Functional evaluation of an iridotomy in primary angle closure eyes
Objective To evaluate the functional efficacy of an iridotomy in primary angle closure (PAC) eyes by measuring IOP responses to provocative tests before and after iridotomy. Design Prospective cohort study. Subjects 50 consecutive adult patients, 40–60 years of age, having primary angle closure. Met...
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| creator | Sihota, Ramanjit Rishi, Karandeep Srinivasan, Geetha Gupta, Viney Dada, Tanuj Singh, Kulwant |
| description | Objective
To evaluate the functional efficacy of an iridotomy in primary angle closure (PAC) eyes by measuring IOP responses to provocative tests before and after iridotomy.
Design
Prospective cohort study.
Subjects
50 consecutive adult patients, 40–60 years of age, having primary angle closure.
Methods
Clinical examination, perimetry, biometry and ultrasound biomicroscopy of the angle were done. A darkroom prone provocative test (DRPPT), a mydriatic test and a Valsalva maneuver were performed before and after the iridotomy.
Main outcome measures
IOP change in response to the provocative tests before and after iridotomy, and correlation with baseline parameters.
Results
IOP at baseline and after iridotomy was 14.4 ± 2.7 mmHg and 14.3 ± 2.6 mmHg, respectively (
p
= 0.)83. There was no significant change on diurnal phasing before and after an iridotomy (
p
= 0.)11. The mean IOP rise was 5.9 ± 3.7 mmHg on the DRPPT, 4.3 ± 3.5 mmHg on the Mydriatic test and 9.1 ± 4.9 mmHg on the Valsalva maneuver, and was reduced significantly to 3.2 ± 2.1 mmHg, 2.3 ± 1.8 and 6.4 ± 3.5, respectively(
p
|
| doi_str_mv | 10.1007/s00417-016-3298-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1792771886</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4071181391</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-edba9483691673a3827baa3b02d409fdbd07fe81c5b0b5bc3ba199c7ee764b363</originalsourceid><addsrcrecordid>eNp1kM9LwzAUx4Mobk7_AC8S8OIlmh9N0xxlOBUELwq7hSRNR0fbzGSV7b83pVNE8BRe3ud9H-8DwCXBtwRjcRcxzohAmOSIUVmg3RGYkoxxJDBdHoMpFpSggtHlBJzFuMYJZ5ycggnNC8kJl1MwX_Sd3da-0w10n7rp9VBAX0HdwTrUpd_6dg_rDm5C3eqwT_-rxkHb-NgHB93exXNwUukmuovDOwPvi4e3-RN6eX18nt-_IMsE3SJXGi2zguWS5IJpVlBhtGYG0zLDsipNiUXlCmK5wYYby4wmUlrhnMgzw3I2Azdj7ib4j97FrWrraF3T6M75PioiJBWCFMWAXv9B174P6ciRojnlHCeKjJQNPsbgKnU4UhGsBsNqNKySYTUYVrs0c3VI7k3ryp-Jb6UJoCMQU6tbufBr9b-pX2JUhsI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1792262550</pqid></control><display><type>article</type><title>Functional evaluation of an iridotomy in primary angle closure eyes</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Sihota, Ramanjit ; Rishi, Karandeep ; Srinivasan, Geetha ; Gupta, Viney ; Dada, Tanuj ; Singh, Kulwant</creator><creatorcontrib>Sihota, Ramanjit ; Rishi, Karandeep ; Srinivasan, Geetha ; Gupta, Viney ; Dada, Tanuj ; Singh, Kulwant</creatorcontrib><description>Objective
To evaluate the functional efficacy of an iridotomy in primary angle closure (PAC) eyes by measuring IOP responses to provocative tests before and after iridotomy.
Design
Prospective cohort study.
Subjects
50 consecutive adult patients, 40–60 years of age, having primary angle closure.
Methods
Clinical examination, perimetry, biometry and ultrasound biomicroscopy of the angle were done. A darkroom prone provocative test (DRPPT), a mydriatic test and a Valsalva maneuver were performed before and after the iridotomy.
Main outcome measures
IOP change in response to the provocative tests before and after iridotomy, and correlation with baseline parameters.
