Non-pupillary block angle-closure mechanisms: a comprehensive analysis of their prevalence and treatment outcomes

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dc.contributor.authorJunqueira, Daniela L. M.
dc.contributor.authorPrado, Vitor G. [UNIFESP]
dc.contributor.authorLopes, Flavio S. [UNIFESP]
dc.contributor.authorBiteli, Luis Gustavo [UNIFESP]
dc.contributor.authorDorairaj, Syril
dc.contributor.authorPrata, Tiago S. [UNIFESP]
dc.contributor.institutionHosp Med Olhos
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionMayo Clin
dc.date.accessioned2016-01-24T14:38:03Z
dc.date.available2016-01-24T14:38:03Z
dc.date.issued2014-11-01
dc.description.abstractPurpose: To assess the prevalence and treatment outcomes of angle-closure mechanisms other than pupillary block in a population of Brazilian patients.Methods: A retrospective chart review was conducted to evaluate patients who had undergone laser peripheral iridotomy (LPI) due to occludable angles at a single institution between July 2009 and April 2012. An occludable angle was defined as an eye in which the posterior trabecular meshwork was not visible for >= 180 degrees on dark-room gonioscopy. Key exclusion criteria were any form of secondary glaucoma and the presence of >90 degrees of peripheral anterior synechiae. Collected data were age, race, gender, angle-closure mechanism (based on indentation goniocopy and ultrasound biomicroscopy), intraocular pressure (IOP), number of antiglaucoma medications and subsequent management during follow-up. If both eyes were eligible, the right eye was arbitrarily selected for analysis.Results: A total of 196 eyes of 196 consecutive patients (mean age 58.3 +/- 11.6 years) who underwent LPI were included. in most of the patients [86% (169 patients; 133 women and 36 men]), LPI sucessfully opened the angle. Mean IOP was reduced from 18.3 +/- 6.4 mmHg to 15.4 +/- 4.5 mmHg after LPI (p<0.01). Among the 27 patients with persistent occludable angles, the most common underlying mechanisms were plateau iris (56%) and lens-induced component (34%). Most of these patients (85%) were treated with argon laser peripheral iridoplasty (ALPI); approximately 90% showed non-occludable angles following the laser procedure (mean IOP reduction of 18.9%), with no significant differences between patients with plateau iris and lens-induced components (p=0.34; mean follow-up of 11.4 +/- 3.6 months).Conclusions: Our findings suggest that, in this population of Brazilian patients, several eyes with angle closure were not completely treated with LPI. in the present large case series involving middle-age patients, plateau iris was the leading cause of persistent angle closure and was effectively treated with ALPI. A detailed eye examination with indentation gonioscopy should always be performed after LPI to rule out persistent angle closure due to non-pupillary block mechanisms.en
dc.description.affiliationHosp Med Olhos, Glaucoma Unit, Osasco, SP, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, São Paulo, Brazil
dc.description.affiliationMayo Clin, Jacksonville, FL 32224 USA
dc.description.affiliationUnifespUniversidade Federal de São Paulo, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent360-363
dc.identifierhttp://dx.doi.org/10.5935/0004-2749.20140090
dc.identifier.citationArquivos Brasileiros de Oftalmologia. São Paulo: Consel Brasil Oftalmologia, v. 77, n. 6, p. 360-363, 2014.
dc.identifier.doi10.5935/0004-2749.20140090
dc.identifier.fileS0004-27492014000600009.pdf
dc.identifier.issn0004-2749
dc.identifier.scieloS0004-27492014000600009
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/38373
dc.identifier.wosWOS:000348589700005
dc.language.isoeng
dc.publisherConsel Brasil Oftalmologia
dc.relation.ispartofArquivos Brasileiros de Oftalmologia
dc.rightsAcesso aberto
dc.subjectAngle closureen
dc.subjectNon-pupillary block mechanismsen
dc.subjectIris diseasesen
dc.subjectIris/pathologyen
dc.subjectIridectomyen
dc.subjectTreatment outcomeen
dc.titleNon-pupillary block angle-closure mechanisms: a comprehensive analysis of their prevalence and treatment outcomesen
dc.title.alternativeMecanismos de fechamento angular sem bloqueio pupilar: análise de prevalência e resultados terapêuticospt
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