title: Argon Laser Peripheral Iridoplasty for Primary Angle-Closure Glaucoma: A Randomized Controlled Trial.
abstract: OBJECTIVE
  To determine the effectiveness of argon laser peripheral iridoplasty (ALPI) in primary angle closure (PAC) and primary angle-closure glaucoma (PACG).
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Eighty PAC or PACG subjects who underwent laser iridotomy (LI) and had at least 180° of persistent appositional angle closure and intraocular pressure (IOP) of more than 21 mmHg were enrolled.
  
  
  METHODS
  Subjects were randomized to receive either 360° ALPI (Visulas 532s; Carl Zeiss Meditec, Jena, Germany) or medical therapy (Travoprost 0.004%; Alcon-Couvreur, Puurs, Antwerp, Belgium). Repeat ALPI was performed if the IOP reduction was less than 20% from baseline along with inadequate angle widening at the month 1 or month 3 visit. Intraocular pressure was controlled with systematic addition of medications when required.
  
  
  METHODS
  The primary outcome measure was success rates after ALPI at 1 year. Complete success was defined as an IOP of 21 mmHg or less without medication, and qualified success was defined as an IOP of 21 mmHg or less with medication. Failure was defined as an IOP more than 21 mmHg despite additional medications or requiring glaucoma surgery.
  
  
  RESULTS
  Forty subjects (51 eyes) were randomized to ALPI and 40 subjects (55 eyes) were randomized to medical therapy. Complete success (IOP ≤21 mmHg without medication) was achieved in 35.0% eyes of the ALPI group compared with 85.0% of eyes in the prostaglandin analog (PGA) group (P < 0.001), and qualified success (IOP ≤21 mmHg with medication) was achieved in 35.0% and 7.5%, respectively (P = 0.003). The IOP decreased by 4.9 mmHg (95% confidence interval [CI], 3.5-6.3 mmHg) in the ALPI group (P < 0.001) and by 6.1 mmHg (95% CI, 5.1-7.1 mmHg) in the medication group (P < 0.001). A failure rate of 30.0% was noted in the ALPI group compared with 7.5% in the medication group (P = 0.01). No treatment-related complications were recorded in either group.
  
  
  CONCLUSIONS
  After 1 year, ALPI was associated with higher failure rates and lower IOP reduction compared with PGA therapy in eyes with persistent appositional angle closure and raised IOP after LI.
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Republic of Singapore.
authors.forename: Arun
authors.initials: A
authors.lastname: Narayanaswamy
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Republic of Singapore.
authors.forename: Mani
authors.initials: M
authors.lastname: Baskaran
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Republic of Singapore.
authors.forename: Shamira A
authors.initials: SA
authors.lastname: Perera
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Republic of Singapore.
authors.forename: Monisha E
authors.initials: ME
authors.lastname: Nongpiur
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Republic of Singapore.
authors.forename: Hla M
authors.initials: HM
authors.lastname: Htoon
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Republic of Singapore.
authors.forename: Tin A
authors.initials: TA
authors.lastname: Tun
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Republic of Singapore.
authors.forename: Tina T
authors.initials: TT
authors.lastname: Wong
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Republic of Singapore.
authors.forename: David
authors.initials: D
authors.lastname: Goh
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Republic of Singapore.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Su
authors.affiliation: Department of Ophthalmology, National University Hospital, National University Health System, Singapore, Republic of Singapore.
authors.forename: Paul T K
authors.initials: PT
authors.lastname: Chew
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Republic of Singapore.
authors.forename: Ching-Lin
authors.initials: CL
authors.lastname: Ho
authors.affiliation: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Republic of Singapore; Department of Ophthalmology, National University Hospital, National University Health System, Singapore, Republic of Singapore. Electronic address: aung.tin@snec.com.sg.
authors.forename: Tin
authors.initials: T
authors.lastname: Aung
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000068438:Brimonidine Tartrate / Q000627:therapeutic use; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D032801:Iridectomy; D007498:Iris / Q000601:surgery*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D062606:Tertiary Care Centers; D014065:Tonometry, Ocular; D000069557:Travoprost / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D000068438:Brimonidine Tartrate; D000069557:Travoprost