Results
IOP at baseline and after iridotomy was 14.4 ± 2.7 mmHg and 14.3 ± 2.6 mmHg, respectively (
p
= 0.)83. There was no significant change on diurnal phasing before and after an iridotomy (
p
= 0.)11. The mean IOP rise was 5.9 ± 3.7 mmHg on the DRPPT, 4.3 ± 3.5 mmHg on the Mydriatic test and 9.1 ± 4.9 mmHg on the Valsalva maneuver, and was reduced significantly to 3.2 ± 2.1 mmHg, 2.3 ± 1.8 and 6.4 ± 3.5, respectively(
p
< 0.001 for all tests). The decrease in pupillary block component for all 50 eyes was 46.5 % for the mydriatic test, 45.8 % for the DRPPT and 29.7 % for the Valsalva maneuver. PAC eyes positive on the DRPPT and mydriatic test prior to an iridotomy became negative after laser iridotomy in 75.9 and 84.6 % eyes, respectively, but on the Valsalva maneuver, only 23.8 % became negative. After iridotomy, eyes that continued to be positive on the mydriatic test had a significantly thicker lens (
p
= 0.02), decreased TCPD (
p
= 0.014) and narrower trabecular–iris angle (
p
= 0.048). On the DRPPT, they had a thicker lens (
p
= 0.03), shorter iris thickness (
p
= 0.025) and TCPD (
p
= 0.032), and on the Valsalva maneuver, they had a narrower scleral–ciliary process angle (SCPA;
p
= 0.019) and shorter TCPD (
p
= 0.015).
Conclusions
This comprehensive functional evaluation of laser iridotomy in early PAC eyes showed a significant reduction in the pupillary block component of IOP response to provocative testing, possibly decreasing IOP fluctuations over time. An iridotomy does not, however, significantly change mean IOP or diurnal phasing of IOP in PAC eyes. Eyes with a very narrow angle or a thick lens may continue to have angle closure due to other pathomechanisms for angle closure.</description><identifier>ISSN: 0721-832X</identifier><identifier>EISSN: 1435-702X</identifier><identifier>DOI: 10.1007/s00417-016-3298-x</identifier><identifier>PMID: 26895159</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Biometry ; Cohort Studies ; Female ; Glaucoma ; Glaucoma, Angle-Closure - physiopathology ; Glaucoma, Angle-Closure - surgery ; Gonioscopy ; Humans ; Intraocular Pressure - physiology ; Iridectomy ; Iris - surgery ; Laser Therapy ; Lasers, Solid-State - therapeutic use ; Male ; Medicine ; Medicine & Public Health ; Microscopy, Acoustic ; Middle Aged ; Ophthalmology ; Prospective Studies ; Pupil Disorders - physiopathology ; Tonometry, Ocular ; Valsalva Maneuver - physiology ; Visual Field Tests</subject><ispartof>Graefe's archive for clinical and experimental ophthalmology, 2016-06, Vol.254 (6), p.1141-1149</ispartof><rights>Springer-Verlag Berlin Heidelberg 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-edba9483691673a3827baa3b02d409fdbd07fe81c5b0b5bc3ba199c7ee764b363</citedby><cites>FETCH-LOGICAL-c372t-edba9483691673a3827baa3b02d409fdbd07fe81c5b0b5bc3ba199c7ee764b363</cites><orcidid>0000-0002-0986-5954</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00417-016-3298-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00417-016-3298-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26895159$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sihota, Ramanjit</creatorcontrib><creatorcontrib>Rishi, Karandeep</creatorcontrib><creatorcontrib>Srinivasan, Geetha</creatorcontrib><creatorcontrib>Gupta, Viney</creatorcontrib><creatorcontrib>Dada, Tanuj</creatorcontrib><creatorcontrib>Singh, Kulwant</creatorcontrib><title>Functional evaluation of an iridotomy in primary angle closure eyes</title><title>Graefe's archive for clinical and experimental ophthalmology</title><addtitle>Graefes Arch Clin Exp Ophthalmol</addtitle><addtitle>Graefes Arch Clin Exp Ophthalmol</addtitle><description>Objective
To evaluate the functional efficacy of an iridotomy in primary angle closure (PAC) eyes by measuring IOP responses to provocative tests before and after iridotomy.
Design
Prospective cohort study.
Subjects
50 consecutive adult patients, 40–60 years of age, having primary angle closure.
Methods
Clinical examination, perimetry, biometry and ultrasound biomicroscopy of the angle were done. A darkroom prone provocative test (DRPPT), a mydriatic test and a Valsalva maneuver were performed before and after the iridotomy.
Main outcome measures
IOP change in response to the provocative tests before and after iridotomy, and correlation with baseline parameters.
