title: Role of Laser Iridoplasty in the Management of Angle Closure Mechanisms other than Pupillary Block.
abstract: OBJECTIVE
  To investigate the treatment outcomes of argon laser peripheral iridoplasty (ALPI) in angle closure mechanisms other than pupillary block.
  
  
  METHODS
  We conducted a comprehensive chart review to evaluate consecutive patients who underwent ALPI due to unsuccessful laser iridotomy (whenever the angles remained occludable) between July 2009 and April-2012. An occludable angle was defined as the posterior trabecular meshwork not visible for ≤180° without indentation on dark room gonioscopy. Eyes with previous incisional surgery or more than 90° of peripheral anterior synechiae were excluded. Main data collected were age, presence of glaucoma, pre- and postlaser intraocular pressure (IOP), angle-status, and underlying angle closure mechanism. Main outcomes were post ALPI angle widening on gonioscopy and magnitude of IOP reduction.
  
  
  RESULTS
  A total of 41 eyes (27 patients) with persistent occlu-dable angles were initially included in the analysis, comprising approximately 14% of the 196 patients (321 eyes) that had under gone laser iridotomy during the predefined period. Among these cases, most common angle closure mechanisms were plateauiris (56%) and lens-induced component (34%). Patients with plateau iris were mostly women and younger than those with lens-induced component (p ≤ 0.03). A total of 35 eyes (23 patients) underwent ALPI (63% had glaucoma). Mean IOP was significantly reduced from 18. 2 ± 4.7 to 14.6 ± 3.8 (p < 0.01), with no significant difference between patients with plateau iris and lens-induced components (p = 0.22). Over 91% of these eyes showed nonoccludable angles following ALPI (follow-up of 11.8 ± 3.3 months).
  
  
  CONCLUSIONS
  In this series of middle-aged patients with occlu-dable angles, despite a patent iridotomy, ALPI was a useful procedure independent of the underlying mechanism, leading to angle widening and moderate IOP reduction in most cases. How to cite this article: Prado VG, Dorairaj S, Biteli LG, Sousa AKS, Moreno PAM, Lopes FS, Prata TS. Role of Laser Iridoplasty in the Management of Angle Closure Mechanisms other than Pupillary Block. J Curr Glaucoma Pract 2014;8(2):82-84.
authors.affiliation: Resident, Department of Ophthalmology, Glaucoma Services, Fiederal University of São Paulo, São Paulo, Brazil.
authors.forename: Vitor
authors.initials: V
authors.lastname: Gomes Prado
authors.affiliation: Associate Professor, Department of Ophthalmology, Glaucoma Anterior Segment Surgery, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Syril
authors.initials: S
authors.lastname: Dorairaj
authors.affiliation: Medical Staff, Department of Ophthalmology, Glaucoma Services, Fiederal University of São Paulo, Hospital Medicina dos Olhos, São Paulo, Brazil.
authors.forename: Luis
authors.initials: L
authors.lastname: Gustavo Biteli
authors.affiliation: Medical Staff, Department of Ophthalmology, Glaucoma Services, Fiederal University of São Paulo, São Paulo, Brazil.
authors.forename: Aline
authors.initials: A
authors.lastname: Ks Sousa
authors.affiliation: Medical Staff, Department of Ophthalmology, Glaucoma Services, Fiederal University of São Paulo, Hospital Medicina dos Olhos, São Paulo, Brazil.
authors.forename: Pilar Am
authors.initials: PA
authors.lastname: Moreno
authors.affiliation: Glaucoma Fellow, Department of Ophthalmology, Glaucoma Services, Fiederal University of São Paulo, Hospital Medicina dos Olhos, São Paulo, Brazil.
authors.forename: Flavio
authors.initials: F
authors.lastname: Siqueira Lopes
authors.affiliation: Associate Professor, Department of Ophthalmology, Glaucoma Services, Fiederal University of São Paulo, Hospital Medicina dos Olhos, São Paulo, Brazil.
authors.forename: Tiago
authors.initials: T
authors.lastname: Santos Prata
keywords: Angle closure; Laser peripheral iridoplasty.; Nonpupillary block mechanisms; Plateau iris