Document Detail


Randomized trial of early phacoemulsification versus peripheral iridotomy to prevent intraocular pressure rise after acute primary angle closure.
MedLine Citation:
PMID:  18164064     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To compare the efficacy of early phacoemulsification versus laser peripheral iridotomy (LPI) in the prevention of intraocular pressure (IOP) rise in patients after acute primary angle closure (APAC). DESIGN: Prospective randomized controlled trial. PARTICIPANTS: Sixty-two eyes of 62 Chinese subjects, with 31 eyes in each arm. METHODS: Subjects were randomized to receive either early phacoemulsification or LPI after aborting APAC by medications. Patients were followed up on day 1; week 1; and months 1, 3, 6, 12, and 18. Predictors for IOP rise were studied. MAIN OUTCOME MEASURES: Prevalence of IOP rise above 21 mmHg (primary) and number of glaucoma medications, IOP, and Shaffer gonioscopy grading (secondary). RESULTS: Prevalences of IOP rise for the LPI group were 16.1%, 32.3%, 41.9%, and 46.7% for the follow-ups at 3, 6, 12, and 18 months, respectively. There was only one eye (3.2%) in the phacoemulsification group that had IOP rise at all follow-up time points (P<0.0001). Treatment by LPI was associated with significantly increased hazard of IOP rise (hazard ratio [HR], 14.9; 95% confidence interval [CI], 1.9-114.2; P = 0.009). In addition, a maximum IOP at presentation > 55 mmHg was associated with IOP rise (HR, 4.1; 95% CI, 1.3-13.0; P = 0.017). At 18 months, the mean number of medications required to maintain IOP <or= 21 mmHg was significantly higher in the LPI group (0.90+/-1.14) than in the phacoemulsification group (0.03+/-0.18, P<0.0001). Mean IOP for phacoemulsification group (12.6+/-1.9 mmHg) was consistently lower than that of the LPI group (15.0+/-3.4 mmHg, P = 0.009). Mean Shaffer grading for the phacoemulsification group (2.10+/-0.76) was consistently greater than that of the LPI group (0.73+/-0.64, P<0.0001). CONCLUSION: Early phacoemulsification appeared to be more effective in preventing IOP rise than LPI in patients after abortion of APAC. High presenting IOP of >55 mmHg is an added risk factor for subsequent IOP rise. For patients with coexisting cataract and presenting IOP of >55 mmHg, early phacoemulsification can be considered as a definitive treatment to prevent IOP rise.
Authors:
Dennis S C Lam; Dexter Y L Leung; Clement C Y Tham; Felix C H Li; Yolanda Y Y Kwong; Thomas Y H Chiu; Dorothy S P Fan
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-12-27
Journal Detail:
Title:  Ophthalmology     Volume:  115     ISSN:  1549-4713     ISO Abbreviation:  Ophthalmology     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-07-07     Completed Date:  2008-07-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1134-40     Citation Subset:  IM    
Affiliation:
Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong, China. dennislam_pub@cuhk.edu.hk
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Antihypertensive Agents / administration & dosage
Cataract / complications
Female
Follow-Up Studies
Glaucoma, Angle-Closure / complications*,  drug therapy
Gonioscopy
Humans
Intraocular Pressure*
Iridectomy / methods*
Laser Therapy
Lasers, Solid-State
Lens Implantation, Intraocular
Male
Ocular Hypertension / etiology,  prevention & control*
Phacoemulsification / methods*
Prednisolone / administration & dosage,  analogs & derivatives
Prospective Studies
Tonometry, Ocular
Treatment Outcome
Visual Acuity
Visual Fields
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 50-24-8/Prednisolone; 52-21-1/prednisolone acetate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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