Goals

To compare the safety and efficacy of combined laser iridoplasty followed by surgical iridectomy (LI-SI) versus trabeculectomy in the management of medically unresponsive acute primary angle closure (APAC) with minimal cataract.

Patients and methods

This was a randomized controlled trial in patients with medically unresponsive ACPA without significant cataracts. Study participants were randomized to: LI-SI or non-augmented trabeculectomy. The primary endpoint of the study was the rate of postoperative surgical complications in the first 3 months after surgery. The secondary outcome assessed at 1 year was whether treatment was completely successful (IOP

Results

The study included 67 eyes of 67 patients (59 women/8 men = 7.4/1) who were randomized into 2 groups: LI-SI (Group 1, 37 eyes) and trabeculectomy (Group 2, 30 eyes) . There was no statistical difference between the two groups at baseline. Overall, there were more postoperative complications in group 1 than in group 2 (45.9% versus 33.3% – p= 0.23), although all responded well to medical treatment and resolved without sequelae. Complete success was found in 97.1% (34/35 eyes) in group 1 and 92.6% in group 2 (p= 0.19, Fisher’s exact test).

conclusion

There was a higher rate of postoperative complications after LI-SI compared to trabeculectomy performed for medically unresponsive APAC with minimal cataract. Both procedures had similar surgical outcomes at 1 year.