Results
IOP at baseline and after iridotomy was 14.4 ± 2.7 mmHg and 14.3 ± 2.6 mmHg, respectively (
p
= 0.)83. There was no significant change on diurnal phasing before and after an iridotomy (
p
= 0.)11. The mean IOP rise was 5.9 ± 3.7 mmHg on the DRPPT, 4.3 ± 3.5 mmHg on the Mydriatic test and 9.1 ± 4.9 mmHg on the Valsalva maneuver, and was reduced significantly to 3.2 ± 2.1 mmHg, 2.3 ± 1.8 and 6.4 ± 3.5, respectively(
p
< 0.001 for all tests). The decrease in pupillary block component for all 50 eyes was 46.5 % for the mydriatic test, 45.8 % for the DRPPT and 29.7 % for the Valsalva maneuver. PAC eyes positive on the DRPPT and mydriatic test prior to an iridotomy became negative after laser iridotomy in 75.9 and 84.6 % eyes, respectively, but on the Valsalva maneuver, only 23.8 % became negative. After iridotomy, eyes that continued to be positive on the mydriatic test had a significantly thicker lens (
p
= 0.02), decreased TCPD (
p
= 0.014) and narrower trabecular–iris angle (
p
= 0.048). On the DRPPT, they had a thicker lens (
p
= 0.03), shorter iris thickness (
p
= 0.025) and TCPD (
p
= 0.032), and on the Valsalva maneuver, they had a narrower scleral–ciliary process angle (SCPA;
p
= 0.019) and shorter TCPD (
p
= 0.015).
Conclusions
This comprehensive functional evaluation of laser iridotomy in early PAC eyes showed a significant reduction in the pupillary block component of IOP response to provocative testing, possibly decreasing IOP fluctuations over time. An iridotomy does not, however, significantly change mean IOP or diurnal phasing of IOP in PAC eyes. Eyes with a very narrow angle or a thick lens may continue to have angle closure due to other pathomechanisms for angle closure.</description><subject>Adult</subject><subject>Biometry</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Glaucoma</subject><subject>Glaucoma, Angle-Closure - physiopathology</subject><subject>Glaucoma, Angle-Closure - surgery</subject><subject>Gonioscopy</subject><subject>Humans</subject><subject>Intraocular Pressure - physiology</subject><subject>Iridectomy</subject><subject>Iris - surgery</subject><subject>Laser Therapy</subject><subject>Lasers, Solid-State - therapeutic use</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Microscopy, Acoustic</subject><subject>Middle Aged</subject><subject>Ophthalmology</subject><subject>Prospective Studies</subject><subject>Pupil Disorders - physiopathology</subject><subject>Tonometry, Ocular</subject><subject>Valsalva Maneuver - physiology</subject><subject>Visual Field Tests</subject><issn>0721-832X</issn><issn>1435-702X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kM9LwzAUx4Mobk7_AC8S8OIlmh9N0xxlOBUELwq7hSRNR0fbzGSV7b83pVNE8BRe3ud9H-8DwCXBtwRjcRcxzohAmOSIUVmg3RGYkoxxJDBdHoMpFpSggtHlBJzFuMYJZ5ycggnNC8kJl1MwX_Sd3da-0w10n7rp9VBAX0HdwTrUpd_6dg_rDm5C3eqwT_-rxkHb-NgHB93exXNwUukmuovDOwPvi4e3-RN6eX18nt-_IMsE3SJXGi2zguWS5IJpVlBhtGYG0zLDsipNiUXlCmK5wYYby4wmUlrhnMgzw3I2Azdj7ib4j97FrWrraF3T6M75PioiJBWCFMWAXv9B174P6ciRojnlHCeKjJQNPsbgKnU4UhGsBsNqNKySYTUYVrs0c3VI7k3ryp-Jb6UJoCMQU6tbufBr9b-pX2JUhsI</recordid><startdate>20160601</startdate><enddate>20160601</enddate><creator>Sihota, Ramanjit</creator><creator>Rishi, Karandeep</creator><creator>Srinivasan, Geetha</creator><creator>Gupta, Viney</creator><creator>Dada, Tanuj</creator><creator>Singh, Kulwant</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0986-5954</orcidid></search><sort><creationdate>20160601</creationdate><title>Functional evaluation of an iridotomy in primary angle closure eyes</title><author>Sihota, Ramanjit ; Rishi, Karandeep ; Srinivasan, Geetha ; Gupta, Viney ; Dada, Tanuj ; Singh, Kulwant</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-edba9483691673a3827baa3b02d409fdbd07fe81c5b0b5bc3ba199c7ee764b363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Biometry</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Glaucoma</topic><topic>Glaucoma, Angle-Closure - physiopathology</topic><topic>Glaucoma, Angle-Closure - surgery</topic><topic>Gonioscopy</topic><topic>Humans</topic><topic>Intraocular Pressure - physiology</topic><topic>Iridectomy</topic><topic>Iris - surgery</topic><topic>Laser Therapy</topic><topic>Lasers, Solid-State - therapeutic use</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Microscopy, Acoustic</topic><topic>Middle Aged</topic><topic>Ophthalmology</topic><topic>Prospective Studies</topic><topic>Pupil Disorders - physiopathology</topic><topic>Tonometry, Ocular</topic><topic>Valsalva Maneuver - physiology</topic><topic>Visual Field Tests</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sihota, Ramanjit</creatorcontrib><creatorcontrib>Rishi, Karandeep</creatorcontrib><creatorcontrib>Srinivasan, Geetha</creatorcontrib><creatorcontrib>Gupta, Viney</creatorcontrib><creatorcontrib>Dada, Tanuj</creatorcontrib><creatorcontrib>Singh, Kulwant</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Graefe's archive for clinical and experimental ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sihota, Ramanjit</au><au>Rishi, Karandeep</au><au>Srinivasan, Geetha</au><au>Gupta, Viney</au><au>Dada, Tanuj</au><au>Singh, Kulwant</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Functional evaluation of an iridotomy in primary angle closure eyes</atitle><jtitle>Graefe's archive for clinical and experimental ophthalmology</jtitle><stitle>Graefes Arch Clin Exp Ophthalmol</stitle><addtitle>Graefes Arch Clin Exp Ophthalmol</addtitle><date>2016-06-01</date><risdate>2016</risdate><volume>254</volume><issue>6</issue><spage>1141</spage><epage>1149</epage><pages>1141-1149</pages><issn>0721-832X</issn><eissn>1435-702X</eissn><abstract>Objective
To evaluate the functional efficacy of an iridotomy in primary angle closure (PAC) eyes by measuring IOP responses to provocative tests before and after iridotomy.
