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Impressum
Advantage of Surgical Iridectomy over Nd:YAG Laser Iridotomy in Acute Primary Angle Closure Glaucoma
Tanasescu I., Grehn F.
University Eye Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, Germany
Background: Nd:YAG-Laser iridotomy is routinely used as a procedure
for primary acute angle closure glaucoma (AACG). Despite its clear advantage
to resolve pupillary block without opening the eye, it remains unclear
whether Nd:YAG laser iridotomy is equally effective as compared to surgical
iridectomy. In a retrospective study we analysed cases in which AACG recurred
despite patent Nd:YAG Laser iridotomy.
Patients and Methods: We studied the charts of 90 patients who
presented with unilateral primary AACG in our department over 3 years
and were treated with a surgical iridectomy. Surgical iridectomy at the
12 o`clock position was performed using a self sealing corneal incision.
Results: Of the 90 patients with primary AACG, 13 (14.4%) had already
been treated with Nd:YAG laser iridotomy before.Despite the laser intervention,
these eyes developed recurrent AACG.The presenting intraocular pressure
(IOP) of these 13 eyes was 49.07 ± 12.65 mmHg. In 4 eyes, continuous
medical glaucoma therapy was used prior to AACG. 8 eyes showed signs of
glaucoma damage at the optic disk or/ and the visual field. In 2 eyes,
the presenting high IOP at AACG could be lowered by medication. The interval
between the Nd:YAG laser iridotomy and the AACG was 24.51 weeks. After
surgical iridectomy, the IOP was reduced to 12.69 ± 4.11 mmHg and
was 16.62 ± 3.86 mmHg at the end of the observation period.
Conclusions: Surgical iridectomy has advantages compared to Nd:YAG
laser iridotomy in cases of AACG with severe ischemia and synechiae of
the anterior chamber angle. It should be considered as a primary therapy
in cases with ischemic iris or lack of response to medical therapy of
AACG.