Immediate argon laser peripheral iridoplasty (ALPI) as initial treatment for acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction: a preliminary study

Purpose To study the safety and efficacy of immediate argon laser peripheral iridoplasty (ALPI) as initial treatment of acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction. Methods In all, 10 consecutive patients with acute phacomorphic angle-closure and intraocular pressure (IOP) ⩾40 mmHg were recruited into the study. Each patient received topical atropine (1%) and timolol (0.5%), and immediate ALPI as initial treatment. The IOP at 15, 30, 60, and 120 min, and then 1 day, after ALPI were documented by applanation tonometry. Systemic IOP-lowering drugs were only started if IOP remained above 40 mmHg at 2 h after ALPI. Cataract extraction was subsequently performed as definitive treatment. Results In total, 10 patients (five male, five female), with a mean age±SD of 73.1±10.3 years were recruited. Mean duration of symptomatic attack was 128±232 h. After ALPI, the mean IOP was reduced from 56.1±12.5 to 45.3±14.5 mmHg at 15 min, 37.6±7.5 mmHg at 30 min, 34.2±9.7 mmHg at 60 min, 25.5±8.7 mmHg at 120 min, and 13.6±4.2 mmHg at 1 day. In one patient, systemic acetazolamide was administered, because the IOP remained above 40 mmHg at 2 h after ALPI. All 10 patients had uncomplicated cataract extraction performed within 4 days after ALPI. No complications from the laser procedure were encountered. Conclusion Immediate ALPI, replacing systemic antiglaucomatous medications, appeared to be safe and effective as first-line treatment of acute phacomorphic angle-closure.