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Editors Selection IGR 10-3

Surgical treatment: Side effects from iridotomy-on-the-side

Comment by Stefano Gandolfi on:

56864 Dysphotopsia after temporal versus superior laser peripheral iridotomy: a prospective randomized paired eye trial, Vera V; Naqi A; Belovay GW et al., American Journal of Ophthalmology, 2014; 157: 929-935

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The authors have addressed the issue of newly-onset visual disturbances after an uneventful laser peripheral iridotomy (LPI) in eyes with angle closure. Traditionally, most of the available guidelines and textbooks suggest to place the LPI in an iris area fully covered by the upper eyelid, thereby reducing the possibility of symptoms induced by the straylight entering freely into the eye through the iridotomy. Recently, several reports, showing patients complaining of symptoms in spite of a fully covered LPI, have raised new doubts on where to place the LPI in order to avoid dysphotopsias.

Vera et al. Enrolled, then, 208 patients, with bilateral angle closure, and placed LPI temporally in one eye and superiorly in the other. Dysphotopsia proved more common in eyes with superior LPI (10.7%) than in eyes with temporal LPI (2.4%). This striking difference is highly significant. In fact, the study is properly sized to support the conclusions, and the scientific reasoning is consistent with the outcomes: interestingly, the authors' data support the hypothesis that a 'base-up' prism-like effect, induced by the tear meniscus, is the responsible for the onset of dysphotopsia when LPI is placed superiorly. Vera et al.'s conclusions push the scientific community to re-consider the preferred pattern of LPI placement in eyes with angle closure. Gathering comparable data in different anatomical phenotypes (for example in eye with pigment dispersion syndrome and a deep anterior chamber) could prove useful and informative.

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