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PubMed1995

Prophylactic Nd:YAG-laser iridotomy versus surgical iridectomy: a randomized, prospective study.

Both surgical iridectomy and YAG-laser iridotomy have been shown to prevent angle-closure glaucoma. However, it remains unknown as to which procedure is superior. We therefore conducted a prospective randomized study, which compared the effect of the two methods on visual acuity, intraocular pressure, endothelial cell density, depth of the anterior chamber, and iris configuration as well as acceptance by the patients. A total of 30 patients, who were treated for acute angle-closure glaucoma in one eye, were subjected to either surgical iridectomy or Nd:YAG-laser iridotomy in the other eye according to a randomized protocol. All patients were followed for 12 months by examination at the 1st, 6th, and 12th month post treatment. No significant difference between the two treatments was found regarding visual acuity or intraocular pressure. The peripheral anterior chamber increased in depth following both methods, whereas the central depth of the anterior chamber was unaffected. A better gonioscopic visibility of the trabecular meshwork resulted from the increased width of the chamber angle. Whereas the number of endothelial cells remained constant in the patients treated with laser iridotomy, a small decrease was observed in the group of patients who underwent iridectomy (-7.2% after 12 months; difference not significant). The subjective acceptance by the patients was better in the group treated with laser iridotomy. We conclude that the two methods are equivalent with regard to intraocular pressure and visual acuity. The constant number of endothelial cells and the better acceptance by the patients suggest Nd:YAG-laser iridotomy to be the preferable method for prophylaxis of acute angle-closure glaucoma.

Acute Disease↗

PubMed2004

A study of iridectomy histopathologic features of latanoprost- and non-latanoprost-treated patients.

OBJECTIVES: To examine the histopathologic features of iridectomy specimens from patients undergoing glaucoma surgery and to compare histologic abnormalities in a group of patients with a history of latanoprost therapy with those in a group of patients who had no history of prostaglandin therapy (controls). METHODS: Iridectomy specimens and patient history forms were submitted to the central Latanoprost Pathology Center. These were independently examined by 3 ophthalmic pathologists in a masked fashion. Specimens were evaluated for malignant, premalignant, and other changes including differences in levels of pigmentation, degrees of cellularity, inflammation, vascular abnormalities, and changes in the iris pigment epithelium. RESULTS: Specimens were received from 449 patients with a history of latanoprost treatment and 142 patients who had no history of treatment with latanoprost or other prostaglandin analogues. No evidence of malignant or premalignant changes was found. In latanoprost-treated irides, the prevalence of iris freckles was higher (P = .001) than in control irides, as was the combined number of stromal fibroblasts and melanocytes (P<.001). In a subgroup of specimens received through June 2002, there was no significant difference in mean melanocyte counts (P=.35) obtained by immunohistochemical staining techniques between the latanoprost-treated and control groups. CONCLUSIONS: These findings support previous studies indicating that latanoprost-induced eye color changes are due to an increased amount of melanin within the iris stromal melanocytes. The increased numbers of freckles may be a focal manifestation of this effect.

Antihypertensive Agents↗

PubMed2003

Iridectomy of the anterior iris stroma using the vitreocutter during phacoemulsification in patients with iridoschisis.

We present a technique to manage iridoschisis. This technique for anterior iridectomy of the affected iris fibers avoids intraoperative obstruction of the phaco tip and prevents postoperative complications such as corneal decompensation and glaucoma. Before the capsulorhexis is created, a vitreocutter is inserted in the anterior chamber and used to cut the iris strands at the site of the iridoschisis, making an anterior sectorial stromal iridectomy and preserving the iris pigment epithelium. Phacoemulsification is then performed. After the pupil is constricted with carbacol, remnants of the loose anterior iris fibers are excised with the vitreocutter and the scleral incision is sutured.

Aged↗

PubMedDate not supplied

An "exploding cataract" following Nd:YAG laser iridectomy.

A case of an "exploding" cataract (an iatrogenic posterior capsular rupture) following Nd:YAG laser iridectomy is described. Rapid cataract development was observed in the right eye of a 76-year-old woman following an iridectomy. B-scan ultrasonography documented cortical debris in the vitreous cavity. The patient underwent an extracapsular cataract extraction and intraocular lens implantation. During the cataract extraction, a posterior capsular tear extending from the 10-o'clock to the 4-o'clock position was noted, through which fluffy cortical material was floating in the vitreous.

Aged↗

PubMed1988

Corneal decompensation after argon laser iridectomy.

