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Editors Selection IGR 24-3

Prognostic factors: Risk factors for Progression post Laser iridotomy

Comment by Jorge Monasterio & Augusto Azuara Blanco on:

109183 Biometric Risk Factors for Angle Closure Progression After Laser Peripheral Iridotomy, Bao YK; Xu BY; Friedman DS et al., JAMA ophthalmology, 2023; 141: 516-524

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There are relatively few trials evaluating the effectiveness of interventions for PACG disease and we need better evidence to inform decisions for the management of this condition, a leading cause of blindness worldwide.

This publication by Bao et al. arises from a retrospective analysis of Zhongshan Angle Closure Prevention (ZAP) trial data.^1,2 ZAP trial was designed to evaluate the efficacy and safety of laser peripheral iridotomy (LPI) in people diagnosed as primary angle-closure suspect (PACS).^1,2

Bao et al. used data from this trial to elucidate what biometric data two weeks after LPI were associated with disease progression. This paper complements a previous publication of the same cohort describing baseline characteristics predicting angle widening after LPI.³

The authors found out an association between persistent angle narrowing on anterior-segment optical coherence tomography (AS-OCT) and gonioscopy and higher risk of angle closure progression in PACS eyes.⁴ This is an important finding, as it corroborates clinical impressions that those angles that remain appositionally closed after LPI may be at higher risk of disease progression and require closer follow-up.

This is an important finding, as it corroborates clinical impressions that those angles that remain appositionally closed after LPI may be at higher risk of disease progression and require closer follow-up

This study has some limitations. Firstly, it is a retrospective study of a single trial that would need validation among different cohorts. Also, ZAP was conducted in a Chinese population, which makes the study results potentially not generalizable to other populations.

Overall, this study adds valuable information about the importance of characterization with AS-OCT of angle findings after interventions. This is a step forward in the individualization of the managing patients with PACG disease. We would like to see further research to, e.g., evaluate whether these observations can be also found in people with more severe disease (PAC and PACG).

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