Laser peripheral iridoplasty for angle-closure glaucoma

Ng WS, Ang GS, Azuara-Blanco A

Published Online:

July 16, 2008

Angle -closure glaucoma is a leading cause of irreversible blindness in the world. Treatment is aimed at opening the drainage system and lowering the pressure in the eye with medical and/or surgical treatment. Laser peripheral iridoplasty is used in patients with angle-closure when other treatments fail to open the anterior drainage system. It works by shrinking and pulling the peripheral iris tissue away from the trabecular meshwork. Due to the lack of randomised controlled trials, this review found no strong evidence for the use of 0laser peripheral iridoplasty in the treatment of angle-closure.

Abstract (click to read)

Background:

Angle-closure glaucoma is a leading cause of irreversible blindness in the world. Treatment is aimed at opening the anterior chamber angle and lowering the IOP with medical and/or surgical treatment (e.g. trabeculectomy, lens extraction). Laser iridotomy works by eliminating pupillary block and widens the anterior chamber angle in the majority of patients. When laser iridotomy fails to open the anterior chamber angle, laser iridoplasty may be recommended as one of the options in current standard treatment for angle-closure. Laser peripheral iridoplasty works by shrinking and pulling the peripheral iris tissue away from the trabecular meshwork. Laser peripheral iridoplasty can be used for crisis of acute angle-closure and also in non-acute situations.

Objectives:

To assess the effectiveness of laser peripheral iridoplasty in the treatment of narrow angles (i.e. primary angle-closure suspect), primary angle-closure (PAC) or primary angle-closure glaucoma (PACG) in non-acute situations when compared with any other intervention. In this review, angle-closure will refer to patients with narrow angles, PAC and PACG.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library), MEDLINE, EMBASE and LILACS (Latin American and Caribbean Literature on Health Sciences). The databases were last searched on 11 February 2008.

Selection criteria:

Only randomised controlled trials (RCTs) were eligible for inclusion in this review. Patients with narrow angles, PAC or PACG were eligible. Studies that included only patients with acute presentations, using laser peripheral iridoplasty to break acute crisis were excluded.

Data collection and analysis:

No analysis was carried out due to lack of trials.

Main results:

There were no RCTs assessing laser peripheral iridoplasty in the non-acute setting of angle-closure.

Authors' conclusions:

There is currently no strong evidence for laser peripheral iridoplasty’s use in treating angle-closure.

This record should be cited as:

Ng WS, Ang GS, Azuara-Blanco A. Laser peripheral iridoplasty for angle-closure. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006746. DOI: 10.1002/14651858.CD006746.pub2

Assessed as up to date:

February 11, 2008

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Primary Review Group:

Eyes and Vision Group

Health topics:

Eyes & vision > Glaucoma > Angle closure

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Laser peripheral iridoplasty for angle-closure glaucoma

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