Immediate diode laser peripheral iridoplasty as treatment of acute attack of primary angle closure glaucoma: a preliminary study

PURPOSE: To study the efficacy and safety of diode laser peripheral iridoplasty as a first-line treatment of acute primary angle-closure glaucoma (PACG) without the use of systemic anti-glaucoma medications. PATIENTS AND METHODS: Nine consecutive patients with acute PACG were recruited into the study. Each patient received topical pilocarpine (4%), timolol (0.5%), apraclonidine (1%), and immediate diode laser peripheral iridoplasty as primary treatment. The intraocular pressures (IOPs) 15, 30, and 60 minutes after diode laser peripheral iridoplasty were documented by Goldmann applanation tonometry. RESULTS: The mean IOP of this group of patients was reduced from 66.3 +/- 9.7 mm Hg, before diode laser peripheral iridoplasty, to 36.6 +/- 16.4 mm Hg at 15 minutes, 26.3 +/- 12.6 mm Hg at 30 minutes, and 18.9 +/- 8.4 mm Hg at 60 minutes after diode laser peripheral iridoplasty. In seven of the nine patients, the corneal edema cleared up 1 hour after diode laser peripheral iridoplasty. In the remaining patient, the cornea cleared up 12 hours after diode laser peripheral iridoplasty. No significant complications were encountered. CONCLUSION: Diode laser peripheral iridoplasty, together with topical antiglaucoma medications without adjunctive systemic carbonic anhydrase inhibitors and hyperosmotic agents, appeared to be effective and safe in controlling the IOP in acute PACG.