Evaluation of the learning curve of laser peripheral iridectomy:the 20^(th)case reaches the turning point

AIM:To explore the learning curve for ophthalmologists at the start of laser peripheral iridectomy(LPI)training.METHODS:The learning curve of 4 doctor groups without previous LPI experience was studied.Three main parameters of LPI were reviewed:total energy,argon energy and neodymium-doped yttrium aluminum garnet(Nd:YAG)energy.Procedures were evaluated in cohorts of 20 cases to identify the turning points of the three variables.RESULTS:There was no significant difference in terms of age or eye among the 4 doctor groups.There were stable trends on the learning curve for the Doctor A and C groups regarding total energy and argon energy.In addition,the turning points on the learning curve were determined after the 20th procedure for the Doctor B and D groups regarding total energy and argon energy.Moreover,the Nd:YAG energy was relatively stable since the first procedure.CONCLUSION:It requires approximately 20 procedures for a beginner to reach a turning point on the learning curve regarding LPI.It can serve as a point of reference or guideline for training beginners to perform LPI.

Combined Argon and Nd: YAG Laser Peripheral Iridectomy: A New Approach in Clinical Practice

Purpose: To evaluate the therapeutic effect of combind argon and Nd: YAG laser peripheral iridectomy.Methods: 151 cases (200 eyes) of primary angle-closure glaucoma and combined glaucoma were treated by combined procedure. Argon laser was the first used to create partial iridectomy in 2/3-3/4 thickness without penetrating pigmented epithelium, and then Nd: YAG laser was required to complete a patent iridectomy. Results: A successful iridectomy was achieved in all patients independent of any type of irides (100%). Iris penetration rate in one session presented in 95. 0%. Complications appeared to be less common in our patients: iris bleeding was only seen in 5. 0% cases; the postoperative inflammation was mild; corneal burns, lecalized lenticular opacities and closure of iridectomies were less frequent. The follow-up ranged from 3m to 6. 5 years. The success rate in controling IOP with/ without medications were 99. 0% except 2 eyes failur. No attack occured in 129 eyes with prophylatic laser therapy

Intraocular pressure and gonioscopic findings in primary angle-closure disease in India—a big data study

AIM:To describe the gonioscopic profile and intraocular pressure(IOP)in primary angle-closure(PAC)disease in patients presenting to a tertiary eye care network in India.METHODS:A cross-sectional hospital-based study that included 31484 new patients presenting between 2011 and 2021.Patients with a clinical diagnosis of PAC/suspect/glaucoma were included.The data was collected from an electronic medical record system.RESULTS:PAC glaucoma(PACG)(47.55%)was the most common diagnosis followed by PAC(39.49%)and PAC suspect(PACS;12.96%).Female preponderance(54.6%)was noted with higher mean age at presentation among males(P<0.0001).PACS and PAC showed the highest prevalence in 6th decade but PACG was higher at 7th decade.The probability of angle opening was 95.93%,90.32%and 63.36%in PACS,PAC and PACG eyes respectively post peripheral iridotomy(PI).Plateau iris syndrome(PIS)was noted in 252 eyes and all showed post dilated rise of IOP.A post dilated IOP rise was also noted with 8.86%,33.95%and 57.19%eyes with PACS,PAC and PACG respectively with IOP rise between 6-8 mm Hg across the disease spectrum.CONCLUSION:The superior quadrant is the narrowest angle and difficult to open with indentation and post PI.The probability of angle opening is less in PIS especially the complete variety along with post dilated IOP rise.The post dilated IOP rise in angle closure eyes warrants a careful dilatation,especially with PIS.

Intervention of laser periphery iridectomy to posterior iris bowing in high myopic eyes

Background For some high myopic patients with posterior iris bowing, laser periphery iridectomy should be performed pre-operation to prevent pupil block glaucoma if these patients would have phakic intraocular lens implantation to correct high myopia. So we had the opportunity to analysis the influence of laser iridectomy on posterior iris bowing. Methods Eighteen high myopic patients with posterior iris bowing （11 males and 7 females） were involved in the study in Beijing Tongren Eye Center from March 2008 to July 2008. Phakic intraocular lens were implanted to correct their ametropia. The mean age was （32＋6） years （range, 25-40 years）. The center anterior chamber depth, the pupil diameter, the posterior iris bowing depth and the anterior chamber angle were measured with anterior segment coherence tomography （AS-OCT） under the normal condition, myosis condition induced by 2% pilocarpine, laser periphery iridectomy after myosis, and 2% pilocarpine eluting condition respectively. Results There was no significant difference of center anterior chamber depth under the four conditions （P=0.512）. The pupil constricted after pilocarpine （P=0.001）. After＇ laser iridectomy performed and pilocarpine eluted, posterior iris bowing depth reduced more than that in normal condition （P=0.003）. The anterior chamber angle reduced significantly after laser periphery iridectomy and pilocarpine eluted （P=0.012）. Conclusion Laser periphery iridectomy can reduce the posterior iris bowing, which might be due to the change in aqueous circulate pathway.