Five eyes of three patients developed generalized corneal decompensation after undergoing argon laser iridectomy for angle closure glaucoma. Factors possibly associated with corneal decompensation include episodes of angle closure glaucoma with pressure elevations and inflammation, corneal guttate, diabetes, and the need for multiple treatments requiring a high-laser energy. It is important for ophthalmologists to inform their patients of the rare risk of developing bullous keratopathy after argon laser iridectomy and to consider obtaining prelaser specular microscopy to document the corneal status in high-risk patients.

Aged↗

PubMed1993

Effect of peripheral iridectomy on intraocular pressure in chronic primary angle closure glaucoma.

In 67 eyes of 46 patients with chronic primary angle closure glaucoma, the effect of peripheral iridectomy in lowering the intraocular pressure was investigated retrospectively. In the majority of cases the pressure was reduced. For the whole population the mean reduction was 3.9 mmHg (SD 6.7 mmHg). The presence or extent of peripheral anterior synechiae showed no significant correlation with the amount of pressure reduction. A peripheral iridectomy is still recommended as first step in the treatment of primary angle closure glaucoma.

Aged↗

PubMed1975

Visual effects of peripheral and sector iridectomy.

Twenty-five patients had bilateral cataract extractions: one eye with peripheral iridectomy and the fellow eye with sector iridectomy. They were followed from four months to two years. No significant differences in visual acuity between the two eyes were found. No patient reported any subjective difference between the right or left eye.

Adult↗

PubMed1977

Cataractogenic factors in patients with primary angle-closure glaucoma after peripheral iridectomy.

In this retrospective study we evaluated 154 patients with primary angle-closure glaucoma operated on by peripheral iridectomy to determine the factors contributing to the high occurrence (57%) of cataracts. Cataract formation in an eye operated on by peripheral iridectomy was age-dependent and less related to the time after surgery. The acute attack enhanced the appearance of the lenticular changes but did not influence the overall occurrence of cataracts in older patients.

Adult↗

PubMed1986

Neodymium-YAG laser iridectomies in glaucoma associated with closed or occludable angles.

A review of our first 200 neodymium-YAG laser iridectomies performed over a two-year period in various forms of glaucoma showed patent iridectomies in 180 of 182 eyes (99% success) at the last examination (one to 26 months postoperatively). Both failures had preexisting chronic uveitis. Eighteen eyes were lost to follow-up. Complications included intraocular pressure increased more than 10 mm Hg in 54 eyes (30%), hemorrhage in 36 eyes (20%), iritis in 21 eyes (11.5%), posterior synechiae in 13 eyes (7%), corneal changes in seven eyes (4%), and pupillary distortion in six eyes (3%). With experience, fewer applications are required to penetrate the iris, and retreatment to obtain patency is less likely to be needed.

Glaucoma↗

PubMed1998

Optical iridectomy for corneal opacities in Peter's anomaly.

Three children were born with partial corneal opacity and anterior segment anomalies but no cataract (Peter's anomaly type 1). In each affected eye, the corneal scar was off center and encroached on the visual axis. Glaucoma (if present) was controlled medically or surgically, after which an optical iridectomy was performed in each eye (in lieu of a penetrating keratoplasty). After surgery, in all patients the pupil extended beyond the corneal opacity and the corneal opacity decreased slightly. All could fixate and follow around the opacity. Optical iridectomy should be considered in selected cases of congenital corneal opacities.

Anterior Eye Segment↗

PubMed1991

A randomised, prospective comparison of Nd:YAG laser iridotomy and operative peripheral iridectomy in fellow eyes.

A prospective, randomised comparison of Nd:YAG laser iridotomy and operative peripheral iridectomy in the fellow eye of 52 patients presenting with acute angle closure glaucoma has been undertaken. Nd:YAG laser iridotomy resulted in a significantly higher incidence of iris bleeding at the time of treatment (p less than 0.05), higher intraocular pressure one hour (p less than 0.02) and three hours (p less than 0.02) following treatment, and a higher incidence of focal corneal oedema 24 hours following treatment (p less than 0.001). One laser treated patient developed acute angle closure glaucoma two weeks following treatment despite the presence of a small patent iridotomy. After a mean follow-up period of 11.8 months there was no significant difference between the two groups in visual acuity, or intraocular pressure. It is concluded that Nd:YAG laser iridotomy is a satisfactory alternative to operative peripheral iridectomy in the prophylactic treatment of fellow eyes.

Adult↗

PubMed1982

[Results of prophylactic iridectomy].

Between 1974 and 1981 263 patients were treated for acute narrow-angle glaucoma; in 117 of these cases a prophylactic iridectomy was performed on the fellow eye. In two cases there were surgical complications. In none of the 52 patients followed up for at least two years did narrow-angle glaucoma recur. The formation or progression of lens opacities were attributable not to the iridectomy but to the age of the patients.