Design
Prospective cohort study.
Subjects
50 consecutive adult patients, 40–60 years of age, having primary angle closure.
Methods
Clinical examination, perimetry, biometry and ultrasound biomicroscopy of the angle were done. A darkroom prone provocative test (DRPPT), a mydriatic test and a Valsalva maneuver were performed before and after the iridotomy.
Main outcome measures
IOP change in response to the provocative tests before and after iridotomy, and correlation with baseline parameters.
Results
IOP at baseline and after iridotomy was 14.4 ± 2.7 mmHg and 14.3 ± 2.6 mmHg, respectively (
p
= 0.)83. There was no significant change on diurnal phasing before and after an iridotomy (
p
= 0.)11. The mean IOP rise was 5.9 ± 3.7 mmHg on the DRPPT, 4.3 ± 3.5 mmHg on the Mydriatic test and 9.1 ± 4.9 mmHg on the Valsalva maneuver, and was reduced significantly to 3.2 ± 2.1 mmHg, 2.3 ± 1.8 and 6.4 ± 3.5, respectively(
p
< 0.001 for all tests). The decrease in pupillary block component for all 50 eyes was 46.5 % for the mydriatic test, 45.8 % for the DRPPT and 29.7 % for the Valsalva maneuver. PAC eyes positive on the DRPPT and mydriatic test prior to an iridotomy became negative after laser iridotomy in 75.9 and 84.6 % eyes, respectively, but on the Valsalva maneuver, only 23.8 % became negative. After iridotomy, eyes that continued to be positive on the mydriatic test had a significantly thicker lens (
p
= 0.02), decreased TCPD (
p
= 0.014) and narrower trabecular–iris angle (
p
= 0.048). On the DRPPT, they had a thicker lens (
p
= 0.03), shorter iris thickness (
p
= 0.025) and TCPD (
p
= 0.032), and on the Valsalva maneuver, they had a narrower scleral–ciliary process angle (SCPA;
p
= 0.019) and shorter TCPD (
p
= 0.015).
Conclusions
This comprehensive functional evaluation of laser iridotomy in early PAC eyes showed a significant reduction in the pupillary block component of IOP response to provocative testing, possibly decreasing IOP fluctuations over time. An iridotomy does not, however, significantly change mean IOP or diurnal phasing of IOP in PAC eyes. Eyes with a very narrow angle or a thick lens may continue to have angle closure due to other pathomechanisms for angle closure.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>26895159</pmid><doi>10.1007/s00417-016-3298-x</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-0986-5954</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0721-832X |
| ispartof | Graefe's archive for clinical and experimental ophthalmology, 2016-06, Vol.254 (6), p.1141-1149 |
| issn | 0721-832X 1435-702X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1792771886 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Adult Biometry Cohort Studies Female Glaucoma Glaucoma, Angle-Closure - physiopathology Glaucoma, Angle-Closure - surgery Gonioscopy Humans Intraocular Pressure - physiology Iridectomy Iris - surgery Laser Therapy Lasers, Solid-State - therapeutic use Male Medicine Medicine & Public Health Microscopy, Acoustic Middle Aged Ophthalmology Prospective Studies Pupil Disorders - physiopathology Tonometry, Ocular Valsalva Maneuver - physiology Visual Field Tests |
| title | Functional evaluation of an iridotomy in primary angle closure eyes |
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