eprintid: 10070625
rev_number: 28
eprint_status: archive
userid: 608
dir: disk0/10/07/06/25
datestamp: 2019-03-21 08:32:17
lastmod: 2021-09-25 23:22:47
status_changed: 2019-03-21 08:32:17
type: article
metadata_visibility: show
creators_name: He, M
creators_name: Jiang, Y
creators_name: Huang, S
creators_name: Chang, DS
creators_name: Munoz, B
creators_name: Aung, T
creators_name: Foster, PJ
creators_name: Friedman, DS
title: Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomised controlled trial
ispublished: pub
subjects: MOOR
divisions: UCL
divisions: B02
divisions: C07
divisions: D08
note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
abstract: BACKGROUND: Primary angle-closure glaucoma affects 20 million people worldwide. People classified as primary angle closure suspects have a higher but poorly quantified risk of developing glaucoma. We aimed to assess efficacy and safety of laser peripheral iridotomy prophylaxis against primary angle-closure glaucoma in Chinese people classified as primary angle closure suspects. METHODS: In this randomised controlled trial, bilateral primary angle closure suspects aged 50-70 years were enrolled at the Zhongshan Ophthalmic Center, a tertiary specialised hospital in Guangzhou, China. Eligible patients received laser peripheral iridotomy in one randomly selected eye, with the other remaining untreated. The primary outcome was incident primary angle closure disease as a composite endpoint of elevation of intraocular pressure, peripheral anterior synechiae, or acute angle-closure during 72 months of follow-up in an intention-to-treat analysis between treated eyes and contralateral controls. This trial is registered with the ISRCTN registry, number ISRCTN45213099. FINDINGS: Of 11 991 screened individuals, 889 individuals were randomly assigned from June 19, 2008 (889 treated and 889 untreated eyes). Incidence of the primary outcome was 4·19 per 1000 eye-years in treated eyes compared with 7·97 per 1000 eye-years in untreated eyes (hazard ratio 0·53; 95% CI 0·30-0·92; p=0·024). A primary outcome event occurred in 19 treated eyes and 36 untreated eyes with a statistically significant difference using pair-wise analysis (p=0·0041). No serious adverse events were observed during follow-up. INTERPRETATION: Incidence of angle-closure disease was very low among individuals classified as primary angle closure suspects identified through community-based screening. Laser peripheral iridotomy had a modest, albeit significant, prophylactic effect. In view of the low incidence rate of outcomes that have no immediate threat to vision, the benefit of prophylactic laser peripheral iridotomy is limited; therefore, widespread prophylactic laser peripheral iridotomy for primary angle-closure suspects is not recommended. FUNDING: Fight for Sight, the Sun Yat-Sen University 5010 Project Fund, Moorfields Eye Charity, and the National Natural Science Foundation of China.
date: 2019-04-20
date_type: published
official_url: https://doi.org/10.1016/S0140-6736(18)32607-2
oa_status: green
full_text_type: other
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1641102
doi: 10.1016/S0140-6736(18)32607-2
pii: S0140-6736(18)32607-2
lyricists_name: Foster, Paul
lyricists_name: Jiang, Yuzhen
lyricists_id: PJFOS52
lyricists_id: YJIAN59
actors_name: Novi, Maya
actors_id: MNOVI52
actors_role: owner
full_text_status: public
publication: The Lancet
volume: 393
number: 10181
pagerange: 1609-1618
event_location: England
issn: 1474-547X
citation:        He, M;    Jiang, Y;    Huang, S;    Chang, DS;    Munoz, B;    Aung, T;    Foster, PJ;           He, M;  Jiang, Y;  Huang, S;  Chang, DS;  Munoz, B;  Aung, T;  Foster, PJ;  Friedman, DS;   - view fewer <#>    (2019)    Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomised controlled trial.                   The Lancet , 393  (10181)   pp. 1609-1618.    10.1016/S0140-6736(18)32607-2 <https://doi.org/10.1016/S0140-6736%2818%2932607-2>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10070625/3/He_2019%2003%20March%20%20-%20ZAP%20manuscript%20Lancet%20R2final.pdf