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PURPOSE: To determine the prevalence of appositional angle closure (AAC) after laser peripheral iridotomy(LPI) in the eyes of Chinese patients with primary angle closure (PAC) and primary angle closure glaucoma(PACG), and to evaluate its pathogenesis by investigating anatomic characteristics. METHODS: This was a cross-sectional observational study. PAC and PACG subjects after LPI were consecutively enrolled. UBM image in darkness of each quadrant without peripheral anterior synechia (PAS) under gonioscopy was qualitatively assessed. Darkroom provocative test (DRPT) was also performed. RESULTS: One hundred and thirty-four eyes of 134 patients were enrolled. AAC was observed in ≥1 quadrant of UBM image in 85 subjects (63.4%). There were 116 (86.6%) randomly selected quadrants without PAS for 134 patients. AAC existed in 38 quadrants (32.8%).Among these, plateau iris accounted for 44.7%, anteriorly inserted iris for 13.2%, thick iris for 13.2%, and anteriorly inserted iris combined with thick iris for 18.4% of the total. One hundred and fifteen subjects underwent DRPT and its positive rate of eyes with AAC ≥ 2 quadrants (37.5%, 12/32) was significantly higher than those≤ 1quadrant (16.9%, 14/83)(p=0.018).However, no significant difference was found between eyes with non- synechia plateau iris ≥ 2 quadrants (36.4%, 4/11) and those ≤ 1 quadrant (21.2%, 22/104) (p=0.266). CONCLUSIONS: About two thirds of PAC and PACG eyes of Chinese patients after LPI had AAC. Plateau iris was accounted for less than 50% of AAC. Other factors such as a thick peripheral iris and an anteriorly inserted iris also contributed to AAC. DRPT results suggested AAC might have more functional meaning than plateau iris.
department of ophthalmology, china-japan friendship hospital,Peking University Third Hospital, 2 Yinghua Dongjie, Hepingli Beijing, China, beijing, 100029, China.
Full article9.3.5 Primary angle closure (Part of: 9 Clinical forms of glaucomas > 9.3 Primary angle closure glaucomas)
9.3.1 Acute primary angle closure glaucoma (pupillary block) (Part of: 9 Clinical forms of glaucomas > 9.3 Primary angle closure glaucomas)
12.2 Laser iridotomy (Part of: 12 Surgical treatment)
2.4 Anterior chamber angle (Part of: 2 Anatomical structures in glaucoma)