser treatment for each group.
PAC progression defined as presence of any of the following: 1. Acute angle closure crisis 2. Intraocular (IOP) was 8mmHg higher than initiation 1 month after the laser procedure 3. IOP was ≥22mmHg when measured three times of continuous 1 month after the lase procedure 4. The progression of peripheral anterior synechiae ≥ 1 clock hour within 3 years after the laser procedure as measured by gonioscopic examination. 5. glaucomatous neuropathy within 3 years after the laser procedure
Time frame: 3 years
Additional medication or surgery required questionnaire
1. the medication required to control the IOP 2. the additional surgery required to control the progression of the PAC
Time frame: 3 years
The change of the best corrected visual acuity after the laser procedure
Time frame: 3 years
The number of the cornea endothelial cells
Time frame: 3 years
The change in angle width and configuration as measured by ultrasound biomicroscopy (UBM)
Time frame: 3 years
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LPIP was applied with a VISULAS diode laser of 532 nm (Carl Zeiss Meditec, Dublin, CA). 30 minutes prior to the procedure, a drop of 2% pilocarpine will be instilled into the eye every 15 minutes, Topical anaesthesia will be administered. Twenty to 30 spots of 250-300 mW power with 300-500 microns of size and duration of 400-500 ms were applied. Power was modified arbitrarily until an effective iris contraction was obtained. Effective iris contraction was considered as a concentric movement around the laser spot, with minimal iris pigmentation and immediate angle opening observed through the lens mirrors using a Goldmann lens. Power was lowered if there was any bursting sound perceived, pigment dispersion, air bubbles or considerable pain. LPI was performed after LPIP procedure.
30 minutes prior to the procedure, a drop of 2% pilocarpine will be instilled into the eye every 15 minutes, Topical anaesthesia (Proparacaine) will be administered
LPI was performed with a VISULAS diode laser of 532 nm (Carl Zeiss Meditec, Dublin, CA). 30 minutes prior to the procedure, a drop of 2% pilocarpine will be instilled into the eye every 15 minutes, Topical anaesthesia (Proparacaine) will be administered. The treatment site was selected in the superior nasal iris or in a crypt, where present. Treatment was initiated with a pulse of 3-5mJ, the power was increased until patency was achieved, the opening of iris \>0.1mm. and patency was determined by direct visualization of the posterior chamber.