Laser peripheral iridoplasty for angle-closure glaucoma

Glaucoma is a leading cause of irreversible blindness in the world. Angle-closure glaucoma describes one of the mechanisms which leads to glaucoma. In angle-closure, the "angles" that act as drains for the aqueous in the eye are closed which leads to high eye ball pressure. Treatment is aimed at opening the drainage system and lowering the pressure in the eye with medical or surgical treatment or both. 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 (angles). Although one randomised controlled trial with 158 participants was found, due to its limitations and the lack of a statistically significant difference observed with laser peripheral iridoplasty intervention, this review found no strong evidence for the use of laser peripheral iridoplasty in the treatment of angle-closure in the non-acute setting.

Authors' conclusions: 

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

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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 (PACs), PAC and PACG.

Search strategy: 

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 12), MEDLINE (January 1950 to January 2012), EMBASE (January 1980 to January 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 5 January 2012.

Selection criteria: 

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

Data collection and analysis: 

No analysis was carried out as only one trial was included in the review.

Main results: 

We included one RCT with 158 participants. The trial reported laser peripheral iridoplasty as an adjunct to laser peripheral iridotomy compared to iridotomy alone. The authors report no superiority in using iridoplasty as an adjunct to iridotomy for IOP, number of medications or need for surgery.

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