Glaucoma↗

PubMed1990

Provocation and medical treatment in post-iridectomy glaucoma.

Residual glaucoma after an iridectomy in primary angle-closure glaucoma, or so called post-iridectomy glaucoma, is rather well recognized recently. It is also realized that probably different mechanisms in addition to the pupillary block mechanism co-exist in the same glaucoma eye. The efficacy of medical treatment for such glaucoma was evaluated by dark prone provocative test after timolol or pilocarpine topical instillation to compare with non-medication as control in 72 iridectomized eyes. The results revealed pilocarpine medication has only six eyes positive (8.3%) and significantly prevents IOP elevation in the test while timolol has no significant effect (23 eyes positive, 31.9%) when both were compared with the control study (31 eyes positive, 43.1%). The results may also suggest additional different mechanisms involved in this glaucoma.

Administration, Topical↗

PubMed1992

Creeping angle-closure glaucoma. The influence of iridotomy and iridectomy.

In 16 patients (30 eyes) with creeping angle-closure glaucoma YAG laser iridotomy or surgical iridectomy was performed as part of treatment. The initial characteristics of the affected eyes (refractive state, intraocular pressure, anterior chamber depth, iris contour, gonioscopic features, extent and severity of synechia formation and result of dark-room testing in six eyes) are recorded, and also the influence on these features of iridotomy or iridectomy. Intraocular pressure was reduced on average by 2.46 mmHg (1.72 mmHg in non-trabeculectomised eyes) (P less than 0.02), and anterior chambers deepened on average by 0.05 mm (P less than 0.05). Extension of peripheral anterior synechiae was recorded in nine eyes.

Adult↗

PubMed1983

Pathology of iridectomy specimens in gyrate atrophy of the retina and choroid.

Gyrate atrophy of the retina and choroid is an autosomal recessive disease characterized by progressive retinal degeneration and ornithine aminotransferase deficiency. We report here the new histological findings and ultrastructural changes in 3 iridectomy specimens from 2 Finnish patients with gyrate atrophy. The iridectomy specimens were removed during routine cataract extraction and studied with a transmission electron microscope. The dilator muscle showed atrophy, abnormal mitochondria, and tubular aggregate type structures similar to those found in skeletal muscle. Degenerative changes such as extracted cellular matrix, dropout of cellular organelles, and dilated intercellular spaces were observed in the pigmented posterior epithelium and the anterior iris epithelium.

Adult↗

PubMed1977

Peripheral iridectomy in closed angle glaucoma-- late complications.

Of 70 eyes with therapeutic peripheral iridectomy (PI), 51% suffered a loss of two or more lines on the Snellen chart; 57% developed posterior synechiae (PS) and 57% showed lens opacities. Thirty-three per cent of eyes that underwent PI prophylactically had a vision drop of two lines or more, 39% developed PS and 42% showed varying degrees of lens opacities. Although vision drop, lens opacities and PS were less marked in the prophylactic group, it appears that PI is a surgical procedure not without its hazards. We therefore suggest that peripheral iridectomy should not be performed routinely on the second eye not suffering an acute attack. This procedure should be undertaken only in cases with positive provocative tests and/or clinical signs of closed angle glaucoma.

Adult↗

PubMed1979

Management of chronic or intermittent primary angle-closure glaucoma: a long-term follow-up of the results of peripheral iridectomy used as an initial procedure.

Patients presenting with either intermittent closed-angle glaucoma which gave to subacute congestive attacks or with chronic angle-closure glaucoma were followed up over 12 years. Peripheral iridectomy was performed as a primary procedure on these patients during this period. It was found to be a highly effective procedure in those patients without field loss at the time of presentation, but because of the figures presented here we would recommend that any patient presenting with angle closure and disc and field changes should have a trabeculectomy performed as a primary procedure. We found no way of predicting which patients would require further surgery from the history, initial intraocular pressure, or the gonioscopic findings. No patient in this series developed malignant glaucoma after trabeculectomy although it occurred in 2 eyes after peripheral iridectomy.

Adult↗

PubMed1983

Acute glaucoma: results of treatment by bilateral simultaneous iridectomy, now without admission to hospital.

Medical treatment followed by bilateral simultaneous iridectomy appears to be an effective basis for managing a patient who presents with acute glaucoma. Admission to hospital is seldom necessary. There was minimal evidence that delay in starting treatment caused more sight to be lost, but as the patient's age increased the prognosis for recovery of sight in an affected eye decreased quite significantly. The long-term prognosis for the sight of an individual patient who has had prophylactic iridectomy in the unaffected eye is excellent.

Acute Disease↗